2008200720062005

09-16-08 – Upcoming ProviderLAW / Self-Pay Seminar Series  – Starting October 8th, ProviderLAW will be hosting a round of 6-hour seminars throughout the country in the major U.S. cities. The seminars, held under the title, Self-Pay Seminars, will focus on major issues surrounding self-paying patients, patient discounts, cash payment plans, and of course, getting paid by insurance.... Full Text.

09-25-08 – OIG Clarifies New Form of Discount! – "Prompt Pay" Discounts  – Recently, the OIG (Office of Inspector General) issued an Advisory regarding "Prompt Pay" Discounts. As its name suggests, a "Prompt Pay" discount is designed to help providers encourage prompt payment and thereby avoid the costs of debt collection... Full Text.

09-24-08 – Free Online Resource Center For Getting You Paid!  – ProviderLAW Corporation and newly-formed Tipology.org have announced their intent to create a free Online Resource Center for providers and affiliates. The Resource Center, which will be located at www.tipology.org will focus on helping health care providers with reimbursement, practice growth, and compliance issues.... Full Text.

09-23-08 – Cool New Resource on Hardship Discounts!  – The Federal Government has long made it clear that providers can discount the patient-portion-due based on hardship principles. This Advisory takes a look at a powerful resource for providing such discounts..... Full Text.

05-24-07 – Note! If You Market Your Care Around Medical Equipment, Make Sure to Review the "Scooter Store" Case  – The United States Department of Justice had alleged that "[i]nstead of the 'zippy' power scooters that were advertised, The Scooter Store sold the beneficiaries expensive power wheelchairs that they did not want, need, and/or could not use...," and that "[m]any beneficiaries had no idea what kind of equipment they were getting, until it was delivered by the Scooter Store." ... Full Text.

05-18-07 – Chiropractic Scope in New Jersey  In light of recent cases and laws, NJ DCs are encouraged to get formal legal opinions. DCs elsewhere should take note. The issues surrounding scope of practice are significant. Not understanding the scope of practice can lead to recoupment, claims of malpractice, and worse. With scope of practice being questioned in so many states it seems, not just in New Jersey, DCs everywhere are well-advised to stay tuned to the most recent developments.... Full Text.

04-24-07 – Light Therapy & Low-Level Laser Therapy (Cold Laser):  How Do I Code For These Services and Are They Interchangeable? ... Full Text.

04-04-07 – Can CPT Code 97012 (Mechanical Traction) Be Used for the Flexion-Distraction Technique?  – The overwhelming majority of commentators agree that the Cox Flexion-Distraction technique constitutes a form of Chiropractic Manipulative Therapy... Full Text.

03-01-07 – Active Stretching – 97112 or 97110?  – "If I'm Performing Active Stretching One-on-One in the Treatment Room with a Patient, Can I Code the Service as CPT Code 97112 Neuromuscular Re-education?" ... Full Text.

01-31-07 – Nutritional Counseling: A Summary of the AMA's CPT Coding Guidelines and Instructions and ICD-9 Authorities  – When it comes to nutritional counseling, providers should consider guidelines for regarding coding and documentation.... Full Text.

10-10-06 – Decompression Therapy News –District Attorney obtains permanent injunction and fine against a doctor regarding his decompression therapy advertising. Court finds the advertising "misleading" and also "unfair and deceptive." Considering purchasing a table? Already purchased a device? Make sure to closely review your advertising materials.... Synopsis

10-09-06 – New Seminar Schduled for November: "Key Reimbursement Issues & Solutions in PA – Nov. 2006" This full-day seminar focuses exclusively on SOLUTIONS to key payment issues in Pennsylvania, based on Pennsylvania and Federal law. Topics covered will include CMT / Manual Therapy, Introduction to Pre-Paid Plan and Financial Discounts, "Across-the-Board" Delegated Services Denials, and more... Full Text.

10-09-06 – Martin Law Firm Issues Open Letter to PA Chiropractors.– The letter focuses on three reimbursement issues including: (1) "Across-the-Board" Delegation Denials / Recoupment, (2) CMT / Manual Therapy, and (3) the "12-Month" Recoupment Bill. The letter addresses the question – Is the insurance industry wrongly denying your claims and improperly recouping from you? The letter also introduces a series of reimbursement presentations which will be held in November... Open Letter. November Presentations.

