Georgia's Trusted Healthcare
& Medical Provider Attorneys

The Most Important Lists You Need To Write Today  

Medication List Special Needs Trusts Jeyaram & AssociatesMost of us write lists – To Do Lists, Bucket Lists, Christmas Lists, Grocery Lists, Wish Lists, etc. But the most important lists we need to write are the ones that could be life-saving for our differently abled children.

Medications & Healthcare Providers Lists

Many of us are on auto pilot and can recite our child’s medication list and dosage by heart. However, if something were to happen to us, it’s important for someone else to be able to jump in and continue our child’s medications.

With many of our differently abled children, these medications are critical to their overall health – and in some cases – they could mean a matter of life or death. As a result, Medication Lists should include the name of the medications, dosage, frequency, purpose of the medication, how the medications are administered, where the medications are located (ex. fridge), and the name of the pharmacy for each medication.

Another list we need to make is a list of all of our child’s medical providers. The Medical Providers List should include our child’s primary care physician, specialists, pharmacists and therapists. At minimum, this list should include their names, locations and phone numbers. In addition, this list should include your child’s insurance ID number(s) and date of birth.

Add Special Notes

As part of our lists, I also recommend including the date last seen by each of the health care providers, as well as any other special notes or information. For example, we have a great relationship with one of our pharmacists, and she is well versed in our son’s medical history.

We’ve included a note in our Medical Provider List that she be contacted for anything related to our son’s medicines. Further, on our son’s Medication List, we’ve noted that we hide his nighttime medicine in applesauce.

You’ve Probably Already Created It

Many of us have already created these lists for things like Katie Beckett applications or IEPs. And while they take just a few minutes to create, these lists could ultimately be lifesaving if something happened to you and someone needed to immediately begin caring for your child.

Make Sure This Information Is Part Of Your Special Needs Estate Plan

Finally, I recommend that these lists be included in your special needs estate plan. Families often include these lists as part of their annual letter to their child’s guardian.

It’s important for everyone to know who to contact and how to continue your child’s medications in case of an emergency. So while we’re busy making all our lists, you can now add one more item to your To-Do List – your child’s Medication and Healthcare Providers List.

Contact Us

If you need help with your special needs estate plan, we’d love to help. We’ve helped hundreds of families create legal plans that give them a peace of mind should anything happen to them. DJ@JeyLaw.com 678.325.3872.

Avoid Being A Target Of HIPAA Audits | Here’s How

HIPAA AuditPhase 2 OCR HIPAA Audits Are Here – What Providers Should Do to Prepare

The Office of Civil Rights (OCR) has taken the first step in the next round of HIPAA audits.

OCR has begun to send out surveys in order to collect information from providers, health plans, and clearinghouses in preparation for phase 2 of their HIPAA audits. From the hundreds of entities receiving surveys, OCR will select over 200 providers and over 100 health plans to be audited.

It is more important than ever to make sure that you have complied with the HIPAA Rules. Here are the top 3 areas every provider should address:

1. When was the last time you conducted a Risk Assessment? If it has been more than a year or two, you should conduct a comprehensive Risk Assessment now.

If you are a small to medium sized office you can take advantage of HHS’s security risk assessment tool available on their website: HHS.gov SRA Tool

2. Have you recently reviewed your HIPAA policies and procedures to ensure that they are up to date and are being followed? There are three main areas that need to be addressed in your policies: Security Standards, Privacy Standards and Breach Notification Standards.

    • Security Standards – focus on how you keep Protected Health Information (PHI) secure, whether it is stored and/transmitted electronically or in some other form. Your practice must have appropriate safeguards in place (for example, requiring the use of secure passwords to access electronic health records and encrypting all devices that might contain e-PHI).
    • Privacy Standards – do you conduct periodic trainings for personnel regarding privacy practices? Do you have records that such trainings have been completed by all personnel? Is your Notice of Privacy Practices current and made available to your patients?
    • Breach Notification Standards – do you have a policy in place that outlines the steps for identifying and reporting a breach? Such a policy should address steps to take to investigate and contain the problem, as well as a means for identifying how many people were affected, who those individuals are, and how to send out breach notices. Keep in mind that under the Breach Notification Rule, providers must provide notice of a breach within a certain time frame. Your procedures for responding to a breach should allow for adequate time to meet this deadline.

