This past July, the Federal Communications Commission (“FCC”) released a ruling (the “Ruling”) interpreting the Telephone Consumer Protection Act (“TPCA”) restrictions on certain communications to wireless telephone numbers. The Ruling significantly restricts business’ ability to use auto-dialers and artificial / prerecorded voices for contacting wireless telephone numbers, including via text message (“automated contact system ”), prior to obtaining customer consent. Fortunately for the many health care providers who rely on this type of technology for important patient correspondence such as appointment reminders, the FCC has provided a significant exception for providers’ automated contact systems that meet certain criteria set forth in the Ruling. While the criteria are not overly burdensome, they are numerous and specific, so health care providers with automated contact systems should review them carefully to ensure ongoing compliance with the TPCA.
Following the Ruling, health care providers with automated contact systems must either obtain patient consent prior to using automated contact systems, or be sure that their automated contact system comply with the Ruling. Generally, to be exempt from obtaining prior express consent from patients calls to wireless numbers using automated contact systems:
- must not be charged to patient-recipients;
- must be for specific, health-related purposes;
- must include easy opt-out options; and
- are subject to volume and brevity restrictions.
The Ruling describes in greater detail the steps that health care providers must take to meet the above standards.
The FCC ruling is available here. Contact a member of the Benesch team if you have any questions about your automatic contact system after the FCC’s recent ruling.
Ohio’s transition to Medicaid managed care continues. The Ohio Department of Medicaid, the contracting agency with the 5 managed care companies now providing services to Ohio’s dual eligible population is [providing more information to Ohio providers during this transition period. Those dual eligible (eligible individuals for both Medicare and Medicaid) are being transitioned into these managed care private sector insurance programs. Some providers have been experiencing technical difficulties in submitting claims under the new managed care systems and providers are frustrated with slow payments. An updated released by the Ohio Department of Medicaid provides some statistics by region on the number of submitted claims and percentages of paid claims within 30 days of submission. The information provides a link to the Provider Payment Technical Assistance program to work with providers on a case-by-case basis to assist in resolution of issues and to resolve payment concerns. The Ohio Department of Medicaid issuance that includes the Provider Payment Technical Assistance link can be found at http://healthtransformation.ohio.gov/LinkClick.aspx?fileticket=V9a0WTwYchs%3d&tabid=105
Posted in Adult Home, Ambulance, Ambulatory Surgery Centers, Assisted Living, Clinical Laboratory, Clinics, Diagnostic Testing, Durable Medical Equipment, Group Home, Health Care Providers, Home Health, Hospice, Hospital, Intermediate Care Facility, Long Term Care Hospital, Medicaid, Nursing Facility, Nursing Home, Occupational Therapy, Ohio, Participation, Pharmacy, Physicial Therapy, Physician Assistants, Physicians, Residential Care, Skilled Nursing Facility, States
The Office of the Inspector General (“OIG”) issued a 2014-2018 strategic plan including outlining the visions, goals, and priorities of that office for the upcoming several years. The plan sets forth four goals: 1. Fight fraud, waste and abuse; 2. Promote quality, safety, and value; 3. Secure the future; and 4. Advance excellence and innovation. Each goals is identified with several priority areas that support the stated goal. The report can be found at the OIG’s website http://go.us.gov/WdbV
Posted in Acute Care, Ambulance, Ambulatory Surgery Centers, Anti-Kickback, Assisted Living, Clinical Laboratory, Clinics, Community Based Care, Compliance Programs, Continuing Care, Diagnostic Testing, Disability, Durable Medical Equipment, Fraud and Abuse, General, Health Care, Health Care Providers, Health Care Workers, Health Information Privacy, HIPAA, Home Health, Hospice, Hospital, Intermediate Care Facility, Long Term Care, Long Term Care Hospital, Medicaid, Medicare, Mental Health, Nursing Home, Occupational Therapy, OIG, OIG Reports, OIG Work Plans, Out-Patient Care, Palliative Care, Pharmacy, Physicial Therapy, Physician Assistants, Physicians, Post Acute Care, Primary Care, Regulatory Compliance, Rehabilitation, Rehabilitation Hospital, Residential Care, Senior Housing, Skilled Nursing Facility, Supplier, Transportation
Compliance program fatigue is nothing new. Over at least the last 15 years, health care organizations have jumped in head first, put together detailed manuals and taken the plunge. However, reimbursement cuts, quality initiatives, RACs, ZPICs, whistleblowers, physical plant renovations and simply significant industry challenges got in the way of sustaining an efficient and effective compliance effort. Health care organizations have also become desensitized to the barrage of compliance education, enforcement press releases, audits and reviews and other shock-value communications on the importance of regulatory compliance. In that vein, this very article may get lost in the shuffle, although, we hope it doesn’t.
