7 Legal Areas for Physicians to Focus on in 2013

From increasing HIPAA training among staff to stepping up billing compliance efforts, here are key action steps to consider making in the New Year.

In my final blog post of 2012, I want to take this opportunity to look at some of the issues that will face physicians and their practices in 2013.  These issues include the following:

1. There will be a continued emphasis on EHRs and collection of data by both physicians and hospitals.  In addition, there is no doubt that data will increasingly be collected and accessed via mobile devices. A recent HIMSS Mobile Technology survey found that 93 percent of physicians surveyed use mobile health technology in their day-to-day activities.  This increase in data usage, particularly on mobile devices, is an area of risk for physician practices, as we will continue to see heightened HIPAA enforcement in 2013.  For physician practices, HIPAA compliance and training must remain an important goal.

2. The Office of Inspector General (OIG) for HHS issued its work plan for 2013, which includes two new reviews related to physicians.  The first review will be for Medicare Part B claims for personally-performed anesthesia services. The second new review will focus on billing for ophthalmological services. The OIG is focusing both reviews on questionable billing and adequate documentation in these areas.  Providers offering anesthesia or ophthalmologic services should be particularly aware of the OIG’s planned reviews, and should plan for internal audits and an appropriate compliance plan before any such audit occurs.  All providers should continue to work on billing and fraud compliance as auditing of all physicians for fraud and billing irregularities continues to be a primary goal for the OIG in 2013.

3. The Physicians Payment Sunshine Act is expected to come into play in 2013, requiring pharmaceutical, device, and other companies to publish amounts paid to physicians for consulting services, research, or other purposes.  The Sunshine Act is intended to make all such transactions transparent to the public.  Physicians should continue to be vigilant about giving and receiving anything of value from referral sources, or those in a position to influence physician referrals. Continued government scrutiny of physician relationships, contracts, and referral patterns will continue.

4. The role of accountable care organizations (ACOs) and other integrated models under the Affordable Care Act will impact physicians across the country. Physician will experience reimbursement changes and the impact of ACOs on patient care and costs.  Physicians need to carefully evaluate their participation in ACOs and carefully review any ACO agreements to best understand how ACO involvement will influence their practice model and the control they may be giving to the ACO partner (often a hospital) through ACO participation.

5. As I wrote in a recent blog, the physician shortage is a growing concern, especially if the health law delivers on the predicted number of new patients it will bring into the healthcare system.   Introduction of new training programs for physicians and nonphysician providers are likely to be areas of heightened discussion, as well immigration as it pertains to healthcare providers. Physicians should continue to evaluate what benefits physician-extenders may bring to the practice in this changing healthcare environment.

6. There is no doubt that consolidation of hospitals is a trend that will continue into 2013, although it is expected to slow.  The Federal Trade Commission, which works to prevent anticompetitive mergers and conduct that might undermine competition in healthcare markets, has redoubled its efforts to prevent hospital mergers that may leave insufficient local options for inpatient services, challenging three such mergers in federal court in the past year.  In 2013 we will likely see more FTC challenges of hospital mergers and, potentially, large physician group practice mergers.

7. Physicians who certify and conduct face-to-face encounters for home health agencies will find themselves subject to increased scrutiny in 2013.  Regulators will be conducting frequent audits focused on compliance with certification and face-to-face requirements.

It has been a pleasure to hear from so many readers over the past year, whether positive or negative, and I look forward to continuing to share my thoughts and experiences with you in 2013.  Please feel free to e-mail me with any questions or topics that are facing you or your medical practice.