January - February 2011
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The attorneys of the HLP regularly author articles in publications nationwide.  We invite you to read a selection of the articles we have published in January and February of this year regarding developments in healthcare law and what it can mean for your future business decisions.  As always, we encourage you to visit our website and our blog for timely guidance on regulatory developments and government actions, as well as contacting us directly by phone or e-mail to address your specific needs.
by Abby Pendleton, Esq. and Jessica L. Gustafson, Esq. featured in G-2 Compliance Report, February 2011.
The Centers for Medicare and Medicaid Services (CMS) Recovery Audit Con¬tractor (RAC) program is now operational nationwide. Laboratories and pathologists should begin to prepare now for increased auditing activity. Should a provider be faced with a RAC denial and overpayment demand, such a deter¬mination can be appealed. This article will outline the fundamentals of the RAC program and will set forth key issues of which all providers should be aware to challenge RAC denials… Learn more >
The October 2010 Regulatory Review column addressed the September 23, 2010 Centers for Medicare and Medicaid Services (CMS) proposed rule for establishing new screening requirements for enrollees in Medicare, Medicaid, and the Children’s Health Insurance Programs (CHIP) pursuant to Section 6401(a) of the Patient Protection and Affordable Care Act (PPACA). The final rule, published in the Federal Register on February 2, 2011, is slightly more stringent, with respect to providers and suppliers of radiology services. The
Final Rule will be effective on March 25, 2011 for both newly enrolling providers and suppliers as well as currently enrolled providers and suppliers whose revalidation cycle ends between March 25, 2011 and March 25, 2012. For all other currently enrolled providers and suppliers, the effective date for this final rule will be March 25, 2012... Learn more >
On November 22, 2010, the US Department of Health and Human Services (HHS) Departmental Appeals Board (DAB) issued a final decision concerning an independent diagnostic testing facility’s (IDTF) billing privileges, which clarifies industry confusion regarding (1) the definition of a mobile IDTF; (2) what constitutes “sharing a practice location;”and (3) leasing/subleasing relationships between fixed-based IDTFs and other Medicare-enrolled individuals or organizations... Learn more >
By now, most healthcare providers have at least a basic understanding of the recent and broad sweeping federal healthcare reform legislation commonly known as the Affordable Care Act, which was adopted during March, 2010.  Although Republicans in Congress are expected to use the “power of the purse” to limit the impact of the Affordable Care Act, it is anticipated that those aspects of the law focusing on reforming the healthcare delivery system will be less constrained than those provisions focusing on health insurance reform... Learn more >
The prospect of physician practice mergers can look clean and clear on the front end: perceived efficiencies, additional in-office revenues and additional power to negotiate attractive prices from commercial health insurance plans. But bigger doesn’t always mean better. The back end of a merger can get ugly with the Federal Trade Commission (FTC), especially if the merged practice tries to bully its way to higher reimbursement. Compliance with antitrust rules is an important due diligence component of any health care combination... Learn more >
by  Robert S. Iwrey, Esq., Michigan Medical Law Report Winter 2011
Long past are the days when a physician could simply devote virtually all of his or her efforts to seeing patients and providing high-quality care.  With the avalanche of new regulations, the ever-tightening belt of third-party payor reimbursement, the increased scrutiny and the increased emphasis on cost-containment and pay-for-performance measures, physicians find themselves having to play the role of business manager, accountant, financial advisor, attorney, billing consultant—and, if time permits, practicing physician... Learn more >
by Abby Pendleton, Esq. and Jessica L. Gustafson, Esq., Michigan Medical Law Report Winter 2011
On Nov. 10, 2010, the Centers for Medicare & Medicaid Services (CMS) published its much-anticipated Proposed Rule regarding the new Medicaid Recovery Audit Contractor (RAC) program.  Section 6411 of the Patient Protection and Affordable Care Act (Affordable Care Act) required each state to establish a Medicaid RAC program, similar to the existing Medicare RAC program.  Like Medicare RACs, Medicaid RACs will be tasked to audit claims to identify overpayments and underpayments and will be compensated on a contingency fee basis... Learn more >
by  Adrienne Dresevic, Esq. and Carey F. Kalmowitz, Esq., Michigan Medical Law Report Winter 2011
As many in the health care industry already know, there are two important payment reform provisions triggering a wave of new or modified legal structures.  Those provisions are part of the Patient Protection and Affordable Care Act (PPACA), which focuses on clinical integration among physicians, hospitals and other health care providers and suppliers.  Section 3022 of PPACA establishes a shared savings program pursuant to which Medicare will share cost savings for high-quality care delivered by an accountable care organization (ACO) to Medicare beneficiaries in its traditional fee-for-service program (the Shared Savings Program)... Learn more >
by  Abby Pendleton, Esq. and Stephanie P. Ottenwess, Esq., Michigan Medical Law Report Winter 2011
On Nov. 5, 2010, the Office of Inspector General (OIG) released its most recent compliance guidance for physicians.  While it is intended as a primer for new physicians, it is an excellent resource for established practitioners, as well.  This guidance is an informational pamphlet entitled “A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse.”  It can be accessed at www.oig.hhs.gov... Learn more >
We have extensive experience with RAC audits and appeals, working directly with healthcare entities subject to RAC audits.
We represent Independent Diagnostic Testing Facilities ("IDTFs"), mobile leasing entities, radiology group practices, and other imaging providers.
We provide assistance and guidance through the legal process focused on the goal of resolving your matter successfully and efficiently.
The RAC Corner
Connect with The HLP

We regularly provide guidance to health care providers and suppliers subject to RAC audits, assisting health care providers and suppliers to successfully navigate the appeals process.

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It is our goal to provide high quality health care legal services, employing a client-focused approach emphasizing excellence in quality, responsiveness and attentiveness to our clients' business objectives.

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January - February 2011
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