Archive for the ‘Wisconsin Hospitals’ Category

Health Law Blog Wisconsin Healthcare Lawyer Blog

Wednesday, January 25th, 2017

Health Care Blog Articles Published by John Fisher

Here is a list of some of the recent health law related blog articles that I have recently posted across several different blog sites:

HIPAA Breach Notification Settlement – First Case of Untimely Notice of Breach

OIG Annual Work Plan for 2017 – Topics Covered

Skilled Nursing Facility and Nursing Home Initiatives OIG 2017 Annual Work Plan

Don’t Overlook Special Status of Behavioral Health Records

Off-Campus Provider-Based Departments Site-Neutrality

21st Century Cures Act Signed by President Obama

US Attorney Manual Updated to Incorporate Yates Memorandum DOJ Directives Incorporating the Yates Principles

Certification of Investigation of Individual Wrongdoing Under the Yates Memorandum

How Should Compliance Process Integrate the Yates Memorandum?

New Federal Prosecution Standards Require Revisions to Investigation Policies

300 Pages of New Regulations Ruining Health Care Attorney Lives Across the Country

60 Day Repayment Rule Affordable Care Act

ACO Primary Care Exclusivity Requirement – Not As Broad As Some Believe

Ambulatory Surgery Center Advisory Opinions

Antitrust Law Application In Rural Areas- Hospital Mergers

Antitrust Market Analysis In Provider Integration

Antitrust Policies Avoiding Spillover – Clinically Integrated Networks

Auditing Physician Payments For Stark Law

Bundled Payment Arrangements for Clinically Integrated Networks

Certification of Investigation of Individual Wrongdoing Under the Yates Memorandum

Clinical Integration Readiness Analysis CINs

CMS Releases Final Rules Under Medicare Shared Savings Program

CMS Releases the First Comprehensive Overhaul of Nursing Home Conditions of Participation in Over 25 Years

False Claims Act Basics – Known Overpayment Becomes False Claim

False Claims Act Liability – Conditions of Participation and Conditions of Payment

Final Rule Under the Medicare Shared Savings Program Released

HHS Releases Inflation Adjusted Federal Civil Penalties

How Should Compliance Process Integrate the Yates Memorandum?

Incident To Billing Rules Changed In New CMS Regulations

Major Revamp of Nursing Home Regulations Proposed By CMS

Medicare Shared Savings Program Changes Under 2016 Physician Fee Schedule Regulations

Medigap PHO Discount Program Receives OIG Approval

New Federal Prosecution Standards Require Revisions to Investigation Policies

Off-Campus Provider-Based Departments Neutrality

OIG Fraud Alert – Medical Director Compensation Arrangements

Outpatient Surgery Article On Using A Safe Surgery Checklist

Population Health Management and Clinical Integration

President Signs the 21st Century Cures Act

Primary Care Integration Strategies – Divisional Group Practice Mergers

Provider Self-Disclosure Decisions – Voluntary Disclosure Process

Referral Requirements – Can Employed Doctors Be Required to Make Referrals?

Reimbursement for Telemedicine and Telehealth Services

Telemedicine Credentialing By Proxy

When Can Violation of a Condition of Participation Result in False Claims Act Liability? Update on Escobar’s Materiality Standard

Clinical Integration Readiness – Determining Organizational Readiness to Clinically Integration

Wednesday, January 27th, 2016

Clinical Integration is the word of the day for provider organizations.  Clinical integration projects have emerged in all corners of the State of Wisconsin.  Our law firm has been at the center of many of these clinical integration programs and the creation of Accountable Care Organizations.

In a recent Article published on the Health Law Blog, we cover the issue of Clinical Integration Readiness Assessment.  During early assessment and design stages, we attempt to encourage broad participation by providers.  We will normally recommend the creation of a governance and committee structure that is as inclusive as possible.  Clinical integration is primarily a process that physicians perform.  Mechanisms are created through which physicians collaborate across specialty, in an interdependent way toward the end goals of increasing quality and efficiencies.  Ideally, the process should be collaborative between physicians and institutional providers.  However, the dynamics between hospitals and physicians can sometimes adversely impact the working relationship.

Find more by reading the full post over at the Health Care Blog.  This is an issue that all Wisconsin health care providers will want to follow because it is changing the central dynamic of the health care system.

Are You Ready For Clinical Integration?

Ruder Ware Clinical Integration Practice

How Much Clinical Integration Is Enough?

Tuesday, May 20th, 2014

By John Fisher, JD, CHC, CCEP

Clinical Integration Attorney

 

Analysis of all available resources makes it clear that there is no single formula for achieving clinical integration and each organization will be unique in the mechanisms and processes that are used to achieve required levels of collaboration and interdependence between providers.  Clinical integration is a process of continual assessment and enhancement.  When we are speaking of clinical integration from an antitrust standpoint, we must determine whether the systems and mechanisms are in place and continuously operating to enhance quality and efficiency.

