News & Analysis as of

Physicians Healthcare Billing

J.S. Held

Inside the Healthcare Industry: The Critical Role of Medical Coding, Billing & Nurse Review

J.S. Held on

In what is already a highly regulated industry, it is becoming increasingly difficult for healthcare organizations to navigate the growing volume, complexity and enforcement of laws, regulations and guidance that surround...more

Spilman Thomas & Battle, PLLC

The Health Record - Healthcare Law Insights, Issue 1, May 2024

Welcome to our inaugural issue of The Health Record - our healthcare law insights e-newsletter! As such, we wanted to pull together our insights and pass them along to you. Our goal is to create a publication that is...more

McDermott Will & Schulte

OIG Pathology Lab: Don't Pay for Services You Don't Need

McDermott Will & Schulte on

In September, the US Department of Health and Human Services Office of Inspector General (OIG) issued an unfavorable advisory opinion to a pathology laboratory concerning a proposed services arrangement with referring...more

Mintz - Health Care Viewpoints

OIG Issues Advisory Opinion Nixing Purchased Services Arrangement Between Certain Anatomic Pathology Laboratories

Last week the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) issued Advisory Opinion 23-06 (AO), which advised that a proposed arrangement between certain laboratories for the purchase...more

Butler Snow LLP

Prior Authorization Reform in Healthcare: Winds of Change?

Butler Snow LLP on

Bob Dylan, winner of the Nobel Prize in Literature and one of the greatest American songwriters of all time, has effectively used wind as a metaphor in a number of songs he has written, each with its own distinct message....more

McDermott Will & Schulte

Reforms to the Florida Patient Self-Referral Act: A Closer Look at the Impact of SB 768

Florida Senate Bill 768 (SB 768) amends the Florida Patient Self-Referral Act of 1992 (PSRA), which regulates financial arrangements between referring healthcare providers and providers of healthcare services. This amendment,...more

Bradley Arant Boult Cummings LLP

CMS Proposes to Continue Allowing Remote Supervision Through December 31, 2024

In its Calendar Year (CY) 2024 Physician Fee Schedule (PFS) proposed rule, the Centers for Medicare and Medicaid Services (CMS) proposes to continue to allow supervising physicians and practitioners to conduct “direct...more

Epstein Becker & Green

New York State Department of Financial Services Summarizes Changes Relating to Administrative Denials, Prior Authorizations, and...

Epstein Becker & Green on

On March 10, 2021, the New York State Department of Financial Services (“DFS”) issued Insurance Circular Letter No. 4 (“Circular Letter”), which both explains modifications to the Insurance Law and the Public Health Law...more

Patrick Malone & Associates P.C. | DC Injury...

Hospitals profiteer on injured car wreck victims with sky-high bills and liens

Congressional investigations may be coming none too soon on revelations about predatory billing by big hospitals and hospital chains against patients for costly care they received after they were hurt in vehicle wrecks....more

Sheppard Mullin Richter & Hampton LLP

‘Twas the Season to Contract? A Year-End Review of Network Negotiations and Billing Disputes

As 2017 drew to a close, some health plans and healthcare providers across the country were still busy trying to finalize contracts for in-network services for 2018 and beyond. A number of negotiations made the headlines in...more

King & Spalding

DOJ Announces Settlement with Tuomey CEO Following Yates Memo Directive to Hold Individuals Accountable

King & Spalding on

The Department of Justice’s recent settlement with a healthcare system executive indicates a continued focus on pursuing individuals in enforcement actions. On September 27, 2016, the DOJ announced it reached a $1 million...more

Foley & Lardner LLP

Can My Hospital Bill Medicare for Telehealth Chronic Care Management?

Foley & Lardner LLP on

CMS just introduced proposed rules to clarify the requirements and payment opportunities when hospitals want to bill Medicare for Chronic Care Management (“CCM”) services. CCM is an exciting service covered by Medicare...more

Jackson Walker

New Law Continues to Require Out-of-Network Facility-Based Physicians to Notify Patients of Mediation Rights

Jackson Walker on

Early last week, Gov. Greg Abbott signed SB 481 into law. The new law, which will become effective on September 1st, gives Texas consumers the option to mediate medical bills that they receive from out-of-network...more

Williams Mullen

Health Care Fraud and Abuse Alert: What CMS’s New Billing Requirement For “Incident To” Services Means For Medicare Providers.

Williams Mullen on

In the final Medicare Physician Fee Schedule for 2014 (“2014 PFS”), CMS implemented a new condition of payment for “incident to” services that has significant fraud and abuse implications for any Medicare provider who relies...more

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