Enrolling in Medicare requires confronting forms, regulations and Manuals. Given new Supreme Court caselaw which addresses, among other things, what documents the government can rely on for enforcement purposes, understanding the interrelationships among the relevant government documents is essential.  In “Medicare Enrollment Defenses: Keeping current with Medicare enrollment” Dan tackles the hierarchy of documents, addresses a number of Supreme Court cases which are applicable to potential problems and posits applicable defenses in case trouble arises. His second article, here,  “Keeping current with Medicare enrollment” focuses more on maintaining enrollment, including revalidation. Pitfalls abound here; and he helps clients avoid them.

For most of the history of Medicare, reimbursement has only been available for services where the physician directly interacts with the patient.  As the emphasis on value became stronger, it became necessary to allow payment for services between visits or procedures through with physicians manage their patients’ care. In 2016, Alice first wrote about this but today there are multiple additional codes. These are services which can benefit physicians, but the OIG has also begun to pay attention to them. In “Beyond Face Time v 2.0: The OIG Awakens”  Alice first addresses traditional forms of non-face time services such as incident to, split/shared visits and care plan oversight and then moves through the more modern services of transitional care management, chronic care management, remote physiologic monitoring and concluding with the 2025 new service of advanced primary care management. She explains the details of what each requires, describes relevant OIG activity, and proffers where physicians are likely to fail in documenting and billing effectively.  Also addressing Supreme Court cases, she opines that as the gradual shift to more value-based payments has mandated more coordination of care, these services represent a potential benefit to pay physicians for what they actually do; but they also present a real risk area for them.

In “Quality Fraud: What’s That?” Alice describes, to yet another audience, the ways in which quality failures can lead to government enforcement, instigated by the government or by whistleblowers.  This is a developing area to which physician practices should pay attention and address a pro-active approach explicitly in their compliance programs.

The advent of artificial intelligence (AI) in health care has been widely touted. Most physicians don’t really understand its uses and limitations in medical practice. Dan Shay has previously considered the uses and legal implications  of AI in healthcare. In “Legal Considerations When Using Artificial Intelligence in Practice” he focuses his attention very specifically, and with an emphasis on practicalities, on the range of uses of AI in the physician practice.  He offers caution, while addressing potential benefits which can arise as well.

Enrolling in Medicare requires confronting forms, regulations and Manuals. Given new Supreme Court caselaw which addresses, among other things, what documents the government can rely on for enforcement purposes, understanding the interrelationships among the relevant government documents is essential.  In “Medicare Enrollment Defenses: Keeping current with Medicare enrollment” Dan tackles the hierarchy of documents, addresses a number of Supreme Court cases which are applicable to potential problems and posits applicable defenses in case trouble arises. His second article, here,  “Keeping current with Medicare enrollment” focuses more on maintaining enrollment, including revalidation. Pitfalls abound here; and he helps clients avoid them.