10-04-06 – Special Brief – CMT and Manual Therapy 2 – This second brief, a follow-up to CMT and Manual Therapy I, investigates the issue – What is meant by the phrase "different session or patient encounter" under federal law? ... Full Text.

09-12-06 – Special Brief – CMT and Manual Therapy 1 – This latest brief examines the issues: Is it possible that some payers are misinterpreting the phrase, "same region?" Don't therapies which target "muscle groups" treat an entirely "different site or organ system" than CMT? ... Full Text.

06-23-06 – Pennsylvania DCs – ProviderLAW and DK Coding Announce Joint Initiative on Delegated Services and Carrier Denials. ProviderLAW and DK Coding announce their intent to launch a joint educational initiative regarding carriers that deny properly delegated services. Based on weeks of research, the initiative will shed tremendous light on YOUR RIGHTS when it comes to properly delegated services and carrier denials...  Announcement 1-Page Article Synopsis of 04-27-06 Research

05-12-06 – New Response Letter Posted – Attorneys Who Send Limited or Conditional "Letters of Protection." It appears that increasingly providers are either not receiving letters of protection from attorneys in accident cases, or are receiving... Full Text.

05-12-06 – Special Series – Am I Allowed to Collect My FULL Fees in Auto Accident Cases? Must I Collect My Full Fees? Based on requests from Texas subscribers, ProviderLAW has commenced a special series on an issue which affects providers in many states....  Part i – Brief Overview and Summary  Part 1  Part 2A  Part 2B  Part 2C  Part 3  Part 4  Part 5

05-05-06 – Our May and June Conferences Have Now Been Scheduled. Subscribers, our conferences for May and June have been scheduled.
 Conference Schedule Full Text.

05-04-06 – ProviderLAW Responds to Recent Article on Pre-Paid Plans. Recently, a chiropractic organization published an article encouraging the use of pre-payment plans.... Full Text.

05-04-06 – How to Request Provider Agreements and Copies of Plan Benefits From Health Insurance Payers. Periodically, subscribers have asked whether they are entitled to request copies of insurance documents from carriers. For example, as a provider, you may wish to request a copy of a recoupment provision... Full Text.

05-03-06 – The Latest on the Aetna-ASHN Front Aetna Notifies a Doctor of Its Intent to Terminate the Provider Agreement With Respect to ALL Aetna Products Due to His Decision Not to Join ASHN with Respect to a Few Products.... Full Text.

04-27-06 – Special Advisory – Delegation of Services: Can Carriers Refuse to Pay for Treatment Delegated to Support Personnel? A Look at Chiropractic in Pennsylvania as an Illustration.... Synopsis Full Text. 

03-16-06 – What Exactly is "Medical Necessity" According to One of the Major Health Insurance Carriers? Two Important Lessons for All Healthcare Providers in Extended Care Situations....  Full Text.

03-15-06 – Update on Medicare Therapy Caps. In February, the President signed the Deficit Reduction Act of 2005 (DRA) into law, providing exceptions to therapy caps for certain medically necessary services. Recently, the CMS posted a "fact sheet" describing the exceptions process...  Full Text.

03-15-06 – New Web Conference Scheduled for Apr. 13th: "Treatment Plans – What Elements Should Your Treatment Plan Include? How to Avoid Recoupment Requests." – This Session is Free for Subscribers Only. Recently, Medicare carriers across the country have begun requesting files from providers. Among other things, the carriers are reviewing the charts to see if they include treatment plans which comply with federal law....  Full Text.

02-21-06 – dK Coding Study – Marketing Your Practice Through Various Financial Incentives: Under HIPAA, Can You Offer FREE Services, Discounted Services, or Pre-Payment Plans to Your Insurance Patients? Can You Waive Copay, Deductible, and Coinsurance Amounts? Could "Installment Agreements" Be the Best Alternative?  Full Text.

01-26-06 – New Web Conference Scheduled for Feb. 7th: "Specialty Health Organizations – Should You Join This Type of Managed Care Entity?" – This Session is Free. Open to Providers Only. In this live web conference, we explore a "new" type of managed care entity commonly referred to as "Independent Physician Associations" or "Specialty Health Organizations." Should you join a SHO upon announcement of a contract with a carrier? Should you not join? What are some of the factors you may wish to consider in making your decision? ...  Full Text.

