Some select industries are just different. Like sumo wrestling, aerial acrobatics and space exploration. And, to be sure, the health care industry. Indeed, perhaps no other realm of focus and professional endeavor is so clearly singular and distinct as the medical field. And for good reason. The industry is marked by specialized and highly trained…
On April 11, the Centers for Medicare & Medicaid Services (CMS) announced its largest-ever initiative to, in its words “transform and improve how primary care is delivered and paid for in America”. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented on January 1, 2017 in up to 20 regions. It will…
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…
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…
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…
The health care industry in New York and the rest of the country is undergoing something of a renaissance. Some call it good. Others call it bad. Regardless of what side of the fence you might be on, the one thing that is certain is that the economic trend in health care is in flux….
The 2010 Patient Protection and Affordable Care Act (Obamacare) encourages a “medical home” model of care, which aims to improve patient access and quality of care through increased communication between physicians and patients and increased care coordination, while simultaneously reducing costs. In an effort to jump start this model, starting in 2016, Medicare will pay…
New York Hospitals, clinics and practices and the doctors, nurses and support personnel they employ, can find that the environment in which they operate changes quickly. Under an amendment to the New York Public Health Law enacted this week, starting in April of 2016, NY hospitals will be required to allow patients over the age…
The law is a dynamic thing. With perhaps only a few exceptions there is no such thing as a one-and-done piece of legislation. This can be particularly true for rules and regulations that cover health care delivery in New York. Hospitals, clinics and practices and the doctors, nurses and support personnel they employ, can find…