Since 2022, Kentucky's assisted living community regulations have undergone significant updates. The recent updates to Kentucky’s assisted living community laws and regulations enhance resident safety and improve the communities that support them. Although Senate Bill (SB) 11 passed in 2022, as is often the case with complex regulatory frameworks, the applicable regulations were promulgated and enacted well into the end of 2023.

Traditionally, the Office of the Inspector General for the U.S. Department of Health and Human Services (“OIG”) would take a hard stance on any arrangements that might involve some form of remuneration from a hospital to a referring physician, but the winds of change may be blowing. In Advisory Opinion 22-20, published in December of 2022, the OIG has given a green light, albeit in a limited context, to an arrangement in which a hospital may have its employee nurse practitioners perform some services traditionally performed by the patients’ primary care physicians. This is a small step in the direction of a more flexible OIG stance on the federal Anti-Kickback Statute (“AKS”), but it doesn’t completely sidestep risks.

It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake. The estimated overpayment as a result of these coding errors is a reported $1 billion. Because the payment error rate was so high at a colossal 31%, Medicare-Severity Diagnosis Related Group ("MS-DRG") applicable entities must take note and prepare for a marked increase in Department of Health and Human Services Office of Inspector General ("OIG") audits for these coding practices. The Centers for Medicare & Medicaid Services ("CMS") also plans to implement review practices for malnutrition coding on a sample of inpatient claims. The increased payer audits will result in severe financial damage for hospitals and other MS-DRG applicable entities if they do not mitigate coding and documentation risks.

In mid-February 2019, the Centers for Medicare and Medicaid Services (“CMS”), Innovation Center and the Department for Health and Human Services (“HHS”) announced a ground-breaking payment and medical services initiative for ambulance providers called “Emergency Triage, Treat and Transport” (the “ET3”). This new model is the first step in allowing providers of Emergency Medical Services to finally “take off the gloves” to fully utilize both their medical skills and unique patient knowledge to implement a more efficient and effective care model.

This article appeared in the December edition of MD-UPDATE, available at  http://www.md-update.com/wp-content/uploads/2018/12/MD-Update-Issue-118/#?page=8

Prevention and compliance best practices for healthcare providers are a hot topic, and this isn’t likely to change, maybe ever. As the opioid crisis continues to grow and healthcare providers come under increasing scrutiny, one tool is emerging as a resource for prescribing providers, and it’s probably not what you would expect: KASPER, Kentucky’s prescription reporting database. Below are three ways to get the most out of KASPER to keep your practice in compliance.

As medical advancements and patients in need of medical care continue to increase, the role of mid-level practitioners becomes even more crucial.  While there have been many turns of phrase for these medical professionals, the term “mid-level practitioner” is meant to encompass those non-physician providers, which include advanced practice nurses and physician assistants, among others. In Kentucky, there has been a shortage of primary care providers, which is particularly problematic in the state’s many rural areas.  This in turn has led to the push for more autonomy to these integral medical providers. While there are many reasons why this development is an improvement for patients and providers alike, this also leads to more liability exposure. 

In an evolving world of cyber terrorism where individuals such as Edward Snowden grab headlines by stealing national secrets, it should come as no surprise that protected healthcare information (“PHI”) kept by providers has become a “target rich environment” for foreign governments and individual hackers alike. In addition to threats from outside entities, healthcare providers must also realize and appreciate that state and federal regulatory and statutory requirements govern the creation, maintenance and protection of PHI, including through but not limited to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health (“HITECH”) Act.  Failure to abide by these complex and stringent rules can lead to significant penalties. 

By January 2015, Walmart will be operating dozen primary care clinics across the U.S. Six of these have already opened in South Carolina and Texas. Currently, some Walmart stores include acute care clinics that are operated through leases with local hospital operators. The new primary care clinics are distinct from the existing ones in several ways. The new clinics will be fully-owned by Walmart, offer a broader range of services, and be open seven days a week with longer operating hours. Walmart is partnering with QuadMed nationally to operate the clinics, rather than with local partners. The primary care clinics will be staffed primarily by nurse practitioners and medical assistants and will be supervised by a physician.

In January 2013, the Department of Health and Human Services (“HHS”) published its Final Rule, which significantly increased the privacy and security responsibilities for the “business associates” of “covered entities,” as those terms are defined by HIPAA. A provision within the Final Rule mandated that all covered entities and their business associates revise their business associate agreements to reflect the new responsibilities. Specifically, a business associate must now, among other things: