There are several federal and state laws that govern the provision of health care in the U.S. Medical practices that are unaware of the legal implications of these laws are at a distinct disadvantage because they limit your ability to fully comply with legal and ethical issues. . In this regard, there are some important legal tips that every medical practice should know, as it relates to matters such as entity training, patient care, and compliance with Medicare and Medicaid (Medi-Cal for California).
Entity training
Doctors must ensure that the property conforms to the relevant laws and regulations. Healthcare providers wishing to form their own medical entity must take care to comply with licensing and permitting requirements, as well as other laws governing medical practice training. In particular, they should examine the specific laws that stipulate the permissible ownership and management structure. In some states like California, there are restrictions on the entities that can operate certain categories of health care providers.
Ensure compliance with state and federal health laws
The privacy and security of medical records are protected by federal and state health care laws. The Health Information Portability and Accountability Act (HIPAA) is a federal law that recognizes the sensitivity of patients’ medical records. Therefore, HIPAA has instituted a number of checks and balances to prevent those records from being misused. HIPAA defines identifiable health information that can be transmitted as protected health information (PHI), which must be secured.
Medical practices and providers are required to comply with HIPAA and therefore must establish a compliance unit with staff who are fully aware of policies related to compliance. The compliance unit may prevent violations of the law. California also has several state laws that medical practices must follow, related to the protection and security of medical information. Medical providers often need legal assistance to help negotiate the web of regulations that exist.
Handling non-payment problems by insurance companies
At some point in their existence, medical practices will face the troublesome problem of underpayment by insurance companies. Therefore, they are advised to be proactive and not be left behind when independent practice associations (APIs) fail to pay. ‘Slow payment’ often results in ‘no payment’, therefore doctors must persistently track IPAs for payment, as soon as there is any delay. They should also seek legal assistance when necessary.
Avoid Medicare overpayment problems
Billing errors can have serious consequences for medical practice, so it is important to avoid Medicare overpayment problems. Therefore, physicians must ensure that their billing system is accurate and that services are billed correctly. It is often advisable to seek the help of health care attorneys in this regard, as they are well placed to provide the necessary guidance and supervision.
In the event of an overpayment, the medical provider must report immediately as required by the Affordable Care Act. Under the Affordable Care Act, physicians must report any non-payment within 60 days. Failure to do so may result in them being held liable under the False Claims Act.
Dealing with Dual Eligible Patients
In California, this relates to patients who have both Medi-Care and Medi-Cal. Patients in this category may be eligible for Cal MediConnect. Cal MediConnect was implemented to streamline the provision of health care for dual eligible beneficiaries and is part of the broader Coordinated Care Initiative (CCI).
Physicians must understand the registration process, as well as the implications for their medical practice, as a result of the Cal MediConnect program. In particular, they should have a good understanding of enrollment and billing issues, as well as how they will be affected if patients choose not to participate in MediConnect.
In California, the statutes and regulations regarding medical practices are varied, and all too often, healthcare providers are unaware of the legal nuances that can affect their practices. However, by hiring the services of an experienced health care attorney, they can gain a better understanding of health care laws.
