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Bankruptcies rise among physician practices, bucking the trend

09/16/2024

While the year is not yet out, bankruptcies are hitting the medical practice business harder in 2024 than they did in 2023, climbing a substantial 60% year to year.

Appeals court supports TMA against No Surprises rule

09/16/2024

by: Roy Edroso

A rule based on the No Surprises Act was again handed a legal defeat, this time by the Fifth Circuit Court of Appeals, on August 2. HHS, along with the U.S. Departments of Labor and the Treasury, had appealed last year’s decision in U.S. District Court for the Eastern District of Texas that suspended CMS’ independent dispute resolution process (IDR) by which “surprise billing” of out-of-network claims were adjudicated.

Non-compete rule blocked; watch other forces on restrictive covenants

09/09/2024

by: Roy Edroso

A court has blocked the Federal Trade Commission’s (FTC) noncompete rule that threatened to invalidate contract terms many physician practices rely on to prevent patient poaching. But don’t get too comfortable yet; there are still common and state law standards that can complicate the use of non-competes.

Commenters ask CMS to expand the SDOH risk assessment

09/09/2024

by: Julia Kyles, CPC

CMS issued a broad request for information on the new codes that it created this year to address social needs, including G0136 (Administration of a standardized, evidence-based social determinants of health risk assessment [SDOHRA] tool, 5-15 minutes, no more than once every 6 months). CMS wants “to engage interested parties on additional policy refinements for CMS to consider in future rulemaking,” according to the proposed 2025 Medicare physician fee schedule.

‘No comment’ sounds guilty. Fight bad impressions with a press policy.

09/09/2024

by: Roy Edroso

Question: Recently one of our providers was in the news and reporters called our office. We all refused to comment when contacted. That seemed the safest course, but now we’re wondering if we should have done something else.

Take key lessons learned from latest high-dollar Security Rule settlement

09/09/2024

by: Dom Nicastro

The Office for Civil Rights (OCR) has reached a $950,000 settlement with Heritage Valley Health System Inc. for potential violations of the HIPAA Security Rule, following an OCR investigation after the health system experienced a ransomware attack in 2017.

Surgical, postop-only claims almost even for transfer of care cases

09/09/2024

by: Julia Kyles, CPC

Billing practitioners who do not treat patients during a procedure’s full global period are slightly more likely to report claims with surgical care-only modifier 54 than with postoperative care modifier 55, according to Medicare Part B claims data.

MACs reveal 8 mistakes that still endanger your office E/M revenue

08/26/2024

by: Julia Kyles, CPC

Protect your office/outpatient E/M claims from front-end denials and post-payment recoupments with the freshest information from Medicare administrative contractors (MAC).

Prepare: New DOJ pilot pushes non-FCA fraud reporting, with an online form

08/26/2024

by: Roy Edroso

A new whistleblower pilot threatens to “supercharge” the range of qui tam suits brought against health care entities. Confer with your business insurers, counsel and compliance officers to prepare.

Find insights on HIPAA final rule on reproductive health care privacy

08/26/2024

by: Dom Nicastro

The final rule “HIPAA Privacy Rule to Support Reproductive Health Care Privacy“ aims to safeguard sensitive protected health information (PHI) in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. This landmark ruling has far-reaching implications, particularly in states with restrictive reproductive health laws, prompting a critical need for enhanced privacy protections.

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