Georgia's Trusted Healthcare
& Medical Provider Attorneys

GA’s City & Urban Hospitals Will Be Impacted By The American Health Care Act

Emergency Sign Healthcare LawPassage of the American Health Care Act in its current or proposed form with significant cuts to Medicaid and Medicare will not only impact rural hospitals and facilities, but city and urban hospitals as well. Here’s how.

Steep cuts to Medicaid and Medicare will result in many of Georgia’s 95 health clinics being unable to keep their doors open. These facilities serve a population that is often primarily at the poverty level, the elderly, unemployed and uninsured.

As a result, city and urban facilities could see a significant increase in uninsured and under insured patients as these patients do not have access to any other options for healthcare.

City & Urban Hospitals Need To Prepare for New Challenges

Hospitals will need to:

• Increase medical and administrative staffing to handle the influx of additional patients, especially for patients that may utilize ER services in place of what would have been primary care services prior to the cuts.

• Absorb the costs of an increase in patients and staffing as there will be little or no government money (or at best temporary money) to assist (Medicaid or Medicare).

• Review internal policies on how to handle additional patients and billing procedures for patients who cannot afford medical care.

It’s imperative for all hospitals to begin reviewing policies and procedures before an influx of patients occurs and the potential for lawsuits arises.

Experienced Healthcare Attorneys

Jeyaram & Associates has more than 50 years legal healthcare experience and has helped numerous city and urban hospitals conduct internal audits, write policies and procedures and ensure compliance with state and federal laws.

Contact Us

Free initial consults. Contact DJ at DJ@JeyLaw.com or 678.325.3872.

DJ Jeyaram Quoted in Leading National Medicaid Publication

Screen shot 2016-08-26 at 2.03.18 PMDJ was quoted in the national “Part B News” publication – a leading industry information source for healthcare practice managers and physicians.

Check out DJ’s quotes below in the article: “Negotiate For Patient Record Access When Rival Practices Close:”

Negotiate For Patient Record Access When Rival Practices Close

Increase your patient census and practice revenue when a nearby practice closes by striking a deal for limited access to patient records without paying for the privilege.

In fact, in some cases, the closing practice may pay you.

One of the valuable tangible assets of a practice sale is the patient records that come with it. While the purchaser can’t under HIPAA treat these records as their own until the patients affirm via signed waivers that they want to adopt the new provider, the fact that the buyer is holding the records provides an enormous incentive for them to do so.

It isn’t necessary for the buyer to purchase the entire assets of the practice either, notes Patrick Stanley, an attorney with Comitz | Beethe in Scottsdale, Ariz. Patient records may be included in a limited asset purchase agreement. As with a complete purchase, the retiring practice would then give patients notice and direct them to the purchaser to retrieve their records or, if they choose, continue their care with the new practice. Remember that the patients would have to sign on and have the final say. Note: Laws on the disposition of medical records may vary by state.

How to take custody of records

Vasilios “Bill” Kalogredis, chairman of the health law department of Lamb McErlane in West Chester, Pa., says he has negotiated several arrangements between practices that were closing down and practices that wanted to pick up their patients.

“I see this a lot,” says Kalogredis. “A solo practitioner is retiring and he can’t sell the practice, or he’s leaving one state for another. Hospitals and other practices may not want to buy, but they’re interested in the patients.”

Propose a “custodial” arrangement if buying the practice or part of it is too rich for your blood. In that case, your practice just takes responsibility for the safe- keeping of the other practice’s records. Under such an agreement, when the retiring practice gives notice to its patients, it also would inform them that they can retrieve their records from you and that you also are available to provide continuity of care.

The custodial agreement also should address the length of time that the records will be retained, says D.J. Jeyaram, owner and health care attorney at Jeyaram & Associates in Atlanta.

Consult your legal counsel and malpractice insurance carrier before entering into an agreement to make sure you’re handling things properly from the legal and ethical perspectives, Kalogredis suggests.

Some practices may even receive a fee for accepting this responsibility. But note that while receiving a fee for the storage of medical records would be kosher, an arrangement whereby you pay a fee for the right to store the records “could be seen as remuneration for referrals under the federal anti-kickback statute or its state equivalents,” says Jeyaram.

Mind HIPAA rules

Note that in a custodial arrangement, you would be only holding the patient records — they’re not really your records unless and until the patient releases them to you. “HIPAA only allows for the exchange of protected health information (PHI) without a written release if the transfer is between current or prior health care providers for the purposes of providing treatment,” says Jeyaram.

