Many have been calling in recent days regarding insurance carriers refusing to pay for claims for treatment, essentially saying “sue us for your money.” Aside from potentially discriminatory undertones, this is patently illegal.
The State of Florida has what are known as “Prompt Pay” laws which require an insurance carrier to do just that. While I won¹t get into the details here, I thought I would share this article with you to illustrate that ³you are not alone² when it comes to this headache.
Read more about them with Law360’s article:
Hospitals Can Sue Under Prompt Pay Law: NY Appeals Court
Many of you have called me regarding letters you may have received from DCF regarding Patient Brokering. Please be aware that the letter has been sent to all providers and not to anyone specifically accused of any wrongdoing.
That said, you should remain vigilant that you are closely monitoring any activity by your staff that could be construed to violate s. 817.505, Fla. Stat., the Patient Brokering Act. I have attached a copy for your records.
For purposes of the Act, the repeat question I receive is regarding how to effectively and legally use marketing companies to obtain referrals for new patients. The provision in the statute which addresses that point can be found within subsection (i) which allows for:
Payments by a health care provider or health care facility to a health, mental health, or substance abuse information service that provides information upon request and without charge to consumers about providers of health care goods or services to enable consumers to select appropriate providers or facilities, provided that such information service:
1. Does not attempt through its standard questions for solicitation of consumer criteria or through any other means to steer or lead a consumer to select or consider selection of a particular health care provider or health care facility;
2. Does not provide or represent itself as providing diagnostic or counseling services or assessments of illness or injury and does not make any promises of cure or guarantees of treatment;
3. Does not provide or arrange for transportation of a consumer to or from the location of a health care provider or health care facility; and
4. Charges and collects fees from a health care provider or health care facility participating in its services that are set in advance, are consistent with the fair market value for those information services, and are not based on the potential value of a patient or patients to a health care provider or health care facility or of the goods or services provided by the health care provider or health care facility.
Should you have any questions or concerns about your compliance with this provision, please don’t hesitate to give us a call.
By The Pathology Blawg
The Centers for Medicare and Medicaid Services (CMS) yesterday published its final amendments to HIPAA and CLIA that will allow patients to have direct access to test results.
I talked about this back in October 2013 when HHS announced the patient access to test results final rule would be released soon.
In the broadest terms, the new rules change CLIA’s definition of “authorized person”. Until this rule, an “authorized person” was “the individual authorized under state law to order or receive test results, or both.” In many states, that meant only the physician, or other test-ordering health care provider, and not the patient.
Read the full article here