01-19-06 – If (or When) You Convert a Patient to "Maintenance Care," What CPT Code Can You Use to Bill For Your Service(s)? Can you charge a reduced rate for the service(s)? An introduction to the S8990 temporary HCPCS code.  Full Text.

12-28-05 – Have You Recently Received a Request for Records From Medicare? If so, you should read this advisory. Medicare is specifically asking providers for copies of treatment plans. What are the required fields in a Medicare treatment plan?  Full Text.

12-23-05 – Texas – Under Texas Law, is Health Insurance Primary With Respect to Auto Coverages Such as Medpay, PIP, and Liability? Is It Secondary? Are You Supposed to File One First, and Then the Other? What Does Texas Law Say?  Full text.

12-21-05 – ProviderLAW Releases Study on Recoupment Law. Due to increasing refund requests and recoupment actions by Medicare and other types of insurance payers, ProviderLAW released an initial study on the major limitations on recoupment actions by insurance carriers. The study outlines four major legal limitations on recoupment under Medicare law, and also provides a tool for healthcare practices and others to more easily review relevant regulations on point....  Full Text.

12-19-05 – Under Medicare Law, Can Nonparticipating Physicians/Suppliers Collect Their Full Fees? What Does State Law Say? How Can Medicare Providers Actually Calculate the Allowable Charges, Regardless of Their Participation Status?  Full Text.

10-26-05 – ProviderLAW Launches Its New Electronic Newsletter! The ProviderLAW Newsletter is a substantive, content-based publication. It is designed for healthcare facilities, solution providers, and leaders in the healthcare industry who wish to periodically receive valuable research and information on reimbursement, coding, and compliance isses. It is also designed to enable us to more efficiently disseminate advisories, briefs and other information to our membership... Sign-up for our new electronic newsletter today!  Full Text.

10-14-05 – Under HIPAA, Can Clinics Use Sign-In Sheets in Their Office? Can Clinics Call Out the Names of Patients in Their Waiting Rooms?  Full Text.

09-20-05 – Special Advisories – What Does the Independence Blue Cross Payment "Crisis" Mean for You and Your Practice? Can Carriers Really Recoup From You? Without Notice? In Any Amount They Please? What's Next? This latest series of reports by ProviderLAW is available in the Public Directory of ProviderLAW.com. Part I Part II.

08-24-05 – New Web Conference Scheduled for Sept. 1st: "Work Comp Changes in Texas (House Bill 7)" This program builds on the August 25th session. You can attend this event even if you didn't attend the previous one on workers' comp....  Full Text.

08-24-05 – New Web Conference Scheduled for Sept. 8th: "Insurance Misrepresentation & Refund Requests" – Free For Subscribers!!! This session will cover two main topics: (1) How healthcare providers have been successful in getting paid when an insurance payer misrepresents benefits, coverage, or the terms of the policy at the time of verification, and (2) The law on refund requests and recoupment...  Full Text.

08-03-05 – ProviderLAW Announces its Second Live Web Conference: Work Comp Changes in Texas (House Bill 7) ProviderLAW is hosting its second Live Web Seminar on August 25 on the topic of Texas House Bill 7, and its effect on the Workers' Comp system. Details on this, and other conferences and seminars can be accessed through our Conference Schedule...  Full Text.

08-02-05 – ProviderLAW Launches Live Web Conferences and Seminars – Free For Subscribers!!! Last week ProviderLAW implemented technology, enabling it to deliver live seminars over the web! At least 10 sessions will be held this fall – and possibly more if the beta phase is successful. Subscribers, now our unprecedented conferences / seminars can be accessed over the Internet for free. The first session is scheduled for Aug. 18, 2005...  Full Text.

05-16-05 – An Important Update on Offering Cash Discounts to Patients. ProviderLAW has been receiving an increasing number of calls regarding the propriety of offering discounts to cash patients, waiving deductibles and copays, and other such payment arrangements. Recently, for instance, ProviderLAW received a call from a provider regarding a certain web site and preferred provider plan. The idea of the plan is simple...  Full text.

