What You Need to Know About IRAs

IRABy: Marnique Sparago, Guest Contributor

Investing for retirement is one of the most important things you can do for your future. Yet an employer-sponsored savings plan, such as a 401(k), may not be enough to provide the savings you need since there are many risks to be prepared for. For many, an Individual Retirement Account is one of the best ways to accumulate additional retirement savings on a tax-advantaged basis.

There are two main types of IRAs, Traditional and Roth. Both have the same contribution limits, the same catch-up provisions for people age 50 and older (for this year’s amount, go to the Internal Revenue Service website, http://www.irs.gov), and both allow your investment earnings to compound tax-deferred until you start taking withdrawals, typically at retirement.

To help determine which IRA is right for you, consider how they differ. Continue reading

Kill H.R. 2914

Background

H.R. 2914 is a bill filed by Congresswoman Speier that is intended (among other things) to prohibit medical practices providing the following sorts of medical services (“Non-ancillary Services”) to their own patients—

*The technical or professional component of (i) surgical pathology, (ii) cytopathology, (iii) hematology, (iv) blood banking, or (v) pathology consultation and clinical lab interpretation services

*Radiation therapy services and supplies

*Advanced diagnostic imaging studies (which include for instance MR and CT)

*Physical therapy services

Continue reading

The Effect of being excluded from Participation in Federal Healthcare Programs

blacklist

The Government recently clarified six areas related the effect of exclusion from participation in Federal Healthcare Programs.

  1. Switching professions during a period of exclusion does not change the exclusion and payment prohibitions.
  2. You can accept a referral from an excluded provider as long as the excluded provider does not provide any services to the referred patient.
  3. Being excluded along with the payment prohibitions extends beyond just direct patient care.
  4. If you are excluded you cannot provide either administrative or management services to non excluded provider.
  5. Excluded providers cannot even provide volunteer services, and
  6. Excluded providers can work for non excluded providers as long as the services they provide are furnished to non-federal healthcare program patients.

Providers need to screen every professional, employee and contractor they do business with to insure they are not on the Exclusion list. It is always best to check the list of Excluded Individuals/Entities (LEIE) for anybody you work with.

Why Compliance Plans Make Sense

Clipboard with Checklist and Red PenHas your practice implemented a compliance program or considered improving an existing one?  Is it really necessary?  Prior to the Patient Protection and Affordable Care Act (ACA), the necessity for physician practices to develop compliance plans was merely voluntary.  However, the ACA will now require physician practices to have a fraud and abuse compliance plan in place as a condition of continuing to participate in Medicare or Medicaid programs.  Because the government first published guidelines in the year 2000 for the voluntary use of compliance plans in physician practices and has subsequently enacted a mandate in the ACA for compliance plans, many physician practices are proactively implementing them.  While this compliance plan mandate may be viewed by physicians as yet another administrative burden and expense to the practice, it can have many benefits as well.  Implementing an effective compliance program can have the result of not only reducing liability risks, but can also allow a practice to reap monetary benefits.  In fact, it could be more costly for the practice not to have one! Continue reading

The Preventionists Are Coming!

paul-revereThe popular conception in healthcare is that (1) a new law was passed, (2) it changed everything, and (3) in a bad way.  Over time, however, it should get clearer that, while there was a law passed, the law alone is not driving changes to our healthcare system: it’s our own demographics and behavior.  Most of the tax dollars currently fueling our healthcare system (and arguably our economy) are tied to an aging Boomer population that are soon to drop off the income producing cliff into the Medicare population.  Bye bye income earners; hello ridiculous public healthcare expenditures.  Though it is true that the timing for expanding public spending on healthcare (with the federal mandates aimed at employers and Medicaid eligibility expansion) could not be more poorly timed, the situation is more of a “Perfect Storm” than a surgical strike.