3. Keeping track of your Business Associates and Business Associate Agreements – During the audit process OCR might ask for a list of business associates and their contact information. All providers should have this readily available. It is also important to have written Business Associate Agreements that are up to date and can be made available to OCR upon request.

If you have any questions about any HIPAA requirements or the approaching OCR audits our attorneys can help. Please contact Danielle Hildebrand at dhildebrand@jeylaw.com.

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The information on this site should not be construed as formal legal advice and is not intended to create or constitute a lawyer-client relationship.

 

Physicians’ Medicare Payments No Longer Tied To Economy

SRGAfter almost 20 years, Congress finally passed a law repealing the Sustainable Growth Rate (SGR ). Under SRG, Medicare payments to physicians were tied to the growth rate in the economy. Because of the sluggish economy during and after the Great Recession, the growth rate formula has resulted in either a reduction or inadequate increase in Medicare reimbursement rates. As a result, Congress recently passed last minute, short-term fixes to ensure that physicians receive the appropriate fees.

With the passage of the new law, physicians will finally see stabilization in Medicare payments. The statute provides for a 0.5% increase for the next five years. Then the government will transition to a new system in which payments will be based on quality, value and accountability – the Merit-based Incentive Payment System.

The repeal of SGR is good news for physicians treating Medicare patients. Because Medicare reimbursement rates have been so unpredictable for the last decade, physician practices  have had little opportunity to arrange for innovative care models. With the new law, physicians have the chance to come up with groundbreaking care delivery models while developing patient care protocols focused on quality and gearing up for the next phase in Medicare reimbursement.

If you are a physician with questions about Medicare reimbursement or enrollment, or need healthcare regulatory advice, please contact DJ Jeyaram at DJ@jeylaw.com or Danielle Hildebrand at Dhildebrand@jeylaw.com.

What To Do If You Receive A Medicaid Fraud Subpoena In Georgia

medicaid fraudThe Georgia Medicaid Fraud Control Unit (MFCU) investigates and prosecutes fraud and abuse by providers in the Georgia Medicaid program.  One of the first steps MFCU takes when it opens up a case against a provider is often the issuance of an investigative subpoena, requesting specific patient records.

Often the provider has already been looked at by the Georgia Department of Community Health’s Medicaid Program Integrity Unit which handles intake and triage of cases before turning them over to MFCU. In other words, the provider has somehow managed to get on the State’s radar, and it is serious.

Please keep the following in mind if you receive a Medicaid Fraud subpoena:

1. CALL AN EXPERIENCED HEALTHCARE FRAUD ATTORNEY. This is a highly specialized area of the law, and you need someone to represent you that has experience both in defending criminal matters AND in healthcare law. This area of law is like a hybrid car. Just like it takes gas and electric batteries to power a hybrid car, it takes knowledge of criminal and healthcare law to successfully represent a provider facing a Medicaid fraud investigation.

2. Call an attorney BEFORE you respond to the subpoena or talk to an investigator.

3. Remember: the Investigator is NOT your friend. They are doing a job, and their job is find evidence against you. We recently represented a client who was complying with a subpoena from MFCU. Five investigators showed up to get the documents. Since there was no threat of an armed suspect, one can only guess that the use of five investigators to collect documents had to be an intimidation tactic. Likewise, these investigators tried desperately to butter up the employees to get them to talk, and this was with an attorney standing there. Remember: the investigator is NOT your friend.

4. Be Polite and cooperative. If your attorney determines that the subpoena is lawful and enforceable, you have to turn over the documents requested. This can be quite labor- intensive, but you must comply and polite cooperation can only help you in establishing the tone for whatever next steps will be taken.

5. Make copies of every document and electronic file you turnover to MFCU PRIOR to turning them over.

6. DO NOT provide MFCU with anything more than what they have requested in the subpoena- not one document more. And remember, they are only entitled to the records of Medicaid members.

7. Neither you nor your employees are required to speak with the investigator unless individually subpoenaed. Have an attorney present during any interviews.

8. Don’t panic. While a MFCU subpoena should be taken seriously, in Georgia, in 2014, there were 410 Medicaid Fraud Investigations. Of those investigations, only 4 led to indictment.1 The math indicates that MFCU investigates often but indicts with much less frequency.

If you are receive a subpoena from the Georgia Medicaid Fraud Unit, Jeyaram & Associates can help. Contact Kimberly Sheridan at ksheridan@Jeylaw.com or 678.325.3872.

