Five Things Physicians Should Know
medical profession’s ever-changing legal and regulatory landscape constantly
introduces new challenges into the practice of medicine
To help you meet some of the myriad regulatory
challenges, here are five important things with which physicians should be
As of January 1, 2010, if you provide CT, MRI or PET services in your
office, you need to provide written disclosure to your patients, at the time
you refer them to your own imaging service, informing them of the name,
address and telephone number of at least five unrelated providers of that
service that are located within a 25-mile radius of your office. In most
cases, the list does not need to include hospitals within the area. Written
documentation of compliance with this requirement is required, and you can
meet that requirement by making a notation in the patient’s chart. Failure
to comply could constitute a violation of the federal Stark law.
If you identify an overpayment from Medicare, you must
refund it within 60 days of the determination. An overpayment is defined as
any funds a person receives or retains under Medicare or Medicaid to which
the person, “after applicable reconciliation,” is not entitled. It is still
unclear what constitutes a “determination” of an overpayment. Failure to
comply with this 60-day deadline makes the overpayment amount a false claim,
which can subject you to treble damages and penalties.
Red Flag Rules
Physicians are no longer defined as “creditors” under the
Red Flag Rules and, therefore, do not have to comply with those burdensome
requirements. However, if you obtain a credit report or submit information
to a consumer credit reporting agency as part of credit transactions with
your patients, you would be subject to the rules. Consider this carefully
before adopting such a policy.
Under the Health Care Reform law, as a condition of enrollment in Medicare,
Medicaid or CHIP, physicians must develop and implement a compliance
program. While it has been good practice for some time to establish and
follow a compliance plan, many physician practices have not done so.
Regulations on this requirement have not yet been issued, but it will soon
be not only good practice but an obligation to have a compliance plan for
Electronic Health Records Incentives
Payment incentives are available for “meaningful use”
of electronic health records systems under Medicare ($44,000 per eligible
professional) and Medicaid ($63,750 per qualifying practitioner), although
you cannot receive both. Online registration for the incentives began on
January 3, 2011, and is continuing. More information is available at the
Centers for Medicare and
Medicaid Services "Path to Payment" website.
Any one of these items could make a big difference in the way you practice.
If you would like more information about any of them, please contact Steve