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Monumental changes in the healthcare system has ushered in a new role for urgent care centers. With increased responsibility comes numerous challenges for urgent care providers. Some of the common issues include:
• Compliance with Stark law, and state and federal anti-kickback statutes
• Fee splitting
• Medicare and Medicaid compliance regulations
• Fraud and abuse investigations by the government
• MAC, OMIG, RAC, ZPIC or private insurance audits
• Business management, which includes setting up the center, forming the corporation, mergers, internal compliance, purchases and sales
• Credentialing and accreditation
Another essential issue for urgent care centers is to have carefully drafted and negotiated employment agreements. A law firm that has experience with physician contracts can examine current contracts to identify potential problems that conflict with regulations and exposes the centers to an audit.
Urgent Care Centers and Audits
Urgent care centers are growing across the country. They have become a treatment alternative to emergency rooms. Because of this increase in patient care, these facilities have also encountered increased scrutiny by Medicare, Medicaid and private payor audits. Typically, insurance audits are the result of overpayment demands. Negative findings can lead to sanctions such as exclusion from the insurance programs and recoupment actions.
Among the most focused billing issues, auditors are particularly interested in reviewing the following:
• Unauthorized billing for services not permitted by the Operating Certificate
• Unauthorized billing for services previously denied due to lack of necessity
• Incorrect provider identified on the claim
• Using incorrect diagnostic codes
• Providing incomplete or incoherent explanation of services
• Qualified practitioners not signing orders
It is very important that urgent care center staff avoid unintentional errors and maintain proper billing practices. Doing this will keep them off the radar of government and private insurance auditors. Legally questionable activities thought to be acceptable should also be avoided.
The best way to prevent such issues is to have an effective compliance plan. Skilled attorneys can assist urgent care centers with implementing and following such plans. Partnering with a law firm also guarantees legal representatives at every stage of an audit and/or appeal from Medicare, Medicaid and commercial insurance payors.
Legal Issues for Urgent Care Centers
Prohibiting the corporate practice of medicine intends to protect the integrity of the medical profession. This doctrine calls for keeping corporate interests separate from healthcare services. It goes one step further by prohibiting physicians from being employed by corporations.
There are other issues that can raise corporate practice of medicine issues. Among these are fee splitting and, fraud and abuse. Involving physicians or other medical professionals in a transaction that raises concerns may result in disciplinary action.
Fee splitting is any type of financial arrangement that involves payments by a physician. Fraud and abuse issues are the most common and serious in the delivery of healthcare services. Medicare and Medicaid patients are not always involved. Federal anti-fraud and abuse, and the safe harbor rules, are complex. Careful analysis is necessary to make sure no rule or statute is being violated.
Dependable Legal Advice Amid Uncertainty
When it comes to the uncertainties of healthcare reform coupled with heightened enforcement of regulatory requirements, urgent care centers cannot afford to stay vulnerable. Help from Boston lawyers for urgent care centers can help keep the primary mission in focus. While you and your staff take care of patients, Raiser & Kenniff, PC will take care of the hidden dangers that could threaten the practice.
Years of experience has positioned us to know how to help you stay compliant – and defend against charges of violating a rule. We provide counsel on different business transactions such as mergers and joint ventures to ensure no conflicts of interest exist.
Raiser & Kenniff, PC offers advice on Medicare reimbursement issues, real estate transactions, compliant with Stark law and anti-kickbacks, patient privacy regulations and so much more. We understand the healthcare industry and the objectives that will keep you serving the public for years to come.