It is back to school time. Although it is still hot outside, many schools have opened, we have taken first day of school pictures, and football practice is underway. As we enter this new season, it’s a good time for physicians to review some practice fundamentals. To that end, I offer ten reminders about regulatory compliance fundamentals that can help to avoid legal liability and an unwanted invitation to Montgomery.
Why do physicians leave their employment with a practice group?
There’s no single reason for such a separation. A physician's leaving might be planned well in advance, or might be an unplanned, precipitous event.
With the imminent emergency of the Covid virus subsiding, discussions have shifted from the physical dangers to concern about its lasting psychological effects. Healthcare organizations report alarming levels of stress, burnout, anxiety, and depression in employees, especially clinicians. This sharp rise should bring another equally troubling issue to the conversation: substance use disorders and addiction among healthcare providers and professionals.
When the Birmingham Medical News asked me to write a blog, they told me I could write about anything. Anything? Anything.
In the past year, most physicians have been so busy with all the complications and changes in approach to care that resulted from the pandemic that they haven’t had time to examine aspects of their practice that aren’t part of the daily work. If you haven’t performed a recent review of the potential threats to your practices’ financial health, I recommend doing that, starting with your commercial insurance plan.
Partnering with an experienced agent who specializes in the healthcare arena can provide you with multiple carrier options to compare while helping you negotiate more favorable terms than some companies will offer to clients who work directly with the carrier only. Let’s take a look at a few of the items my team is focused on for our healthcare clients and the emerging threats that are continuing to impact more medical businesses.
Everyone should have a developed, thoughtful, and unique financial plan. However, newly practicing physicians face more unique financial challenges than most recent graduates due to many having considerable accumulation of student loan debt. Once physicians begin earning income, there are pressures to play catch-up with peers who have had longer to establish their careers and savings accounts.
Check-ups, tests, and results. Doctors provide, measure, and deliver data to patients every day, often with profound implications. Financial advisors, at least the diligent ones, offer the same to their clients. Much of our data focuses on helping people have confidence that they can do what they want to do and not run out of money at the same time. Approaches and technical tools may vary, often with significant differences in degrees of sophistication. It has been common practice for advisors to use these tools to help project a portfolio’s ability to provide income for retirement. Rates of return are calculated, spending requirements input, withdrawal rates assumed, and end-of-life portfolio values projected.
The False Claims Act (“FCA” or “Act”) is a federal anti-fraud statute that protects against persons and companies defrauding the government. The Act has been dubbed the government’s “primary litigation tool for recovering losses resulting from fraud.” The FCA imposes civil liability on any one who “knowingly presents…a false or fraudulent claim for payment or approval” to the federal government. It is used extensively to protect against fraud in healthcare.
The Department of Justice designated 12 federal prosecutors across the country as part of the Opioid Fraud and Abuse Detection Units. These Units are assigned to areas where the most opioid drug-related deaths have occurred: California, Nevada, Alabama, Central Florida, East Tennessee, West Virginia, North Carolina, Kentucky, Ohio, Pennsylvania, Michigan, and Maryland. Members of these Units also includes numerous federal, state, and local law enforcement and governing entities including the DEA, FBI, HHS, and other federal and state agencies (Medicaid Fraud Control Units, FDA, IRS, State Pharmacy Boards, etc.). These Units have a specific mandate to target physicians, pharmacists, and ancillary services (addiction treatment centers, etc.).
It is especially important for smaller practices to be mindful of Electronic Protected Health Information (ePHI) security regulations – a breach of ePHI can lead to costly notification requirements and potential monetary penalties under the HITECH Act. Managing physicians of small independent practices hold many responsibilities, including the duty to comply with the Security Rule within HIPAA regulations. This article provides a brief overview of federal ePHI compliance safeguards required in a practice. While not meant to be a comprehensive discussion of all requirements, it highlights legal considerations and safeguards a practice must implement to comply with HIPAA ePHI regulations. The federal Security Rule under HIPAA requires a health care provider (typically known as a Covered Entity) to have the minimum ePHI safeguards, listed below.
