There are several federal and state laws governing the provision of health care in the US. Medical practices that are unaware of the legal implications of these laws are at a distinct disadvantage, because it limits their ability to fully comply with legal and ethical issues. In this regard, there are some important legal tips that every medical practice should be aware of, as it relates to matters such as entity formation, patient care, and compliance with Medicare and Medicaid (Medi-Cal for California).
Medical practitioners should ensure that proprietorships are in keeping with relevant statues and regulations. Health care providers desiring to form their own medical entity should be careful to comply with licensing and permit requirements, as well as other laws governing the formation of medical practices. In particular, they should scrutinize the specific laws that stipulate the permissible ownership and management structure. In some states like California, there are restrictions on the entities that certain categories of health care providers can operate.
Ensure Compliance with State and Federal Health Laws
The privacy and security of medical records are safeguarded by federal and state health care laws. The Health Information Portability and Accountability Act (HIPAA), is a federal law that recognizes the sensitivity of patient medical records. HIPAA has therefor instituted a number of checks and balances to prevent those records from being used improperly. HIPAA defines identifiable health information that can be transmitted as protected health information (PHI), which must be secured.
Medical practices and providers are obliged to comply with HIPAA, and therefore need to set up a compliance unit with staff that is fully aware of compliance related policies. The compliance unit will be able to prevent violations of law. California also has several state laws that medical practices must adhere to, relating to the protection and security of health information. Medical providers often need legal assistance to help negotiate the web of regulations that are out there.
Dealing with issues of non-payment by insurance companies
At some point in their existence medical practices are going to be confronted with the troublesome issue of nonpayment by insurance companies. They are therefore advised to be proactive and not sit back when independent practice associations (IPAs), fail to make good on payment. ‘Slow payment’ often results in ‘no-payment,’ therefore physicians ought to persistently follow-up the IPAs for payment, as soon as there is any delay. They should also seek legal assistance where necessary.
Avoiding Medicare Overpayment issues
Billing errors can lead to serious consequences for a medical practice, so it’s important to avoid Medicare overpayment issues. Physicians should therefore ensure that their billing system is accurate, and services are being billed correctly. It’s often advisable to seek the assistance of health care attorneys in this regard, as they are well placed to provide the necessary guidance and oversight.
In the event that an overpayment is made, the medical provider should promptly make a report as stipulated by the Affordable Care Act. Under the Affordable Care Act, physicians are required to report any payment violation within 60 days. Failure to do so can result in them being held liable under the False Claims Act.
Dealing with dual eligible patients
In California this relates to patients that have both Medi-Care and Medi-Cal. Patients that fall in this category may be eligible for Cal MediConnect. Cal MediConnect was implemented to streamline the provision of health care for dual eligible beneficiaries, and forms a part of the wider Coordinated Care Initiative (CCI).
Physicians need to understand the registration process, as well as the implications that will ensue for their medical practice, as a result of the Cal MediConnect program. In particular, they should have a good understanding of issues relating to enrollment and billing, as well as the how they will be impacted if patients opt out of MediConnect.
In California, the statutes and regulations regarding medical practices are varied, and very often health care providers are unaware of the legal nuances that can affect their practices. However, by retaining the services of an experienced healthcare attorney, they can gain a better understanding of the health care laws.