Texas Health Care Law Blog

Appealing a Medicare or Medicaid revocation

Medicare and Medicaid are critically important to many medical providers in Texas. Being denied the ability to bill for these patients would mean a substantial loss of income to many clinics, possibly forcing them to close. Unfortunately, the revocation of Medicare and Medicaid contracts is if anything becoming more common.

If this happens to your facility, there is a process of appealing the decision. It may be possible to have it reversed or, in some cases, even move to a corrective action settlement. Time is of the essence, however, and expertise in the somewhat arcane process is critical for success.

Medical marijuana arrives in Texas, but under high regulation

The medical field is constantly improving; new discoveries, better practices and technological advances allow you to provide the best modern healthcare for your patients. Recently, the health industry has explored the chemical THC, found in cannabis, as a possible treatment for some illnesses.

In fact, Texas has begun to dispense the first doses of medical marijuana to some epileptic patients. This event follows a long and difficult debate between its potential health benefits and the danger for substance abuse. Texas legislators, therefore, have taken a cautious approach within the Compassionate Use Act.

Do not use a family member as an interpreter

In a pinch, it can be very tempting to grab the nearest family member to help interpret for a patient. You can tell yourself "it is ok to do it this once" or "the patient's child speaks English" but in reality, this is a practice that should be avoided at all costs. Just because someone is bilingual does not mean he or she is qualified to be an interpreter.

Benefits of using a trained medical interpreter

The Stark Law: a basic overview of a complex statute

For a physician, navigating regulation and compliance is vital to operating a successful practice. By adhering to the correct legal guidelines, you can alleviate much of the anxiety and risk that comes with a failure to comply. Certain laws and regulations--such as the Stark Law--carry strict penalties as they deal with Medicare and Medicaid. A better understanding of laws like these can go a long way to running a legally sound practice.

For its part, the Stark Law is a statute aimed at preventing kickbacks through the use of federal health care programs. Essentially, it dictates that a physician cannot refer Medicare or Medicaid patients for "designated health services" to entities--or immediate family members--with which they have financial ties. While the Stark Law is complicated and riddled with exceptions, there are a few basic elements to be grasped at the outset.

Provider Implications of the Texas Telemedicine Policy

All over the United States, the telemedicine sector of healthcare has grown into an important component of medical treatment. It offers choice, convenience and access to consumers while paring down overhead and easing staffing stress.

Now that Texas is a telemedicine state, Texas can benefit from what many states have already sanctioned. The new Texas regulation allows physicians to treat patients they have not previously evaluated in person via telemedicine. It gives patients greater access to medical care, including mental health, with some notable restrictions.

When your entire career is at stake

Nothing sends a chill up a professional's spine like realizing you are under investigation. You have not received the letter yet informing you of this, but you suspect a complaint has been filed against you.

What happens next is extremely important. You can be passive and wait to be informed, or you can be proactive and contact an experienced professional license defense attorney immediately. You can minimize the harm an investigation can do to your ability to practice, or you can mount a vigorous and effective defense.

What to expect from a Medicaid or Medicare fraud investigation

Even honest billing mistakes can lead to devastating effects for a health care provider. Take overbilling for example. Health care providers occasionally receive overpayment for Medicare or Medicaid. These issues can easily be resolved with a refund. Unfortunately, if the issue is not fixed quickly then the provider can face serious consequences.

If you do not catch and resolve billing issues then the government may subject you to a Medicaid or Medicare fraud investigation. An investigation can negatively impact your business, your license and your reputation. The government may even seek to press fraud charges. Medical professionals aware of billing errors or fraudulent activity should contact an attorney specialized in health law immediately.

How to address Medicare overpayment claims

Doctors are extremely busy. In addition to caring for their patients, regulations force healthcare providers to fill out seemingly endless paperwork. Medicare Parts A and B healthcare providers face the additional burden of ensuring, at risk of punishment, that all of their received Medicare payments are correct.

In some cases, healthcare providers receive more money from Medicare than they are legally entitled to, known as an overpayment. The overpayment may be the fault of the provider due to a number of factors including: over-billing services, duplicating Medicare submissions or writing down incorrect codes. In other cases, Medicare is responsible for accidentally overpaying a healthcare facility. What should the healthcare facility do if it receives an overpayment?

Difficult patient issues perplex every provider

Providers report an increased number of problems with challenging patients.

These are the patients, or their family members, who become angry, raise their voices and make up their minds early in the interaction that you are not competent, or you are disrespecting them, or you are only after their money.

How can improper Medicare claims affect your practice?

The health care industry comes with stacks of government paperwork necessary for regulatory compliance. You can easily feel like you are drowning in forms, and rush to complete them. Unfortunately, hurrying through government forms, such as those required for Medicaid and Medicare claims, can lead to serious errors and consequences.

Common errors include: filling in the wrong procedural codes, listing the wrong medications or including equipment that was not used on a patient. Are you aware that even innocent mistakes can lead to serious Medicare and Medicaid fraud, or even criminal charges?

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