In this circumstance, under HIPAA, you would be a business associate (BA) of the transferring practice that remains the covered entity, says Jeyaram, and you should execute a business associate agreement (BAA) (PBN 7/11/16).

The BAA, which ensures HIPAA compliance in the transfer and storage of records, should be referenced in the custody agreement, Jeyaram says.
Note that though it varies by state, responsibility for retention of medical records is usually seven years or longer; be prepared to follow through on that if you accept responsibility.

Remember: A custodial arrangement gives you a good shot at inheriting these patients, but it’s not “exclusive” — in some states and under some contracts, other providers from the closed-down practice may take their patient lists with them and reach out to these patients too. In the end, it’s always the patient’s choice (PBN 5/2/16). — Roy Edroso (redroso@decisionhealth.com)

Visit http://pbn.decisionhealth.com/ to learn more.CompressedPartBNewsNegotiatePatientRecords8.16-min.pdf”CompressedPartBNewsNegotiatePatientRecords8.16-min.pdf”

Another Katie Beckett Denial Overturned!!!

Katie Beckett Denial OverturnedWe’re so excited!!!

We’ve helped another family overturn a Katie Beckett denial!

Katie Beckett Legal Help Testimonial 

Here’s the review R. Carrington posted on our site:

“When our son’s Katie Beckett was denied after 9 years of approval, we were lost. Mr. Jeyaram walked us through the appeal process, met with us and helped us write a strong letter for review and followed up with us to make sure our appeal was a success.”

“What could have been devastating for our family, was a small bump in the road, easily handled. Mr. Jeyaram’s is a special needs’ family most needed contact. Thank you Jeyaram & Associates! You really saved the day!”

Thank you R. Carrington for the kind words! We love nothing more than seeing our kids get the benefits they deserve!

Our Attorneys Have Extensive Experience With Katie Beckett

Receive notice that your child’s Katie Beckett has been denied? We can help! Our attorneys have an intimate understanding of how the Katie Beckett and NOW/COMP approval process operates through the Department of Community Health (DCH), as well as the Office of State Administrative Hearings (OSAH), the entity that presides over the Katie Beckett and NOW/COMP appeals.

Before joining Jeyaram & Associates, our attorneys worked as DCH Medicaid attorneys and OSAH judge. They have experience with and insight into the Katie Beckett and NOW/COMP Waiver process at DCH and OSAH that other lawyers cannot offer.

We’ve Been Through The Process

Our attorneys have personal experience applying for, initially being denied and then finally approved Waiver services. We’ve been there, and we want to help other parents whose children would also benefit from these programs. We know the application process is frustrating and confusing. Don’t give up. We’re here to help! We’ve also successfully helped dozens of families appeal Katie Beckett and NOW/COMP denials.

Need Help?

Attorney and special needs dad DJ Jeyaram can help. Contact DJ at DJ@JeyLaw.com or 678.325.3872.

Did You Know?

Katie Beckett Attorney GeorgiaDid you know DJ Jeyaram is Georgia’s leading attorney on Katie Beckett?

He has successfully helped more than 100 families obtain Katie Beckett approvals on appeal!!!

For help with Katie Beckett denials, please contact DJ at DJ@JeyLaw.com or 678.325.3872. You can also learn more on our site by clicking here.

Georgia Department of Community Health Approves $140 million Medicaid Rate Increase

Georgia MedicaidGeorgia doctors, nursing home operators and other healthcare providers will soon see an increase in Medicaid reimbursements. The Georgia Department of Community Health (DCH) approved a reimbursement rate increase earlier this month that will go into effect July 1, 2016.

The increase addresses concerns that low Medicaid reimbursement rates have made it difficult for practices with high volumes of Medicaid patients to be profitable. The rate increases will most likely have the biggest impact on providers in rural Georgia communities, which serve a high Medicaid population. For some providers, the Medicaid reimbursement rate will go up by more than 50% for some procedures.

The rate increases means $140 million in increased reimbursements for Georgia providers. The increase was funded by the General Assembly earlier this year, but the Department of Community Health did not approve the rate increase until the beginning of May. The total will be paid for in part out of the Georgia budget with about two thirds of the increase coming from the federal government.

Jeyaram & Associates is a full service healthcare law firm committed to helping doctors, nurses, hospitals, nursing homes, adult day care facilities, pharmacies, and Medicaid and healthcare providers. Contact DJ at DJ@Jeylaw.com or 678.325.3872.

60 Day Overpayment Questions Answered – CMS Releases Final Rule

Calendar CMSThe Centers for Medicare & Medicaid Services (CMS) published the Final 60 Day Overpayment Rule on Thursday, four years after the initial rule was released.