For more coverage of clinical integration, visit the clinical integration section of the Health Law Blog.

Read more here: Health Law Blog

  

Medical Record Copying Charges In Wisconsin

Wednesday, May 7th, 2014

Wisconsin Law Release of Patient Medical Records

Wisconsin Law requires health care organizations to provide records are to patients “on request.”  Records can be provided directly to the health care provider subject to payment of the statutory fees.  Patient must deliver an “informed consent” to the organization consenting to release of their records.

Fees were revised as provided below:

(a) A patient’s health care records shall be provided to the patient’s health care provider upon request and, except as provided in s. 146.82 (2), with a statement of informed consent.

(b) The health care provider under par. (a) may be charged reasonable costs for the provision of the patient’s health care records.

(2) The health care provider shall provide each patient with a statement paraphrasing the provisions of this section either upon admission to an inpatient health care facility, as defined in s. 50.135 (1), or upon the first provision of services by the health care provider.

(3) The health care provider shall note the time and date of each request by a patient or person authorized by the patient to inspect the patient’s health care records, the name of the inspecting person, the time and date of inspection and identify the records released for inspection.

 (3f)

(a) Except as provided in sub. (1f) or s. 51.30 or 146.82 (2), if a person requests copies of a patient’s health care records, provides informed consent, and pays the applicable fees under par. (b), the health care provider shall provide the person making the request copies of the requested records.

 (b) Except as provided in sub. (1f), a health care provider may charge no more than the total of all of the following that apply for providing the copies requested under par. (a):

Revised Fees for Patient records:

 Wisconsin Medical Record Maximum Fees through June 30, 2014 — (last year’s fees noted for reference)

Paper copies

  • First 25 pages: $1.04/page ($1.02/page)
  • Pages 26-50: 77 cents/page (76 cents/page)
  • Pages 51-100: 52 cents/page (51 cents/page)
  • Pages 101 and above: 31 cents/page (30 cents/page)

Microfiche or Microfilm: $1.55/page ($1.52/page)

Print of an X-ray (per image): $10.32 ($10.15)

If the requestor is not the patient or a person authorized by the patient

  • Certification of copies: $8.26 ($8.12)
  • Retrieval fee: $20.65 ($20.30)

Wisconsin Health Law Legislation Signed By Governor Walker

Thursday, April 17th, 2014

Health Care Legislation Signed By Governor Walker 

Wisconsin Governor Scott Walker signed 63 new pieces of legislation into law on April 9, 2014, several of which relate to the health care industry.  The new health care legislation includes the following:

1.         HIPAA Harmonization.  The HIPAA Harmonization Act which changes laws relating to behavioral health records to better align Wisconsin laws to federal HIPAA requirements.  Assembly Bill 453.

2.         Hospital Conditions of Participation.  A new law requiring the Wisconsin Department of Health Services to use Medicare Conditions of Participation when surveying hospitals.  This legislation gives DHS the authority to enforce standards that are contained in federal regulations as the minimum standards for Wisconsin hospitals.  The DHS is required to interpret the conditions of participation using guidelines established by the Federal Center for Medicare and Medicaid Services (“CMS”).  The new standards will apply beginning July 1, 2016.  Senate Bill 560.

3.         Physician Residency Requirement.  Post medical school residency requirements for physicians are increased from one to two years.  New medical school graduates will now be required to complete two years of residency unless they receive an unconditional endorsement from the residency program director.  The new law also creates a new “resident educational license” to replace the current “temporary educational permit.”  A new “administrative physician license” is also created which authorizes physicians to hold a license limited to administrative services.  Senate Bill 579.

4.         Mental Health Pilot Program.  A new pilot program in Milwaukee County was created which allows emergency detention without the involvement of law enforcement in certain circumstances.  Under this bill, the authority to initiate emergency detention is expanded to a “treatment director” or their designee, including a licensed social worker, professional counselor, or psychiatric nurse.  The stated purpose of the pilot program is to reduce stigma in mental health by allowing a clinical approach rather than a law enforcement approach to emergency detentions.  Assembly Bill 500.

5.         Volunteer Health Care Programs.  A law to allow an out-of-state health care professional to partner with a non-profit provider to participate in Wisconsin’s volunteer health care provider program.  The health care provider must have a current license to practice in their home state or territory and must only volunteer within their scope of their practice.  Senate Bill 391.

6.         Provider “Apology” Protection.  A new law which allows a health care provider to have full and frank conversations with patients or patients’ relatives that may include apology, benevolence, compassion, condolence, fault, liability, remorse, responsibility, or sympathy, without risk of admissibility in civil action, administrative hearing, disciplinary proceedings, mediation, or arbitration as evidence of liability.  Assembly Bill 120.

