BP - Health Care Compliance Association

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Cyber doctors ...continued from page 49 patient in person or is able to visualize some aspect of the patient’s condition without a third person’s judgment. Although services provided by means of a telephone call between the physician and the beneficiary may be covered under Medicare, there are certain services that require a face-to-face visit. Previous OIG work identified instances of physicians billing for services that would normally require a face-to-face examination for beneficiaries who lived a significant distance from the physician. We will also examine factors that contribute to the submission of long-distance physician claims.” Per the Medicare Benefit Policy Manual, Chapter 15, Section 270.2, “the use of a telecommunications system may substitute for a face-to-face, ‘hands on’ encounter for consultations, office visits, individual psychotherapy, pharmacologic management, psychiatric diagnostic interview examination, end stage renal disease related services, and individual medical nutrition therapy.” However, because the CPT codes used are, CCB Accredited in most cases, the same as non-telemedicine encounters, it is unclear how the OIG will pull the data for this review. Conclusion Telemedicine plays a critical role in providing access to health care, especially in underserved areas. Providers must ensure that the risks of providing telemedicine services do not outweigh the benefits, carefully enter into agreements with the assistance of their Legal department, and should develop telemedicine policies. n 1 Wikipedia, the Free Encyclopedia – http://en.wikipedia.org/wiki/ In_absentia_health_care 2 Official Site of the French/Israeli Chamber of Commerce - Article by Michael Finkelstein – 9/27/2008 - Available at: http://www.israelvalley.com/ news/2008/09/27/19708/israel-medical-abecedaire-telemedecine-peut-savoirsi-le-risque-de-crise-cardiaque-est-reel-grace-a-un-telephone-portable-special 3 Reseau RAFT Network - http://raft.hcuge.ch/ 4 Surgeons perform successful near real time telesurgery from New York on patient in France. Available at: http://www.hoise.com/vmw/01/ articles/vmw/LV-VM-10-01-20.html 5 Society of American Gastrointestinal Endoscopic Surgeons (SAGES) 2000 - Remote Surgery Guidelines 6 Radiology Today - “Remote Reading -PACS and Teleradiology Let Radiologists Work Almost Anywhere.” - Dan Harvey - 4/10/06 7 AMA - Physician Licensure: An Update of Trends – Janice Robertson- 2/27/2008 8 Lynn D. Feisher and James C. Dechene, Eds: Telemedicine and E-Health Law. Law Journal Seminars Press; Lslf edition (December 5, 2004) Chapter 1 9 JCAHO Perspectives - Existing requirements for telemedicine practitioners explained – Feb 2003. Available at: http://americantelemed.i4adev. com/files/public/abouttelemedicine/JCP_2_2_2003.pdf 10 Lynn D. Feisher and James C. Dechene, Eds: Telemedicine and E-Health Law. Law Journal Seminars Press; Lslf edition (December 5, 2004) Chapter 1 11 Lynn D. Feisher and James C. Dechene, Eds: Telemedicine and E-Health Law. Law Journal Seminars Press; Lslf edition (December 5, 2004) Chapter 8 12 Medicare Benefit Manual – Chapter 15 – Section 270 – Telehealth Services 13 New, Revised CPT Codes Target Online, Telephone Services - Sheri Porter – 2/29/08 – Available at: http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20080229cptcodes.html 14 The American College of Radiology ( ACR) - Revised Statement on the Interpretation of Radiology Images Outside the United States – 5/23/06 C R E D I B I L I T Y Standing at the crossroads ...continued from page 45 n Is there a higher-level management issue within the department? n Because the employee has a pregnant wife who is about to deliver, should the organization maintain their benefits? If so, for how long? Overall organizational responsibility and commitment to the institutional ethic recognized by this model is dependent on the commitment of the organization’s governance and executive leadership. Almost every hospital operates each of the ethics components described in this model. The model proposed in this paper, though, is just a model. At the end of the day, what counts is how the organization places this model (or any model) into practice; and more importantly, how it is promoted and practiced by its executive leadership and board. As organizations and the delivery of health care evolves, our system of caring is becoming more complex. As a result, we as providers of health care, both clinical and non-clinical, will face more multifaceted ethical and legal challenges. The strategy above is neither a “golden hammer,” nor a one-size-fits-all resolution to the challenge. Instead, it is an attempt to encourage rethinking of our overall ethics strategy and commitment to mission driven health care. n Certificate in Health Care Compliance Gain the knowledge compliance officers need in a unique setting • Interactive courses from industry leaders • Part time program for working professionals • Practical knowledge to prepare for the certification exam—and a meaningful new career 1 Bacon, Francis, ed. Lisa Jardine. New Organon. Cambridge University Press. March 2000. 2 See “Success and Failures of Hospital Ethics Committes: A National Survey of Ethics Committee Chairs” Gleen McGee. Cambridge Quarterly of Healthcare Ethics, Volume 11, Issue 1, January 2002 p87. (Healthcare ethics committees formally began with the adoption of Committees for the Discussion of Morals in Medicine at U.S. Catholic hospitals in the 1960s.). 3 See 63 Fed Reg No. 35, 8987 (February 23, 1998). 4 U.S. Sentencing Commission Guidelines, November 1, 2006, Chapter 8. 5 See Murphy PhD, Kevin. “A ‘Next Generation’ Ethics Committee.” Health Progress. March-April 2006. 6 Clinical Operations, Finance, Risk Management, and Human Resources 7 Paine, Lynn Sharp. Ethics: A Basic Framework. Harvard Business Review. October 12, 2006. www.hamline.edu/law/health | 651-523-2625 | mmiller14@hamline.edu March 2009 50 Health Care Compliance Association • 888-580-8373 • www.hcca-info.org
