Has your insurance company denied coverage or reimbursement of you or your family member’s mental health or substance abuse service claims? In light of the recent New York Attorney General settlements with insurance companies for violations of the federal and New York state mental health parity laws, insurance companies need to take a hard look…
The rise of social media has forever changed not only how individuals communicate with one another in their personal lives, but also how businesses communicate to and with consumers. Traditionally viewed as a more informal and personal means of communication; hospitals, nursing homes and other health care facilities must walk a fine line when attempting…
Within recent decades, there’s been growing concern about the rising costs of health care and the lack of transparency on the parts of physicians, hospitals and insurance providers with regard to those costs. While some states have taken steps to compel health care providers, facilities and private insurance companies to provide detailed information related to…
Increasingly in industries, workplaces and households around the world, privacy is becoming a longed-for relic of the past. While one’s right to privacy was previously assumed; from an individual’s personal identifying information to a bank’s list of security codes— in today’s digital age information is easily and readily discovered and shared. When it comes to…
Most individuals who endure the years of schooling and training it takes to become a full-fledged medical doctor do so because they want to help people. As with many professionals, despite all of their professional training, physicians are often ill-prepared for many of the realities that come with the job. Along with the physical, mental…
For individuals who are age 65 and older or who are permanently disabled, Medicare provides vital health insurance coverage to help pay for doctor visits, medical procedures, hospital stays, physical therapy, prescription drugs and medical equipment. According to The Henry J. Kaiser Family Foundation, during 2014, Medicare spending totaled $597 billion and accounted for 14…
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. For an individual who…
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…
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. For those who may be…
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…