If you surveyed managing physicians and office managers from the Birmingham area about their business continuity plans, how confident do you think they would be with their Disaster Recovery solution? Do they feel prepared? Have they even thought about it?
Physicians and other medical care professionals spend years studying, training and preparing themselves to provide best possible care to their patients. In many instances, these professionals spend the bulk of their attention and energy on treating their patients and meeting the day-to-day challenges that come with providing the best care possible. Unfortunately, practicing in today’s economic climate within a medical industry undergoing a vast transformation has forced many medical professionals to place equal value on business issues that effect their practice. Often times, the business of operating a medical practice is never discussed in medical school. Instead, many healthcare professionals are forced to learn fundamental business principles on the fly in private practice. With the emergence of electronic medical records and coding, many healthcare providers and practices are spending a substantial amount of time concentrating on the business of healthcare in addition to patient care. Of all the business issues that must now be prioritized by the medical industry, medical billing and managing account receivables can bear the most burden of all.
Physicians serve on the frontlines of our healthcare system, and by extension the many social programs guaranteed by the Social Security Administration. It’s a large responsibility and we owe them a debt of gratitude. These dedicated care providers, across many areas of practice and at varied levels within our medical system, help more than 57 million children and adults who live with disabilities across the United States.
Most companies assume their cyber security is pretty good… until a breach happens and then you find out where the holes were. We often find that apathy and a lack of being proactive may cost you lots of money. An annual security audit is a necessity for all medical practices and companies in todays ever changing world of technology. It is a vital part of protecting your digital assets and cyber security plan for your organization. It’s not just about discovering any vulnerabilities or shortcomings, rather it’s about opportunities to strengthen your network security.
No matter the size of the business, a successful business must be paid promptly and in full. However, often a business, including a medical practice is dealing with numerous overdue accounts receivables. Such a financial position can be commonplace in today’s business environment. Although this financial condition is often perceived as “normal” or “accepted” business practice”, savvy business owners should collect promptly and protect their rights in resolving overdue receivables with the proper policy and procedures in place. Effective policy and procedures generally begin with utilizing a new patient form and/or the credit application.
As of September 30, 2017, the Department of Health and Human Services Office of Civil Rights (OCR) has received notices of 237 breaches. 46% occurred as result of hacking or IT security incidents; many at the business associate level. Ransomware is rampant and projected to increase 670%. As a covered entity, although a breach occurs at your business associate, under HIPAA, you are responsible for your protected health information and responding to the breach. OCR has been clear that breaches of 500 or more records will be investigated. Given the significant increase in breaches over the past few years, advance preparation is critical and can reduce the cost and burden of breach response.
The internet is a necessary part of the healthcare world today. This forces us to deal with the issue of managing employee Internet usage which can be a drain on your organizations productivity. This holds true in the healthcare industry whether you run a small clinic, large practice or hospital.
Social Security Disability under Title II of the Social Security Act*
Surveys have shown that most Americans know little about Social Security law and the vital benefits it provides. By far, the least understood Social Security benefit is Social Security Disability Insurance (SSDI). This lack of knowledge has been measured through objective testing in various academic studies. Anecdotally, I know this to be true based on recurring questions and comments I have received from the public and clients alike over the last several decades of my work as a social security disability attorney.
Recycling electronics is a great way to help conserve and reuse valuable resources and materials found in many gadgets, including glass, plastics, and various metals such as copper, gold, palladium, and silver. Many electronics, especially computers and televisions, contain toxic materials such as cadmium, lead, and mercury. Recycling and reusing electronics helps to keep these toxic materials out of our landfills and water supply.
MONTGOMERY – On March 29, officials from the Medical Association of the State of Alabama participated in a proclamation signing ceremony declaring March 30, 2017, the Second Annual Doctors’ Day in Alabama formally recognizing Alabama’s nearly 17,000 licensed physicians serving millions of residents through private practice, in hospitals, in research, and in other health care facilities.
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