Mandatory Stark reporting: Is a denouement nigh, or just another chapter in the saga? Editor’s note: Ed Rauzi and Lisa Hayward are partners in the Seattle Office of Davis Wright Tremaine, LLP. They work for clients in the health care delivery system full-time, all the time. Ed may be reached by telephone at 206/757-8127 and Lisa’s number is 206/757-8058. Although it receives scant attention, the Stark Law has always authorized the Secretary of Health & Human Services to require hospitals to submit information concerning financial relationships such hospitals have with physicians. Regulations purporting to implement that authority have existed since 1991. 1 To date, however, there is no evidence that the Centers for Medicare and Medicaid Services (CMS) has ever used its authority, even in an investigation. That may soon change. In a filing with the Office of Management and Budget (OMB) on December 18, 2008, CMS sought approval of documents that will require selected hospitals to disclose in writing the financial relationships they had with physicians in calendar year 2006. OMB’s permission is required under the Paperwork Reduction Act, which prohibits a federal agency from subjecting any person to a penalty for failing to respond to a request for information unless the request includes an OMB authorization number. If CMS gets its way, 400 hospitals will soon be receiving a form letter transmitting a By Edwin Rauzi and Lisa Hayward packet of information and eight Microsoft Excel spreadsheets. The letter will inform the hospitals that they have 60 days to compile a comprehensive list and provide documentation of virtually all financial relationships with physicians and their immediate family members. 2 The disclosing hospitals will need to identify and disclose each financial relationship with each physician. As compliance officers know, a hospital is prohibited from submitting a claim to the Medicare program based on an order or referral from a physician with whom the hospital has a financial arrangement that does not satisfy a Stark exception. The CEO, CFO or “comparable officer” will be required to certify that the information is “true and correct, to the best of my belief and knowledge.” This is not CMS’s first attempt at obtaining approval to send out a demand for information. As Compliance Today noted in its September 2007 edition, CMS has been pursuing this initiative for some time. 3 Perhaps in response to criticism by lobbyists and the hospital industry, the last iteration of the packet was withdrawn by CMS on April 10, 2008. CMS began retracing its steps with the publication of a notice soliciting additional comments in the April 30, 2008, edition of the Federal Register. The details CMS changed in the new packet include: n Reducing the number of hospitals to be surveyed from 500 to 400; Health Care Compliance Association • 888-580-8373 • www.hcca-info.org n Increasing the estimate of time that will be spent in responding from six to 100 hours; n Disclosing that the responses will be evaluated initially by a Program Safeguards Contractor; n Requiring the disclosure of the National Practitioner Identifier numbers of physicians (instead of Unique Physician Identification numbers); n Acknowledging that “some” hospitals may solicit legal review of the information before it is submitted; n Clarifying that transactions in each direction (e.g., leases to physicians by hospitals as well as leases from physicians by hospitals) are included; and n Warning that the government will not be “estopped” from asserting that an arrangement the hospital characterizes as compliant is non-compliant. Many more things in the packet stayed the same. In addition to the certification requirement: n The deadline to respond remains 60 days after receipt (although CMS will consider granting extensions); n The sanction for late responses is potentially $10,000 per day; n Unless the hospital has a calendar fiscal year, information (and contracts) for two fiscal years will be required; n Unless groups of agreements are “substantially the same,” copies of each agreement must be submitted; n The hospital must assert whether each agreement satisfies all of the elements defined in the applicable regulation; n The hospital must identify not only recruiting, personal service and rental arrangements that they believe fit within an exception, but also relationships that are “implicated” by those exceptions; and n That the information obtained may be “shared” with other government agencies. Continued on page 52 51 March 2009
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