The financial stress of our changing population and of a historic utilization based healthcare system is causing our healthcare system to morph in every way.  “Health insurance,” with increasing cost, copays and deductibles and reduced benefits, is quickly ceasing to look like your father’s 80/20 major medical plan and starting to look more like catastrophic coverage.  Fee for service compensation is fast becoming “spoken” out of existence.  There are more “pay for performance,” “case rate” and other outcome and risk based compensation models than you can shake a stick at.  The simple truths are: payers have to deliver more with less; and patients have to bear more and more of their healthcare expenses. Continue reading

Gift Giving and the Anti Kickback Law

Even though the holiday season is long gone Healthcare Providers need to pay attention to the value of gifts they give or receive to avoid violating the Anti Kickback Laws. Providers may not accept any one gift with a value of more than approximately $30.00 or gifts worth more than $350.00 annually. The Government is concerned that gifts may cause billing for unnecessary services or may affect the referral of patients. Providers as well as their employees must not solicit gifts either. When a gift is given or received it must not be based upon either the volume or value of any referrals. Gifts that are given frequently after referrals or after any specific successful referral are red flags for violations of the law. In fact the Sunshine Act now requires pharmaceutical companies and durable medical equipment companies to report gifts to providers with a value over $25.00. Continue reading

Disability Income Insurance: How Today’s Decisions Impact Tomorrow’s Choices

Provided By:  Marnique Sparago, Northwestern Mutual

Doctors and dentists nationwide clearly understand the importance of having disability income insurance (DI) to protect the time and money they’ve invested in their profession. And most have considered at length what would happen to them, their incomes, their families and their careers if they suddenly found themselves injured or ill – leading them to seek the protection a DI policy provides.

So what’s the problem? DI is a complex buying decision – with varying stipulations in policy contracts that impact the type of benefits a policy owner might receive at time of claim. The problem is that busy medical and dental professionals can’t find the time to fully understand key concepts in their policies, and many would be surprised to find how those details could affect them at the time of claim. Continue reading

Discounted Fee Organizations Have Surprising Regulation

percentageThe idea of an organization which provides discounted fees to patients is not a new concept.  Organizations like independent physician associations (IPAs), even accountable care organizations (ACOs) and simpler discounted fee plans will be surprised to know that Florida may require them to be licensed by the  Office of Insurance Regulation (OIR), even though they do not handle pre payments and do not collect premiums.  That’s perhaps the most startling aspect of the regulations—there is no financial risk involved, and yet Florida law seems to require regulation.

Pursuant to Fla. Stat. 636.202(2), a “discounted medical plan organization” means an entity which, in exchange for fees, dues, charges, or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount.  A “discount medical plan” means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount.  Fla. Stat. 636.202(1).  A discount medical plan does not include any product regulated under chapter 627, chapter 641, or part I of chapter 636 (governing Prepaid Limited Health Service Organization).  Fla. Stat. 636.202(1), which of course is no comfort to providers looking to garner or protect market share by discounting services or by creating a collection of discount services providers, which is typical of IPAs and “networks.”

Before doing business in Florida as a DMPO, an entity must be legally organized in a compliant way and must be licensed by the OIR as a discount medical plan organization or be licensed by the office pursuant to chapter 624 [Florida Insurance Code], part I of this chapter [Prepaid Limited Health Service Organization], or chapter 641 [HMO, Prepaid Health Clinic]. Fla. Stat. 636.204(1) emphasis added.  Each discount medical plan organization must at all times maintain a net worth of at least $150,000.

Providers looking to provide discounted fee arrangements in a simple and effective manner many be surprised to know how complex that endeavor in fact is.  Moreover, the discounts will likely (and ironically) have to be reduced in order to bear the state licensure and financial viability fees.  Go figure!

HIPAA Omnibus Final Rules and Penalties

On Friday January 25, 2013, the Department of Health and Human Services published the Final Rule modifying the HIPAA privacy, security, enforcement, and breach notification rules under the Health Information Technology for Economic and Clinical Health Act (“HITECH”) and the Genetic Information Non-Discrimination Act (“GINA”) as well as other modifications to the HIPAA rules. (See 45 CFR Parts 160 and 164, Federal Register Volume 78 Number 17.)

The omnibus rule actually contains four final rules. The first final modifications to HIPAA which were mandated by “HITECH” include modifications intended to improve the Rules which were issued as a proposed rule on July 14, 2010 include six modifications.

