New Compliance Resources, July 2017

Alice G. Gosfield and Associates, P.C.

To Our Readers:

Compliance program effectiveness has been highlighted by the OIG and HCCA in a recently published Resource Guide to measuring compliance plan effectiveness. It is, however, 54 pages long and contains more than 400 recommendations. While no one is expected to use all of them, we found that unwieldy for our constituency. We have created a new 10 page document which draws on the Guide and speaks to the issues relevant to physician practices and smaller entrepreneurial businesses. In addition, the implications of the Guide have led us to revise our Medical Practice Fraud and Abuse Compliance Plan Development and Maintenance Protocol. We have created our measurement document both as a stand alone piece and as part of the revised Protocol.

ANYONE WHO BOUGHT THE PROTOCOL IN 2016 OR AFTER MAY REQUEST THE REVISED ONE OR THE MEASUREMENT DOCUMENT FOR FREE. To review our updated Protocol, the new document, and our HIPAA Compliance Plan Development Protocol, click here.  We offer discounts to our clients, as well as to those who buy both protocols.

We hope you find these materials useful.

Alice G. Gosfield
agosfield@gosfield.com
Daniel F. Shay
dshay@gosfield.com

 

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Gosfield & Associates
2309 Delancey Pl, Philadelphia, PA, United States
Philadelphia, PA 19103


AGG Update and More, January 2017

Alice G. Gosfield and Associates, P.C.

To Our Readers,

The new year finds us with much to address. While the change in administration creates some uncertainty about what will happen with the Affordable Care Act, the regulators have been undaunted. In our most recent update to our website, we have posted 7 new publications. Several deal with voluntary repayments which we think are among the most important regulations in years for physician practices. Dan has a new article on patient portals and the important legal issues they raise. Alice has a new one on leasing the practice to the hospital, and another addressing the modern managed care contract, which providers still need to understand without blindly signing, especially in the new context of value demands.

We have 5 new Latest Issues addressing the issues in the publications and more, along with a new AGG Note which explains the new safe harbor for local transportation, including shuttle services, as well as exceptions from the civil money penalty laws for certain beneficiary inducements. While the rules permit more transactions than they have before, the nuance and detail in the regulatory commentary are significant. Dan has a new DFS List addressing issues in the modern employment agreement from both the employer's and employee's perspective. While most of our resources are free, we continue to offer for sale our Compliance Plan Development Protocols – one for fraud and abuse and the other for HIPAA.

Even with all the consolidation in the industry, we continue to focus on physician practices, regardless of their architecture (small, large, independent, system-based) as well as those who seek to do business with physicians. We think physicians are the lynchpins to most of what happens in health care. We believe the actual practice of medicine is a noble calling and not just a business, although it cannot succeed without careful attention to business. We are in a service business ourselves; and we take pleasure and pride in helping our clients achieve their goals, quickly and at a fair price.

We look forward to working with more of you in 2017 on these complex developments; and we wish all our readers a successful 2017!


Alice G. Gosfield
agosfield@gosfield.com
Daniel F. Shay
dshay@gosfield.com
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Philadelphia, PA 19103

HIPAA Resources, November 2016

Alice G. Gosfield and Associates, P.C.

To Our Readers,

As we stated in late October, the Department of Health and Human Services Office of Civil Rights (or "OCR" -- the government entity responsible for enforcing HIPAA) is now conducting audits of physician practices and their business associates to determine whether they are in compliance with HIPAA. These audits focus especially on the HIPAA Security Rule, which the OCR has determined is an area with which physician practices have been especially lax in their compliance efforts.

We think the emphasis on the Security Rule merits significant attention and we have marshalled multiple resources to address the challenge. As you know, our firm has published a 63-page HIPAA Compliance Plan Development Protocol, available here for $250 when purchased individually, or for $450 when purchased alongside our firm's Fraud and Abuse Compliance Plan Development Protocol. Each protocol is available to our clients for at a discounted rate of $175, or $300 when purchased together.

On December 6th, we will be hosting a thirty-minute teleconference focusing on SRAs and HIPAA Audits. This teleconference, presented by Dan Shay, our resident HIPAA expert, will discuss the current HIPAA enforcement environment, provide background and detail on the ongoing HIPAA audits, and will discuss how an SRA represents the keystone in a physician practice's HIPAA compliance efforts.

We are also announcing the publication of our "DFS Lists," periodic "checklists" written by Dan Shay, that will address a variety of compliance and regulatory issues faced by physician practices. The first of these is "When Was Your Last SRA?" You may subscribe to the list here. If you intend to join us for the December teleconference, consider subscribing and reviewing the "DFS List" before listening in.

Compliance with HIPAA may seem daunting and confusing, but we are here to help.

Alice G. Gosfield
agosfield@gosfield.com
Daniel F. Shay
dshay@gosfield.com

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Philadelphia, PA 19103


HIPPA Compliance Plan Development Protocol, October 2016

Alice G. Gosfield and Associates, P.C.