7.         Tribal Treatment Facilities.  A new law that permits an approved tribal treatment facility to assess and treat participants in the intoxicated driver program who are either tribal members or relatives of tribal members.  The bill requires a court to notify the person convicted of operating while intoxicated that the offender is eligible for treatment at the facility and the facility must notify the appropriate county assessment agency within 72 hours of assessing the individual.  Assembly Bill 32.

8.         Annual Mental Health Service Reports.  A new requirement that the Wisconsin Department of Health Services provide a report to the Legislature on January 1 of every odd numbered year that describes what mental health services are being provided by the counties.

9.         Fetal Alcohol Syndrome Reports.  A requirement that hospital employees refer infants to a physician if they suspect the infant has fetal alcohol syndrome.  The physician is then required to evaluate the infant for the syndrome if they determine there is a significant risk of fetal alcohol syndrome.  The physician must then report to the agency responsible for investigating cases of child abuse and neglect.  Assembly Bill 675.

If you require further information on any of these legislative enactments, please contact John H. Fisher, II, CHP, CCEP.  Further updates will also be found at http://www.healthlaw-blog.com.

MSA Metropolitan Statistical Areas Wisconsin

Thursday, April 11th, 2013

Metropolitan Statistical Areas in the State of Wisconsin

Wisconsin contains 11 Metropolitan statistical areas that are totally within the state and an additional four MSAs that overlap state borders.  The Wisconsin MSAs include the following areas:

1.         Appleton (Outagamie and Calumet)

2.         Eau Claire (Eau Claire and Chippewa)

3.         Fond du Lac (Fond du Lac(

4.         Green Bay (Brown, Oconoto and Kewaunee)

5.         Janesville (Rock)

6.         Madison (Dane, Columbia and Iowa)

7.         Milwaukee-Waukesha-West Allis (Milwaukee, Waukesha, Ozaukee and Washington)

8.         Oshkosh-Neenah (Winnebago)

9.         Racine (Racine)

10.       Sheboygan (Sheboygan)

11.       Wausau (Marathon)

The four cross-border MSAs applicable to the State of Wisconsin include:

1.         La Crosse (La Crosse/WI plus Houston/MN

2.         Minneapolis-St. Paul-Bloomington (Anoka, Carver, Chicago, Dakota, Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington and Wright/MN plus Pierce and St. Croix, Wisconsin)

3.         Duluth (Carlton and St. Louis/MN plus Douglas, WI

4.         Chicago-Naperville-Joliet (Cook, Dekalb, DuPage, Grundy, Kane, Kendall, Lake, McHenig and Will/IL plus Jasper, Lake, Newton and Porter/IN plus Kenosha, WI

Health Care Provisions In Fiscal Cliff Legislation

Monday, January 7th, 2013

Although physicians averted a nearly 27% reduction in reimbursement under Medicare, the Fiscal Cliff Legislation included a number of changes in reimbursement that in additiona to the “doc fix.”  Many of those chanced will not make health care providers very happy.  For example, the Wisconsin Hospital Association reported on friday about “Troubling Hospital Cuts” that are included in the Fiscal Cliff legislation.  Although some important programs benefiting rural providers were extended, other provisions were included that will not be as positive for hospitals and some other providers.

Some of the health care provisions that were included in the Fiscal Cliff Legislation include:

  • Medicare contractors will be given an additional 2 years to pursue overpayments from providers.  Previous law limited the recovery time period to three years.  The Fiscal Cliff legislation extended the period that Recovery Audit Contractors and other contractors can look at to assess overpayments against providers.
  •  The exceptions process relating to outpatient therapy services cap is extended for an additional year. The cap is also extended to therapy furnished as part of outpatient services provided by a critical access hospital.
  • Limitations were placed on reimbursement for stereotactic radiosurgery.
  • A new competitive pricing system for Medicare diabetic supplies is created.
  • The temporary increase in ambulance costs un certain rural areas was extended for another year.
  • A reduction by 10% in reimbursement for many non-emergency ambulance transports.  The legislation also calls for the preparation of a study on existing cost reports for ambulance services furnished by hospitals and critical access hospitals.  The existence of this study provides evidence that future reforms in ambulance service reimbursement may be on the way.
  • The reduction in reimbursement for certain advanced imaging services is increased from 75& to 90%.
  • CMS is required to adjust bundled payments for end stage renal disease to reflect changes in utilization and current sales prices of certain drugs and biologicals. Implementation of the oral-only ESRD-related drug requirement was delayed through the end of 2015.
  • The Medicare-Dependent and Low-Volume Hospital programs were extended.  Although the extension in for only a short time, these important additional payments for rural hospitals are being extended.
  • Implementation of a system to recoup payments made to hospitals under that result from the shifting of PPS payments to MS/DRG system. The new provisions permit recoupment from hospitals for “upcoding” or “coding creep.” This change is estimated to cost hospitals nationwide around $10.5 billion to be recouped for 2014 through 2017.