Friday, October 30, 2015

The Legal Audit: A 10 Step Checklist for Your Healthcare Practice

10 Step Checklist for Your Healthcare Practice
Heathcare Practice
Legal Checklist

Medical practices are always preaching preventative medicine to their patients. They can be well-advised to practice their own legal preventative medicine through an internal audit of the legal issues involving the practice. Dealing with these issues now rather than when a problem arises will save time, money and stress. According to attorney Charles E. Rosolio, P.A., at, the following is a good checklist that all medical practices should follow when conducting an internal legal audit:
  1. Employment agreements. It is always good to examine all employment contracts to make sure that they are up to date, have not expired or are not outdated by actual practice and implementation. Confirm that there is consistency throughout the practice on all aspects of the terms and conditions of employment.
  2. Contracts with health care providers. Check to see that the practice is in compliance, that the other contracting party is in compliance and all terms and conditions are being met. Pay particular attention to the renewals and termination scenarios to avoid unintended results. 
  3. Compliance with healthcare regulations (HIPAA, Stark, Fraud and abuse). With the ever-changing landscape of health care regulations, examine all current arrangements to insure continued compliance. Examine written contracts and also review implementation to insure that the actual practice is consistent with current regulations.
  4. Policy manual and employment manuals. Insure that such manuals are up-to-date and compliant with actual practice as well as current law. This is an evolving process and an inconsistent or out-of-date manual can spell trouble later. This includes social media policies, a key element with any policy or employment manual.
  5. Reporting requirements for lenders and financial institutions. Examine the reporting requirements in any loan documents to lenders to make sure that the practice is in compliance and has provided all that is required under loan or line of credit agreements with such institutions. 
  6. Corporate documents up to date. Make sure that the governing documents of the practice are up to date. If the practice is a professional corporation or some other type of entity that requires the preparation of minutes on at least an annual basis, attend to these requirements. Work with the practice’s tax advisors to insure that whatever needs to be reflected for purpose of tax compliance has been addressed. 
  7. Contracts with service providers. Review these on a regular basis. Many times, they will have termination requirements and automatic renewals that should not be ignored. Better terms can sometimes be obtained with a long-standing vendor.
  8. Insurance issues, particularly with malpractice carriers. Coverage and compliance requirements should be examined on a regular basis to make sure that the practice is adequately covered.
  9. Review of significant contracts. If there are any other significant contracts not outlined above, they should be reviewed for the same issues as discussed.
  10. Polling for potential claims among group members. Check with the practice physicians to see if there are any potential claims that may be present or percolating so that they may be addressed early and properly. 
Do not hesitate to involve your legal professionals in an internal audit. They can identify issues that may not be identified by a non-lawyer and can offer advice before the issue becomes a real problem.

For more information or guidance, contact:
Charles E. Rosolio
1 Olympic Place, Suite 900 | Towson, MD 21204
Office: 410.576.8912 | Mobile: 410.949.6666
Fax: 410.576.8999

Wednesday, October 14, 2015

There’s Still Time to Succeed at PQRS - Here’s How

Joy Rios
According to Joy Rios, MBA, CHTS-PW, “The year is closing in on us and the countdown to MU and PQRS submission season has begun.”

You may think that the game is over, but there’s still time to make a big impact in your quality score even if you thought it was too late.

At this stage of the game, if you haven’t started PQRS, let’s talk about your best options.

Since the deadline to report as a group passed at the end of June, eligible providers - even if practicing as part of a group - will need to report as individuals.

The two options left to report as an individual are either through your EHR or through a Registry.

Option 1: EHR Reporting

It is important to understand the measures for which your EHR can capture data and whether or not the measures align with your specialty.

Question: In your EHR, when you run the PQRS report, how many measures have a denominator and of those measures, which ones have a numerator greater than zero?

Answer 1: If the answer is 9 or more and the measures align with your specialty, you will likely be able to use the EHR-Direct method to report.

To do so, confirm that your EHR vendor can generate a QRDA I or QRDA III file that passes the validation test to be submitted to QualityNet.

Then make sure you have the right user roles set up to be able to submit that QRDA file — they will most likely be the Security Official and the PQRS Submitter roles.

Answer 2: If you run the PQRS report and you show results for fewer than 9 measures AND/OR if your numerators are particularly low for the measures for which you are capturing data, you may want to consider reporting through a Registry.

Option 2: Registry Reporting

Although you can report 9 individual measures (covering at least 3 NQS domains) through a Registry, you would need to submit data for at least 50% of your Medicare patients from January 1 - December 31, 2015. If you have not been collecting data, this method is too difficult to chase.

However, there is a more attainable Registry-based reporting method — via a Measures Group.
The beauty of the Measures Group method is you only need to collect data on a minimum of 20 patients, 11 of whom must be on Medicare. This is a task that can be completed by the end of the year.

CMS has defined 22 groups of measures (aka a Measures Group) to choose from this year. Each group revolves around a particular topic (i.e. Oncology Care, Diabetes, IBD, etc.) However, if none of those match your patient population, I implore you to consider the Preventive Care group.

This group is designed to collect data on patients aged 50 years and older with a specific patient encounter code (i.e., 99201 - 99205, 99212 - 99215).

You’ll need to collect data on a total of 10 measures that are geared toward preventive care. For example, you’ll ask the patient if they’ve had a flu shot this year or whether they have had their Pneumonia vaccine - that’s two. You’ll ask it for eight more measures.

Then you’ll fill out a Data Collection Worksheet for each of the 20 patients. Don’t worry, this document is provided by the Registry. Once data has been collected on enough patients, you’ll transfer that information over to an Excel Document and upload that to the Registry.

The Registry will then submit the data on your behalf to CMS.

And that’s it - you’re done.

Where can you sign up with a Registry? Well, Joy’s personal favorite is - it will cost about $300 per provider and is worth every penny.

The clock is ticking and if you have done nothing for PQRS up until now, this would be your best option to avoid up to 6% in penalties.

For more information on how to successfully participate in PQRS this year, check out my book,  ABCs of PQRS: Your 2015 Guide to Successfully Participating in the Physician Quality Reporting System or order at (800) 933-3711. Also now available on Kindle.