This Final Rule clarifies application of the 60-day reporting requirements instituted pursuant to the Affordable Care Act. Under the 60-day Overpayment Rule Medicare providers must report and return overpayments within 60 days of when an overpayment is identified (or the cost report due date, when applicable).

Prior to the publication of the Final Rule, there was much speculation, and interpretation by courts as to how to define “Identification.” This definition is important because when an overpayment has been “identified” as provided in the law, the 60 day clock starts ticking and the deadline for reporting and repayment is set.

Key Clarifications On Overpayment

The Final Rule provides a key addition in how “identification” is defined by adding that an overpayment is “identified” after such overpayment has been quantified. The Rule also requires that providers exercise “reasonable diligence,” which according to CMS requires “both proactive compliance activities to monitor claims and reactive investigative activities undertaken in response to receiving credible information about a potential overpayment.”

The Final Rule further clarifies that providers have up to 6 months to investigate a possible billing error before the 60-days start to run. This replaces an indefinite requirement set forth in the Proposed Rule that providers act with “all deliberate speed.”

Another noteworthy change in the Final Rule is the stated “look-back period.” In the Proposed Rule, overpayments had to be reported and returned if a person identified the overpayment within ten years of the date the overpayment was received. However, the Final Rule reduces this time frame to six years. This shortened “look-back period” is likely to reduce the administrative burden of complying with the law.

To review the Final Rule in its entirety it is available at here

Need Help?

If you have questions about the overpayment rules or need assistance, we can help you. Please contact Danielle Hildebrand at dhildebrand@jeylaw.com or 678.325.3872.

 

DJ Jeyaram, Georiga’s Leading Medicaid Legal Expert, Featured in Medicaid’s Who Who

MedicaidCongratulations to DJ Jeyaram for being featured in Mostly Medicaid’s Who Who Series. Originally posted on Mostly Medicaid.

 

DJ JeyaramMedicaid Who’s Who: DJ Jeyaram – Jeyaram & Associates, P.C.

1. Which segment of the Industry are you currently involved?

ALegal and Regulatory compliance including reimbursement appeals.

2. What is your current position and with what organization?

A: Founder of Jeyaram & Associates, P.C., a healthcare law firm.

3. How many years have you been in the Medicaid industry?

A: 19 years

4. What is your focus/passion? (Industry related or not)

A: Making sure the government follows the rules whether in auditing providers or determining eligibility for services.  Most of the time they wrote the rules, they need to follow them!

5. What is the top item on your “bucket list?”

A: With my wife leading the charge; Creation of the WISH House that will provide housing and services to individuals with Williams Syndrome.

6. What do you enjoy doing most with your personal time?

A: Personal time?  What’s that?

7. Who is your favorite historical figure and why?

A: Rosa Parks.  From the smallest of things come the biggest of changes.

8. What is your favorite junk food?

AChocolate chip cookies.

9. Of what accomplishment are you most proud?

A: Raising happy children!

10. For what one thing do you wish you could get a mulligan?

A: Maybe starting a family earlier.  Being an old dad with young kids is tiring!

11. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

A1: Reimbursement and Audits:  As the government audits more aggressively are providers’ documentation sufficient to avoid recoupment?

A2: Member Benefits:  Even if rates are not reduced, states are seeking to effectively lower payments by lowering the units of service available to members.

A3: Due Process:  Are providers and members getting sufficient notice of reduction of reimbursement/benefits so they can file an effective appeal?

 

 

Are You Compliant? HHS Issues Guidance & Likely To Continue HIPAA Compliance Scrutiny

HIPAA AuditThe Department of Health and Human Services (HHS) started the year by publishing new HIPAA guidance with respect to patient access to medical records.

While the recent HHS guidance does not add anything new to the regulations, it serves as a reminder to providers of certain provisions in the law. The guidance is intended as a tool to aid individuals in exercising their rights to access their medical records and to help providers ensure HIPAA compliance.

HHS highlighted certain provisions in the HIPAA regulations including provider obligations to respond to a request from a patient within 30 days and provide PHI in an electronic format if requested (assuming the electronic format requested can be readily produced by the provider).

The guidance also reminds providers that covered entities are not required to provide every single record about an individual even if the individual asks. Certain exceptions to a patient’s right to access include:

  • Patients do not have the right to access to information that is not used to make decisions about that individual. For example, certain quality assessment or improvement records, patient safety activity records, or business planning, development and management records that are used for business decisions do not have to be provided to an individual.
  • Individuals do not have a right to access psychotherapy notes that a mental health professional maintains separately from the individual’s medical record and that document or analyze the contents of a counseling session with the individual.
  • Providers can deny access to certain records if a licensed health care professional determines in the exercise of professional judgment that the access requested is reasonably likely to endanger the life or physical safety of the individual or another person.
  • Patients do not have a right to access certain records compiled in reasonable anticipation of, or for use in, a legal proceeding.