04-19-05 – California – Charging for Missed Appointments Under CA Workers' Comp. A subscriber recently requested to know whether a provider, under California workers' comp, can charge either the patient or the carrier for missed appointments. California law provides that...  Full text.

04-13-05 – Texas – New PIP Brochure. ProviderLAW has developed a tri-fold brochure on Texas PIP coverage which you can give to your patients if you wish (FREE for subscribers). The brochure not only recommends PIP coverage, but also addresses common questions regarding PIP. For instance, the brochure helps the patient answer the following questions...  Full text.

04-12-05 – Texas – PIP / Medpay Information Sheet. Ever had patients who didn't want to file claims with PIP / Medpay for one reason or another? ProviderLAW has developed an informational sheet which you can distribute to your patients in such situations. The document addresses common rationales for not filing claims with PIP / Medpay...  Full text.

04-12-05 – Can I Charge Interest and/or Delinquency Penalties? Periodically, subscribers have asked whether they can charge the patient interest and/or delinquency penalties on medical bills and if so, how much. Based on a particular state statute, ProviderLAW has revised and uploaded a new sample assignment / lien form to include a "floating" definition of interest and delinquency penalties – i.e., a definition that can automatically adjust to the law in any given state. The revised assignment / lien now defines "Charges" as follows...  Full text.

04-11-05 – California – New Brief – Under CA Wcomp, Do the Medical Provider Network (MPN) Provisions of SB 899 Apply to Patients Injured Prior to Jan. 1, 2005? A CA Wcomp provider recently received a denial from a carrier who claimed that the provider was not "in network." In this case, the patient had been injured in 1999 and the provider in question had been treating the patient prior to January 1, 2005 – the effective date of SB 899's Medical Provider Network (MPN) provisions...  Full text.

04-09-05 – Chiropractic "Super Bill." dK Coding & Compliance has provided a sample "super bill" for use in chiropractic offices. A "super bill" is a method for the provider to quickly and accurately code services provided in a compliant fashion. The super bill helps the provider to (1) identify to billing personnel the appropriate diagnoses, (2) link them to the correct procedure codes, and (3) add the appropriate modifiers as necessary. A super bill also enables the provider to obtain a signed statement from the patient verifying the necessity of services while eliminating the need for a sign-in sheet.  Full text.

04-09-05 – Can Health Insurance Request a Refund? Increasingly, ERISA Health Benefits Plans ("health insurance carriers") are requesting refunds after paying the provider. ProviderLAW is currently drafting a series of demand letters designed to address various refund situations. Our first letter is entitled, "ERISA Health Benefits Plan Requests a Refund, Claiming That Your Care Was Not Medically Necessary." All letters are based on federal ERISA laws.  Full text.

04-09-05 – ProviderLAW Forms Alliance With dK Coding & Compliance, Inc. Increasingly, insurance payers are performing post-payment reviews and audits. For this reason, ProviderLAW has recently formed an alliance with dK Coding & Compliance, Inc., a company committed to providing accurate, current, and unbiased coding, documentation, and compliance information for physical medicine. The principal of the company, David Klein, is a Certified Professional Coder (CPC) through the American Academy of Professional Coders. He is also Certified in Healthcare Compliance (CHC) through the Health Care Compliance Board. For more information regarding this excellent new resource, see Coding & Documentation.

04-09-05 – ProviderLAW Revises Financial Policy to Include "Service-Specific Waiver" for Health Insurance. As many are aware, Medicare requires providers to have patients sign an ABN form when they believe Medicare is likely to deny the care based on medical necessity. What many are not aware of is that various PPO agreements allow providers to charge for non-covered services in certain situations. For this reason, ProviderLAW has revised its financial policy form to include a service-specific waiver.  Full text.

04-09-05 – Texas – ProviderLAW Discovers New Law on Assignments in Texas. The law in question applies to attorney settlements and significantly bolsters the provider's right of direct and prompt payment from attorneys.  Full text.

03-28-05 – California – Checks Written as "Payment in-Full" Under California law, if a check is sent to you as "payment in-full," can you endorse the check "under protest" so that the check does NOT constitute payment in-full?  Full text.