Billing & Reimbursement

Widespread testing for the novel Coronavirus is generally recognized as an important tool in combating the spread of the virus. The World Health Organization is an advocate for broad testing, so as to better locate incidents of infection for purposes of isolation, caring, and tracking.

However, the cumulative cost for such testing is significant. In a study commissioned by the … Continue Reading

Medical record requests by payors are commonplace for health care providers. Typically, these requests are received by a front desk employee who responds to the inquiry in short order.  Yet, not all requests should be treated the same.  When a request for documentation is propounded by the “Special Investigation Unit” (S.I.U.)  of an insurance company, special care should be exercised … Continue Reading

Fellow Fox Rothschild LLP attorneys Margaret J. Davino, Salvatore J. Russo and Nawa A. Lodin generously contributed this post.

On March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) broadened access to Medicare telehealth services to allow Medicare patients to receive more services from their doctors without travel to a health care facility.  This benefit is available … Continue Reading

The New Jersey Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Law”), New Jersey’s “surprise” medical billing law, went into effect on August 30, 2018.  Among other things, it requires licensed health care professionals in New Jersey (including, but not limited to, physicians, physician assistants and nurse practitioners) that bill health benefits plans issued or delivered in New … Continue Reading

On October 24, 2018, Congress enacted a new anti-kickback law that applies to many commercial health insurance plans, as well as Medicare and Medicaid.  The law, known as the “Eliminating Kickbacks in Recovery Act of 2018” (the “Law”), was passed as part of the SUPPORT for Patients and Communities Act, which generally targets the national opioid crisis.

PillsMoneyThe Law makes … Continue Reading

Close up of health insurance formThe New Jersey Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act takes effect today, August 30, 2018, and requires all licensed health care professionals in New Jersey (including physicians, nurse practitioners and physician assistants, among others) who bill health benefits plans issued or delivered in New Jersey to provide certain disclosures to patients enrolled in such Plans.

The … Continue Reading

CMS recently issued its proposed changes to the 2019 Medicare Physician Fee Schedule, which include a controversial change to the reimbursement rates for Level 2-5 evaluation and management (E/M) services and some notable changes to the Quality Payment Program.  This post highlights some key aspects of the Proposed Rule that will affect medical practices.

Red stethoscope with a pile of hundred dollar bills.CMS views the Rule as one … Continue Reading

This is the second installment in a new series on the Physician Law Blog entitled “Small Doses” designed to provide you with quick updates on meaningful issues.  We will continue to provide you with detailed updates on significant topics which we think are worth your time to read.  The purpose of “Small Doses” is to give you just enough information Continue Reading

The transportation landscape in America has evolved and these developments are now impacting health care. With about 75 percent of the U.S. population living in a county with access to an on-demand ride-hailing service, many patients are turning to ride-share services, like Uber and Lyft, as a means to obtain their medical care.

The idea of partnering ride-sharing and health … Continue Reading

Last month, CMS Administrator Seema Verma announced several initiatives to innovate the delivery of patient care at the ground level.  In collaboration with the Trump Administration and other federal agencies, CMS is taking steps to implement a system in which patients have control of their electronic health information and can easily transfer it between health care providers.  This system, referred … Continue Reading