Healthcare Providers Need To Examine Billing Practices To Ensure Compliance

healthcare fraudLast month, the Department of Health and Human Services released its annual report for the Health Care Fraud and Abuse Control Program. According to the report, in 2014 more than 900 new criminal health care fraud investigations were opened by the Department of Justice. There was a slight increase in the number of criminal cases and convictions from last year, with 496 cases and 735 defendants convicted of criminal health care fraud. Civil cases alone resulted in $2.3 Billion in settlements and judgments.

The government’s press release reiterated that detecting and eliminating fraud and abuse continues to be a top priority. The government attributes its high recoveries to a change in strategy which uses real-time data analysis to detect fraud more quickly. The Centers for Medicare and Medicaid currently uses advanced analytics on Medicare fee-for-service claims. The goal of this is to detect aberrant and suspicious billing patterns which would then trigger an investigation or enforcement action by the government.

Now is the time to for Medicare and Medicaid providers to review their billing practices and financial relationships to ensure that they are compliant with federal laws. Charges against providers were made under the False Claims Act, as well as Anti-Kickback Statute, the Stark Law (Physician Self-Referral Law), and other federal laws.

The full annual report is available at www.oig.hhs.gov/publications/hcfac.asp.

If you have any questions about the legality of your billing practices or financial relationships, please contact DJ Jeyaram at DJ@jeylaw.com or Danielle Hildebrand at dhildebrand@jeylaw.com.

 

DJ Jeyaram Earns Georgia’s Top Lawyers’ Award – Healthcare & Administrative Law

Healthcare Law AwardPrincipal DJ Jeyaram has achieved the prestigious 2014 peer-reviewed rating of AV Preeminent® by Martindale-Hubbell®. According to Martindale-Hubbell, “The AV Preeminent® Rating is a significant accomplishment and demonstrates that a lawyer’s peers have ranked them at the highest level of professional excellence.” Martindale-Hubbell is the company that has long set the standard for lawyer ratings. DJ earned the award for superior legal service in healthcare and administrative law.

Congratulations DJ Jeyaram!

Are YOU Compliant With New HIPAA Rules?

imgres-6It has been half a year since the new HIPAA Rules were fully implemented, are you compliant?

If you are a healthcare provider or work with healthcare providers you should already know that last year the Department of Health and Human Services published the HIPAA Omnibus Rule expanding the reach of HIPAA enforcement and bolstering notification requirements. Under the rule, business associates must comply with most of the requirements that previously only applied to covered entities.

Furthermore, HHS can now impose penalties directly on business associates, which range from $100 to $50,000 per violation.

Covered entities also have new requirements that they must follow. For example, such entities must provide notifications to the affected individuals and to HHS when a breach has occurred. If a large group of individuals are affected the entities must also notify the media. Furthermore, the definition of a breach is more expansive—an impermissible use or disclosure of protected health information (PHI) is presumed to be a “breach,” unless the HIPAA-covered entity demonstrates there is a low probability that the PHI has been compromised.

Entities that deal with protected health information in the form of electronic health records should also be aware that such entities have become an attractive target for hackers. The information in a medical record is extremely valuable on the black market making protected health information of patients susceptible to theft.

Given the new obligations and penalties under the Omnibus Rule and the increasing vulnerability of protected health information it is more important than ever to ensure that the proper measures are in place to prevent breaches. HIPAA-covered entities and business associates need to consider whether they are in a position to protect against and appropriately respond to breaches through periodic risk assessments and implementation of HIPAA-compliant policies and procedures.

Some threshold questions that your entity will want to ask include:

• Do you have a current written HIPAA policy that reflects the practices of the organization?

• Does your HIPAA policy address what is to be done in the event of a breach?

• Does your policy provide a proper means of assessing whether a breach has occurred?

You can view the Omnibus Rule, including the changes to the Privacy Rule, Security Rule and Breach Notification Rule here: HHS.gov – HIPAA Omnibus Rule

DCH and GaHIN Launch GeorgiaDirect to Automate Healthcare Referrals

GeorgiaDirectThis week,  the Health Information Technology Division (Health IT) of the Georgia Department of Community Health and the Georgia Health Information Network Inc. (GaHIN) launched GeorgiDirect, a free, secure e-mail, and easy-to use messaging service to automate health care referrals between patients, physicians, hospitals, laboratories and other authorized healthcare stakeholders.

