Attorneys Susan St. John and Michael Silverman of the Florida Healthcare Law Firm will present this live lunch n’ learn webinar for providers interested in learning more about the direct patient care model. They will discuss the recent legislative updates that have brought this issue to the forefront in Florida.
Further reading per AAFP.org – The direct primary care (DPC) model gives providers a meaningful alternative to fee-for-service insurance billing, typically by charging patients a monthly, quarterly, or annual fee (i.e., a retainer) that covers all or most primary care services including clinical, laboratory, and consultative services, and care coordination and comprehensive care management. Because some services are not covered by a retainer, DPC practices often suggest that patients acquire a high-deductible wraparound policy to cover emergencies. Direct primary care and concierge care are not synonymous. In practices offering concierge care, the patient typically pays a high retainer fee in addition to insurance premiums and other plan obligations (e.g., copays, out-of-pocket expenditures), and the practice continues to bill the patient’s insurance carrier.
By: Susan St. John
As many chiropractors are likely aware, they cannot “opt-out” of Medicare. Even if a chiropractor has not enrolled to be a Medicare provider, a Medicare beneficiary may require the chiropractor to submit a claim to or bill the Medicare program on his/her behalf for chiropractic services rendered. For chiropractic services to be covered by Medicare, the patient must have a condition necessitating treatment and manipulative services rendered must have a direct therapeutic relationship to the patient’s condition. The manipulative services must provide a reasonable expectation of recovery or improvement of function. Further, the Medicare patient’s condition must be acute and not a chronic subluxation without objective clinical improvement anticipated. Manipulative treatment beyond treating the acute phase, that is, a chronic condition, is considered maintenance therapy and is not covered. Thus, a chiropractor needs to carefully consider at what point a Medicare beneficiary’s treatment becomes palliative or maintenance therapy which would not be covered and thoroughly explain this to the patient. The chiropractor has a duty to let the patient know when treatment is no longer curative or therapeutic, but rather maintenance therapy.
Attorneys Susan St. John and Michael Silverman will present this live lunch n’ learn webinar for providers interested in expanding their practice. They will discuss the following legal and business considerations:
Patient Base –
Current Patient Base – do you have current patients diagnosed with a qualifying medical condition?
Would adding MMJ treatment increase use of alternative treatment offered at your chiropractic clinic (adjustments, massages, nutrition, etc.), that is, for new patients seeking MMJ treatment.
Finding the Right MD or DO
Will MMJ treatment appointments be available to patients every day of the week or only select days (and times)?
Do you need to hire an MD or DO full time or part-time? As an employee or as an independent contractor?
What compensation structure would you offer?
Should you pre-screen patients for qualifying medical conditions prior to scheduling an appointment?
Should you charge for the appointment at the time of scheduling?
Do you need to obtain a patient’s medical records prior to the initial appointment?
What documentation needs to be maintained in a patient’s MMJ Treatment record?
When should you schedule follow-up appointments?
What physical space constraints need to be addressed?
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.