Health law is the federal, state, and local law, rules, regulations and other jurisprudence among providers, payers and vendors to the healthcare industry and its patient and delivery of health care services; all with an emphasis on operations, regulatory and transactional legal issues.
Review EOBs and determine where denials are originating and their root cause
While reviewing EOBs practices need to determine if a trend can be established that identifies the root cause for why claims are being denied. Trends can be established by asking if most denials are originating in your patient access and registration departments, or are denials occurring because of insufficient documentation, or due to billing or coding errors?
In most cases, the limited liability company, or LLC, is the preferred business structure for a wide variety of healthcare businesses. If you’re a licensed professional, you can also use the professional limited liability company, or PLLC for your healthcare practice or business. While generally these two entity types are the same, there’s a small difference to be aware of when organizing the company.
FMVs are at the heart of healthcare regulatory compliance when money or anything of value changes hands in a healthcare business setting. Why? Two reasons:
Healthcare laws (Stark, the Anti Kickback Statute and the Patient Brokering Act) all target money changing hands in the healthcare business space; and
There are clear exemptions and exceptions that have as an essential ingredient that the compensation (or pricing) is consistent with “fair market value.”
How it Goes—A Six Part Process
Locking down an externally performed FMV (part of the “gold standard” in regulatory compliance) is a process. Here’s what it should look like:
Step 1. The healthcare business person or his/her advisors (often accountants) find someone who specializes in performing FMVs for the specific matter (e.g. compensation, price of a business to be acquired);
Step 2. The LAWYER for the healthcare business is immediately involved in the process BEFORE the FMV firm is engaged;
Step 3. The LAWYER engages the FMV firm on behalf of the healthcare business client;
Step 4. The parties (including the lawyer) get on the phone or in a meeting with the “FMV guy” and has a very extensive conversation re the project;
Step 5. Once the FMV process done, a DRAFT FMV study is prepared and discussed interactively with the healthcare business and the lawyer;
Step 6. Once finalized, an execution copy is prepared and provided to the lawyer. read more
If you had investment income in 2013, there may be something in your recently filed tax return that you weren’t expecting – an additional 3.8% tax. For individual taxpayers with adjusted gross income (“AGI”) over $200,000 and joint filing taxpayers with adjusted gross income above $250,000 the Affordable Care Act created an additional tax on investment income of 3.8%. The tax is levied on the lesser of 1) net investment income, and 2) the amount by which their AGI exceeds the threshold limit of $200,000 or $250,000 respectively. Investment income specifically includes gross income from interest, dividends, annuities, royalties, and rents. Investment income does not include distributions from qualified retirement plans, IRAs, gain on the sale of certain business interests, active trade or business income, or any income taken into account for self-employment tax purposes. The surtax became effective after December 31, 2012. read more