The goal of GeorgiaDirect is to “better serve patients and increase efficiencies in health care across Georgia,” said former DCH Commission David A. Cook. Cook also stated, “This network – which should not be confused with a health insurance exchange – will literally transform health care in the years to come, delivering on our goal of a healthy Georgia through greater coordination of care, delivering better health outcomes, increasing administrative efficiencies and more. Additionally, privacy of health information is paramount to the department, and GeorgiaDirect is much more secure for the transmission of information than current methods.”

The more than 2,100 healthcare providers across Georgia who have registered for the free service are able transmit patient health information between authorized providers for a more efficient and secure exchange of patient data versus the current system of faxes, mail, couriers and telephones.

According to a press release by DCH, “GeorgiaDirect was developed using national standards from the Office of the National Coordinator for Health Information Technology’s Direct Project.” GeorgiaDirect also enables healthcare providers to connect with other states, including Alabama, Florida, Hawaii, Mississippi and Wisconsin. The goal is for GeorgiaDirect to expand and include more states so providers can obtain medical records when patients move to another part the country.

To learn more about GeorgiaDirect, you can watch this video or visit the GeorgiaDirect Web site.

 

 

Office of Inspector General’s Advisory Could Affect Payment to All Healthcare Providers

OFFICE OF INSPECTOR GENERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES SEALOn May 8, 2013, the Office of Inspector General (“OIG”) issued an Advisory Bulletin pertaining to exclusion and excluded healthcare providers.  Because exclusion could potentially affect every provider, it is important to learn more details about the designation.

If the OIG excludes a provider, then no Federal health care program payments may be made for items or services furnished by the excluded provider or prescribed or directed by the excluded provider.  If the excluded provider changes from one health care profession to another, the exclusion will still be in effect.

In addition, the prohibition is not limited to direct patient care; it also includes services such as review of treatment plans, preparation of surgical trays, or services provided related to filling prescriptions.  Transportation services provided by excluded individuals are also prohibited.

Finally, according to the Bulletin, excluded individuals are prohibited from providing any administrative or management services, even if they are not separately billable.

There are severe consequences if an excluded individual submits a claim or causes a claim to be submitted to a Federal health care program.  A civil monetary penalty of $10,000 per claimed item or service may be imposed.  In addition, any potential for reinstatement to Federal health care programs may be jeopardized.  Criminal penalties may also be imposed.

Civil monetary penalties may be imposed against providers that employ or enter into contracts with excluded individuals to provide items or services payable by a Federal health care program.  Further, there may be civil monetary penalties for health maintenance organizations that contract with or employ excluded individuals.  This does not mean that entities cannot hire or contract with excluded individuals at all.

If the services or items provided are not paid for by a Federal health care program, then there isn’t a prohibition against hiring or contracting with an excluded individual.  If the excluded individual only provides services or items to patients that are not covered by a Federal health care program, then there is no prohibition.

All individuals and entities should search the OIG program exclusion information that is available on the OIG Web site prior to employing or contracting with any provider of health care services and keep documentation of the search. 

In addition, individuals and entities should proactively monitor the exclusions database to ensure that none of its current employees or contractors is listed as an excluded provider.  Due diligence will help mitigate the risk of civil monetary penalties in the future.

ICD-10 Deadline for Healthcare Providers Fast Approaching – Jeyaram & Associates Can Help

ICD DeadlineThe October 1, 2014 deadline to switch to the ICD-10 codes set is less than five months away. This mandatory requirement replaces the ICD-9 codes set used to report medical diagnoses and inpatient procedures.

All healthcare providers covered by the Health Insurance Portability Accountability Act (HIPAA) must adhere to this new requirement. Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.

All healthcare practices currently using the ICD-9 codes must transition to the new codes. The transition to the new codes set will take several months. If you have not started the transition, we strongly urge to begin now. 

ICD consists of two parts:

1. ICD-10-CM for diagnosis coding
2. ICD-10-PCS for inpatient procedure coding 

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10­ PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

The Centers for Medicare and Medicaid Web site provides detailed check lists to help healthcare providers make the transition. However, if you have questions or need help with the transition to the ICD-10 codes set, Jeyaram & Associates can help. Contact DJ Jeyaram at DJ@Jeylaw.com or 678-708-4705.