The first omnibus final rule includes direct liability modifications for business associates of covered entities for compliance with certain HIPAA privacy and security rule requirements. Strengthening of limitations on the use and disclosure of protected health information, expanded individuals’ rights to receive electronic copies of their health information, modification and redistribution of entities privacy practices protocols, modification of individual authorization forms and other requirements to facilitate research and disclosure of child immunization proof to schools as well as to enable access to decedent information and lastly the enforcement rules have been modified to address violations such as non-compliance with HIPAA rules due to willful neglect.

The second omnibus final rule adopts changes to the HIPAA enforcement rule that increase the civil monetary penalties in a tiered manner.

The third omnibus final rule involves the breach notification for unsecured protected health information under the “HITECH” act. This rule replaces the prior rules “harm” threshold with a more objective standard.

Finally, the fourth rule prohibits most health plans from using or disclosing genetic information for underwriting purposes.

These final rules take effect this month on March 26, 2013. Covered business entities and business associates must comply with the applicable requirements by September 23, 2013. The penalties for violating the final rules are now as follows:

TABLE 2 – CATEGORIES OF VIOLATIONS AND RESPECTIVE PENTALTY AMOUNTS AVAILABLE

Violation Category – Section 1176 (a)(1)

Each Violation

All such violations of an identical provision in a calendar year

(A)  Did Not Know(B)   Reasonable Cause

(C)   (i)Willful Neglect-Corrected

(C) (ii) Willful Neglect-Not Corrected

$100-$50,0001,000-50,000

10,000-50,000

50,000

$1,500,0001,500,000

1,500,000

1,500,000

Providers need to be aware of the penalties for violating the rules as we most recently reported to you the office of civil rights will not hesitate in sanctioning providers for violating the Act in amounts in excess of $1.5 million.

Portal not “Port-All”

doorBy: David Hirshfeld

Whether as a means of satisfying the Stage 2 “meaningful use” requirements of the HITECH Act, or in an effort simply to enhance the efficiency of their practices, many of our clients have been implementing electronic medical records software that includes patient portals.  A “patient portal” is an electronic doorway between patient and practice.  Portals often allow patients to check and download their own treatment records, and to use digital messages as a means of communicating with clinicians.  Portals can be awesome tools with which to enhance your practice, but they need to be implemented thoughtfully.

A portal is often an excellent way in which to add operational efficiencies that reduce costs, increase patient satisfaction, and increase positive outcomes; BUT, if not carefully monitored, they can become inadvertent points of entry for information, the meaning of which can only be appreciated when delivered in a face-to-face office visit, where other aspects of the patient’s condition would be evident (e.g. pallor, swelling, confusion).

Portals should be limited to more benign encounters, such as: patient registration, financial clearance, medical history, appointment scheduling / confirmation, specialty referrals, notification of test results, online bill payment, non-narcotic prescription renewals, follow-up of specific conditions for which there has been a course of in-person treatment that included an agreement as to the use of the portal for follow-up.

I recommend that practitioners train their patients how and to what extent they should use the portal by presenting patients with a “Terms of Use” agreement (that they must sign); and by reminding patients of the Terms of Use if and when they use the portal for an encounter that should have been handled by an in-office visit.

A good “Terms of Use” agreement ought to convey the following information to patients before they use the portal:

  • Identify the proper subject matter to be communicated through the portal and, just as important, the types of communications that should NOT be made through the portal.
  • In addition to communication, what other functions the portal will make available to the patient (e.g. what records can patients view, can they download, can they transmit to other providers, refill prescriptions, help practice to monitor an ongoing condition, etc.).
  • The portal is highly secure, more secure than conventional email, and should be the only way that patients should convey information to the practice other than in-person or, perhaps, on the telephone.
  • Everything conveyed to the practice through the portal will become part of the patient’s medical record.
  • Not only the physician, but other clinicians and practice staff may read communications made through the portal.
  • How quickly, and in what format, will the practice respond to patient communications made through the portal.
  • Whether and on what terms the practice will allow access to records of its minor patients.
  • How modifications to the “Terms of Use” and portal functionality will be conveyed to patients.
  • A primer, as simple as possible, on how to effectively use your practice’s portal.

Portals can be awesome tools with which to enhance your practice; but they need to be implemented thoughtfully, and in conjunction with patient training.