An efficient and effective compliance effort with your organization is extremely important, if only as an insurance policy against government scrutiny. Additionally, the Patient Protection and Affordable Care Act of 2010, H.R. 3590 (“ACA”) includes requirements that CMS implement mandatory compliance program requirements for all providers and suppliers. In a distinct section of ACA, nursing home mandatory compliance programs were given a specific implementation timeline. Continue reading
Posted in Acute Care, Adult Home, Ambulatory Surgery Centers, Assisted Living, Clinical Laboratory, Clinics, Community Based Care, Compliance Programs, Continuing Care, Diagnostic Testing, Disability, Durable Medical Equipment, Fraud and Abuse, Group Home, Health Care, Health Care Providers, Health Information Privacy, Health Reform, Home Health, Hospice, Hospital, Intermediate Care Facility, Long Term Care, Long Term Care Hospital, Medicare, Mental Health, Nursing Facility, Nursing Home, Occupational Therapy, Out-Patient Care, Palliative Care, Pharmacy, Physicial Therapy, Physician Assistants, Physicians, Post Acute Care, Primary Care, Program Integrity, Regulatory Compliance, Rehabilitation, Rehabilitation Hospital, Residential Care, Senior Housing, Skilled Nursing Facility, Supplier
On June 4, 2012, the US Department of Health and Human Services Office of the Inspector General’s (“OIG”) Office of Audit Services issued a report (A-01-10-00508) entitled “Medicare Continues To Pay Twice for Nonphysician Outpatient Services Provided Shortly Before or During an Inpatient Stay”.
The OIG conducted an audit of hospitals and hospital out-patient providers during 2008 and 2009 and determined that Medicare made approximately $6.4 million in overpayments to hospital outpatient providers. The overpayments were made for services provided to beneficiaries within 3 days prior to the date of admission, on the date of admission, or during an inpatient prospective payment system (IPPS) stay. The OIG found that overpayments occurred because: (1) provider controls failed to prevent or detect incorrect billing, (2) providers were unaware that beneficiaries were in-patients at other facilities, and (3) providers were unaware of or did not understand Medicare requirements. Continue reading
Posted in Acute Care, Clinics, Fraud and Abuse, Health Care, Health Care Providers, Hospital, Medicare, OIG, Out-Patient Care, Physicians, Program Integrity, Regulatory Compliance, Reimbursement
On February 24, 2010, the Senate of the State of New York passed (S.3164/A.7729), The Family Health Care Decisions Act (the “FHCDA”). The New York Assembly passed the bill in January. This important piece of legislation allowing for surrogates to make health care decisions in certain circumstances has been in the works since 1993. NY Governor David A. Paterson applauded the passage of the FHCDA.
Consumers and health care providers have historically had to rely on a patchwork of common law decisions and the Health Care Proxy and Do-Not-Resuscitate laws to address personal health care decisions. New York common law (in a line of well know court decisions) provides that life-sustaining treatment cannot be withdrawn or withheld, unless clear and convincing evidence of the patient’s wishes can be produced. An advance directive could serve as that evidence but way too often patients have not completed one when they were competent.
The FHCDA now provides a framework for health care decisions to be made by surrogates. By doing so, it reduces the uncertainty and need for judicial determination in many situations in which current law did not provide a clear way for a health care decision to be made for an incompetent patient.
You can find a copy of (S.3164/A.7729), The Family Health Care Decisions Act at http://assembly.state.ny.us/leg/?default_fld=&bn=A07729%09%09&Summary=Y&Actions=Y&Votes=Y&Memo=Y&Text=Y
Posted in Acute Care, Advanced Directives, Clinics, Consumers, Continuing Care, Health Care Decisions, Home Health, Hospice, Hospital, New York, Nursing Home, Palliative Care, Physicians, Post Acute Care, Rehabilitation
Tagged Advanced Directives, Consumer, FHCDA, Health Care Decisions, Health Care Proxy, Home Health, Hospital, New York, Nursing Home, Patient, Physician, Surrogate Decisions