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December 2015 Archives

How HIPAA applies to patients with mental health conditions

According to the National Alliance on Mental Illness, annually, 20 percent of the U.S. adult population "experiences mental illness." Whether a mental health condition like depression is related to a specific event or is a genetic and chronic condition; mental health conditions are disabling and can also be difficult to treat.

Court Lifting of Stark Law Ban on Per Click Fees May Lead to "Sub-under Arrangements" between Physicians and Hospitals?

The Stark Law prohibits a physician who has a "financial relationship" with a provider of designated health services[i] ("DHS Entity") from referring Medicare patients to that DHS Entity. It also bars DHS Entities from receiving Medicare payments based on these prohibited referrals. Under Stark, a physician has a "financial relationship" with a DHS Entity if he or she owns or invests in it, or if he or she has a compensation agreement with the DHS Entity covering services, equipment, and the like.

Basis of many health care fraud suits to be examined by SCOTUS

An announcement by the Supreme Court could be good news for health care providers. It might not. What legal observers seem to agree on is that regardless of the outcome, it should give providers a better understanding of when they run the risk of violating the federal False Claims Act.

Important Changes Made to "Incident to" Billing in CMS 2016 Revisions to Physician Fee Schedule

Medicare pays practitioners for "incident to" services at the applicable Medicare payment rate as if the practitioner personally furnished the service. For example, if billed by a physician, they are paid at 100 percent of the fee schedule amount, and if billed by a nurse practitioner or clinical nurse specialist, they are paid at 85 percent of the fee schedule amount. Payments are subject to the usual deductible and coinsurance amounts.

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