The need for a vibrant, updated, functional compliance plan in any medical practice is greater than ever. Given the many enormous false claims settlements, the first Stark settlement over internal compensation formulas and the voluntary repayment regulations, the context for compliance plans is decidedly different from fifteen years ago when we first offered our Physician and Medical Practice Fraud and Abuse Compliance Plan Development Protocol. Our document has now been completely revised. It is designed to help physician practices develop, update and maintain a meaningful compliance plan, specific to their circumstances. For practices that already have a compliance plan, as you can see from the Table of Contents attached, this 46 page document addresses much more than billing and documentation issues. Most compliance plans need to be tweaked and updated to reflect the breadth of the voluntary repayment rules, the new enrollment environment, and the potential for quality-based and reporting-based fraud and more. This document can give you some ideas. It also has an Exhibit with links to 10 compliance relevant websites, 2 books, 52 articles and 6 teleconferences.

We help our clients craft their own compliance plan. We review compliance plans and make suggestions regarding improvements and updating. We help clients assess whether their plan is working, using attorney-client privilege. We do not believe in or make available a canned template for a plan. We think they are more dangerous than helpful. But any medical practice without a compliance plan is simply being foolhardy in this day and age.

Our Protocol is for sale for $250 prepaid by credit card to non-clients. Click Here  To our clients, we offer a discounted rate of $175. If you are a client, please call 215-735-2384 to confirm your status as a client and to give us your credit card number.

Alice G. Gosfield
agosfield@gosfield.com
Daniel F. Shay
dshay@gosfield.com
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Philadelphia, PA 19103

New AGG Note and More, July 2016

Alice G. Gosfield and Associates, P.C.


To Our Readers,

Since our last update in January, the long awaited voluntary repayment rule was published. It is a showstopper! Every compliance plan needs to be updated to take those rules into account. At publications we have two new articles on the subject. We offered a teleconference on point which can be purchased as a recording with the handout. In addition, the implications of those rules are so significant that we completely revamped and revised our Fraud and Abuse Compliance Plan Development Protocol which is available for sale atwhere you can review the table of contents of this very practical guide to developing and managing a compliance plan.

We also have a new AGG Note addressing Stark liberalizations – an unexpected development which was published with the last Fee Schedule, but requires no immediate action. Still the changes offer some greater flexibility in applying the regulations which govern the single worst piece of legislation among the many we confront regularly.

We, like our clients, are preparing for MIPS – the new Medicare payment model for which final regulations will undoubtedly be published with the Fee Schedule in November, 2016. We expect there will be significant challenges presented there if CMS’ approach to all the other new forms of payment are any indication. We also think there is much work physicians can do among themselves in terms of clinically integrating better in their own practices to enhance their chances of success going forward. We enjoy helping our clients engage on all these issues. Finally, with the ‘new’ website, we are archiving these notes To Our Readers, to provide some ongoing context for our updates.

We hope you will visit the website at www.gosfield.com and romp around. There is a lot of free information there.

As always, if you have comments or questions, don’t hesitate to get in touch.

Alice G. Gosfield
agosfield@gosfield.com
Daniel F. Shay
dshay@gosfield.com

 

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Philadelphia, PA 19103


New Year Greetings, January 2016

AGG
AGG

 

To Our Readers:

With our greetings of the new year, we'd also like to observe that reports of the demise of fee for service are premature. In fact, even with the death of the dreaded SGR, for good or bad, fee for service remains at the center of the near and foreseeable future. While CMS has said that in 2016 30% of Medicare payments will be value-based, and 50% two years later, all of their models are predicated on fee for service payment in the ordinary course, with reconciliations after the fact. That said, there are, indeed, changes afoot. We address some critical changes that should physician practices should understand now in two major articles: In "Beyond Face Time: The Evolution of Medicare Fee For Service in A Value Driven World", I address the history of fee for service, the traditional emphasis on face to face interactions and the introduction of codes which are not based on face to face encounters, such as care plan oversight, transitional care management, chronic care management and the evolving oncology care model. In "To Quality and Beyond: The Present and Future of Medicare's Quality Reporting Programs" Dan Shay addresses PQRS, Meaningful Use, the Value-Based Payment Modifier for physicians, and how they will form the foundation for MIPS – the Merit-Based Incentive Payment System that will replace the SGR. Both of us consider where false claims liabilities lurk in these developments. We both make the point that these are opportunities for additional monies, but there are also potential pitfalls in these new payment opportunities, They merit mastery now. We will be offering a teleconference on "Beyond Face Time" on February 2. Stay tuned for the announcement.

We suggest you read these articles which we are offering six months early, since they will be published in the 2016 HEATH LAW HANDBOOK in June. Let us know what else you would like to hear or read about.

Alice G. Gosfield and Daniel F. Shay

 

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