Additionally, providers do not have to create new information, such as explanatory materials or analyses, that does not already exist in the record.

The government’s emphasis on HIPAA is expected to continue with pending audits of covered entities and business associates likely to take place this quarter. Now is the time for healthcare providers to review their policies to ensure that they are complying with the HIPAA regulations.

If you would like to review the HHS guidance it is available at http://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html.

If you need help ensuring HIPAA compliance, please contact Danielle Hildebrand at dhildebrand@jeylaw.com or 678.325.3872.

 

 

Champion Change for Special Needs Children: Sign the Katie Beckett Petition

Katie Beckett PeitionIn the early 1980’s a little girl named Katie Beckett was only 3 years old and suffering from a viral brain infection she caught a 5 months old that left her fighting for her life and permanently disabled. Her parents insurance was capped at one million dollars and they quickly surpassed that. Medicaid began covering her hospital stay. She was in the hospital for 3 years before her condition improved to where going home was even a possibility. BUT they faced a huge obstacle. While in the hospital Medicaid covered Katie’s needs. At home, her parents would not qualify. Her parents could not afford her care.

The dire situation of Katie Beckett got the attention of President Ronald Reagan. He too saw the absurdity. Her hospital stay was costing taxpayers more than providing Medicaid to her parents so they could provide her treatment at home. In 1981 Katie Beckett’s family was the first to receive the soon called Katie Beckett waiver and a week before Christmas Katie finally left the hospital with her new doll from the Reagan family in tow. In 1982 it was expanded to be a state plan option provision under Medicaid.

More than 30 years later, it is children in GA that now need help. Children who, like Katie, are severely affected by cognitive, developmental and physical disabilities. These children are in danger of losing the help they NEED and becoming wards of the state and institutionalized if they cannot receive the help their parents need to care for them at home. It is highly likely that Katie Beckett herself would not qualify for the waiver named after her if she were a child today living in the state of Georgia. Currently GA families are facing an unreasonable tightening and reevaluation of the requirements for those children receiving the Katie Beckett Medicaid Deeming Waiver.

The requirements are now stating that therapy/ nursing must be received 5 DAYS a week. While this requirement might not seem extreme, if enforced to this exact interpretation, thousands of children needing help would be denied and thousands of families would be forced with the agonizing decision of ripping apart their families and having their beloved children institutionalized in hospitals at great expense to the taxpayers of the state of Georgia. There is a provision in the guidelines that states that children with disabilities qualify regardless of ability to participate in therapy if they meet certain psychological testing guidelines.  This provision is being overlooked and children are routinely being denied. What are some of the problems?

NURSING:

  • It is very hard for families of medically fragile children to qualify and/or afford in-home nursing care for their children. In fact, the Department of Community Health is removing access to nursing care of these medically fragile, vulnerable children.
  • The majority of private insurance companies do not cover in home, private duty nursing care. In many instances, there are not enough nurses to staff the hours and days, particularly for highly specialized care.
  • A parent may choose to become their child’s unpaid 24/7 nurse for their child after being trained and given oversight by qualified personnel. Because they do not have “skilled nursing hours” they can be denied Katie Beckett with these stricter requirements.

THERAPY:

  • A parent may receive a prescription for therapy 5 or more sessions a week from their doctor which is the amount of therapy that is medically necessary for the child. Many times it is impossible for children to be able to receive it. Lack of availability of therapists and therapy centers.
  • There are not enough therapy centers or therapists to accommodate the growing list of children who now need 5 sessions of therapy a week in order to keep the Katie Beckett Deeming Waiver.
  • If a parent is lucky enough to find such a center, there is then usually a wait list for afternoon hours. Many children attend school during the day and many parents try to have therapy later in the day so the child misses the least amount of school.
  • Most primary insurance plans have limitations on amount of therapy or what type is covered. Many families cannot afford it and may not be enrolled in therapy when they apply for Katie Beckett. Medicaid rarely covers five days per week of therapy for any child, even the most severe.
  • Lack of therapy services and providers in the school setting. Across the state, the majority of children receiving therapeutic services at school through their IEPs are enrolled in group therapy. Many schools only offer this due to limited funding, time, and staffing. While there is NOTHING in the Medicaid guidelines stating that this type of therapy cannot be provided or counted, they are now not being allowed to count this as a session of therapy by the state of Georgia. Furthermore, the majority of these children are not able to continue their therapies at school over the summer and are getting penalized as not having enough therapies because of this.
  • Only physical, occupational, and speech therapies are being counted as counted therapies. This excludes other medically researched, peer reviewed proven therapies like Applied Behavioral Analysis (ABA) and music therapy that have greatly improved the quality of life and health of these children.
  • Stamina and health issues of medically fragile children: Some children are too immune compromised to attend a therapy center and/or miss therapy frequently due to hospitalizations, illnesses, medical procedures/appointments.
  • Many parents do not have the means to safely transport their medically complicated or child with severe physical disabilities 5 sessions a week, and parents have had an extremely difficult time finding therapists to come to their homes. They will be DENIED Katie Beckett for this reason.

