Pursuant to the HIPAA Final Omnibus Rule (“Final Rule”), covered entities and their business associates were required to enter into new business associate agreements (“BAAs”) or modify existing BAAs by Sept. 23, 2013. However, existing BAAs that (i) were entered into on or before Jan. 25, 2013; (ii) met the requirements that were applicable prior to the promulgation of the Final Rule; and (iii) were not modified after March 26, 2013, have until Sept. 23, 2014 to be updated. That deadline is quickly approaching.

The new enrollment and revalidation requirements for providers and suppliers for Medicare/Medicaid participation was previously  detailed on this blog. As promised as a follow-up, this blog post will describe enrollment best practices and tips for ensuring that enrollment or revalidation is properly accomplished. Not only is initial enrollment now more onerous, but revalidation is required for all physicians and other providers/suppliers who were enrolled before March 25, 2011, which generally means that all physicians and physician groups must complete the re-enrollment process. A failure to re-enroll means that CMS will de-activate payment until a successful re-enrollment process is completed. In some cases, CMS may even revoke participation. Thus, it is crucial that physicians, providers, and suppliers get it right the first time.

In 2011, the U.S. Centers for Medicare and Medicaid Services (“CMS”), as part of the reform instituted by the Affordable Care Act, required that home health agencies and hospice patients receive a face-to-face visit (at specified time periods) by a physician or nurse practitioner to ensure that they continue to meet Medicare and Medicaid eligibility criteria.

In 2013, the Department of Justice (“DOJ”) and Office of Inspector General (“OIG”) charged the nation’s largest for-profit hospice chain, Vitas Innovative Hospice Care (“Vitas”), with false Medicare billings, inappropriately admitting patients with “aggressive marketing tactics,” and misleading patients and families about Medicare hospice benefits. This suit is just one of many recently filed against hospice providers, indicating that they are being watched keenly by enforcement authorities and government agencies.

In Kentucky, most trade association-sponsored health plans renew on July 1, 2014. Now is an excellent time for trade association executives to review association and Health Plan materials to ensure compliance with applicable Federal and State requirements prior to renewal.

All too often, the Drug Enforcement Agency (“DEA”) asks a physician to surrender his or her DEA registration when the physician enters into a prescribing-related Agreed Order with the applicable state licensing authority. A DEA registration is important because, in order to write prescriptions for controlled substances or dispense controlled substances in-office, physicians must be registered with the DEA.

As promised, the Centers for Medicare and Medicaid Services released information about Medicare payment to physicians and certain health care professionals on April 9^th. The release is in conjunction with the policy change instituted by the U.S. Department of Health and Human Services, which allows CMS to respond on a case-by-case basis to Freedom of Information Act requests for Medicare payment information related to individual physicians (see more on the topic here).

The Federal Trade Commission (“FTC”) recently released a policy paper suggesting that state legislators should be cautious when evaluating legislative proposals to limit the scope of practice of Advance Practice Registered Nurses (“APRNs”). The FTC is concerned that by imposing more stringent physician supervision requirements, APRNS are effectively being restricted by another type of health care professional (the physician) thereby denying consumers the benefits of greater competition. This is especially troubling in light of the significant shortage of primary care practitioners in the U.S. By allowing APRNs to practice without heavier regulatory burdens, access to health care can be increased and possibly lead to “lower costs, better care, and more innovation,” according to the FTC.

On Tuesday, I shared information about the U.S. Health and Human Services (“HHS”) Office of Civil Rights’ (“OCR”) first settlement with a medical practice for alleged violations of the breach notification provisions of the Health Information Technology for Economic and Clinical Health (“HITECH”) Act. The $150,000 settlement was made with Adult & Pediatric Dermatology, P.C., (“the Practice”) after the entity reported a stolen jump drive that contained PHI of approximately 2,200 patients.

Earlier this week, we discussed the benefits of all-payer claims database (“APCD”) systems. Nine states currently have APCDs in place, but Kentucky is not one of them. These systems provide a multitude of information on the cost, use, and quality of health care in a given state, but the question remains: how do providers feel about APCDs?