Please help us to send a clear message to our lawmakers in GA, that we must help these children who cannot help themselves. Without this waiver, more children will be placed in the care of the state of Georgia and be placed in institutions at a cost that can be six times the cost of caring for the child at home which Georgia taxpayers will be paying!

The state of Georgia will be forced to place many of these children in pediatric facilities like Children’s Healthcare of Atlanta for long-term care creating a bed shortage, and ANY sick child across the state of Georgia will suffer due to a lack of treatment space. This policy will cost the state of Georgia more in the long run than any savings it may gain in the short term!

Please sign this petition and let us remind our Governor, Representatives, and those who oversee the Katie Beckett Medicaid Deeming Waiver that this vulnerable population of children matter. We must be the voice of these children who are unable to speak for themselves.

LETTER TO
Governor of Georgia Governor Nathan Deal (Governor of Georgia)
Chair Health & Human Services – Georgia House of Representatives Representative Sharon Cooper
Georgia House of Representatives Speaker Representative David Ralston
and 15 others
Leutenant Governor of Georgia Leutenant Governor Casey Cagle
Chair Senate Health and Human Services Committee Senator Renee Unterman
Department of Community Health – Office of Communications & Legislative Affairs Janice Abrams
Department of Community Health – Office of Communications & Legislative Affairs Jeremy Arieh
Department of Community Health – Director, Office of Communications and Legislative Affairs Lisa Marie Shekell
Department of Community Health – Constituent Services Constituent Services
CBS 46
WSBTV
Atlanta Business News – Atlanta Business Chronicle
AJC
Fox 5 News
11 Alive News
Newnan Times Herald
Georgia Advocacy Office
Children’s Healthcare of Atlanta CHOA Social Media

Please help Georgia’s children with disabilities and preserve the Katie Beckett Deeming Medicaid Waiver created by President Ronald Reagan! These children are in danger of losing the help they NEED and becoming wards of the state and institutionalized if they cannot receive the help their parents need to care for them at home. It is highly likely that Katie Beckett herself would not qualify for the waiver named after her if she were a child living in Georgia today. Currently GA families are facing an unreasonable tightening and reevaluation of the requirements for those children receiving the Katie Beckett Medicaid Deeming Waiver. Without this waiver, more children will be placed in the care of the state of Georgia and be placed in institutions at a cost that can be six times the cost of caring for the child at home which Georgia taxpayers will be paying! The state of Georgia will be forced to place many of these children in pediatric facilities like Children’s Healthcare of Atlanta for long-term care creating a bed shortage, and ANY sick child across the state of Georgia will suffer due to a lack of treatment space. This policy will cost the state of Georgia more in the long run than any savings it may gain in the short term! Please fix this problem started by President Reagan for the sake of these children and the taxpayers of Georgia.

Jonathan Anderson Joins Jeyaram & Associates

Jonathan AndersonPlease help us welcome Jonathan Anderson to our legal team!

Mr. Anderson is an associate attorney specializing in healthcare law. Prior to joining Jeyaram & Associates, Mr. Anderson worked as a legal intern on the Disability Integration Project for the Atlanta Legal Aid Society.

Mr. Anderson provided legal support to individuals with disabilities to help them remain in or move back the community rather than live in institutions. He also worked extensively with state Medicaid waivers including appealing the State’s decisions to terminate benefits of disabled individuals.

Mr. Anderson also served as an intern for the Health Law Partnership (HeLP) which serves clients whom meet certain income requirements and have a treatment relationship with Children’s Healthcare of Atlanta (CHOA). He conducted interviews, drafted briefs for Supplemental Security Insurance, and researched how changes in Supplemental Security Insurance regulations affected HeLP clients.

Legal Expertise

  • Medicaid Waivers
  • Medicare
  • Mediation

Jonathan can be reached at janderson@jeylaw.com.