Good Faith Estimate FAQs Part II

 

 

Finally! Finally, we have some additional clarity surrounding the Good Faith Estimate rule and how it can be better implemented by providers. 

My members have been peppering me with many of the questions below for months now. And I am glad HHS published these answers for providers that have been confused.

Before you skip down, a few (paraphrased) reminders of definitions:

Convening Provider: the provider or facility at which the patient is being seen (most likely you/your office).

Co-providers: third-party providers that are likely to be involved in the delivery of care to the patient.  

 

These FAQs have been prepared by the Department of Health and Human Services (HHS) to address the provision of GFEs for uninsured (or self-pay) individuals, as described in Public Health Service Act (PHS Act) section 2799B-6 and implementing regulations at 45 CFR 149.610.

 

Q1: Must a GFE include a diagnosis code, even if the provider or...

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Basketball Mindset

 

How does the NCAA basketball tournament relate to you in your practice, in your business, and in your life?  I'm not an expert ball spinner (see video!); however, I did play basketball in college at a small Division 3 school, so I lived and breathed March Madness. Going back to my high school days, I would carry an old radio in my favorite Duke Blue Devils duffel bag, and I’d wire headphones up through a sweatshirt, which in March in Florida is kind of out of place. I remember just sweating through the day, carrying my duffel bag, listening to the games that started at noon EST because I was that much into March Madness. But the real education for me came in college, when we finally played in the NCAA Tournament my senior year in Division 3. 

But today, I am retelling that story not only because we are in March, but also because there are some valuable lessons that coincide with it.

Don’t Compare Yourself to Others

I often get those old basketball pangs to...

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The Importance of GFEs (Good Faith Estimates)

 

 

A new law, now called the No Surprises Act, was passed in December of 2020 to take effect on January 1, 2022. Good Faith Estimates (GFEs) are a new requirement as of 2022 for all physician offices to offer their patients. We are going to look into these new requirements (how you can comply, what you need to do, and when you need to give this to your patients) and make it easy to understand so that you can comply with the law, which will eliminate patient complaints and lawsuits.

Why focus on the Good Faith Estimate?

The most important provision in this new law that we need to take into account is the Good Faith Estimate portion of the Act. The reason for that is twofold. First, most functional medicine providers are in physician offices in this context, so you do not have a team and you have to be the one who complies. Second, the No Surprises Act specifically excludes physician offices from its requirements. So you don't have to worry about it if you are a physician's...

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The Hows and Whys of ANNUAL REPORTS

 

Did you know that the state could shut down your business if you fail to file one form each year? The good news is that the form is very simple. It takes you less than 10 minutes, but if you forget to do it, the state will dissolve or terminate your company, and it will no longer exist. And this action will throw you into a state of sole proprietorship, which does not protect you from any liability if anyone were to sue you through the acts of your business. 

So what is the form? How can you file it? What do you need to put in it? How can you remember to file it?

What is the form?

I had a company called the LCR LLC, a shell company that I eventually let dissolve.  In this company, as I was figuring out my next steps to start Functional Lawyer, I could track expenses when I was in sales and on a commission basis.

The last event for this company that took place with the state of Florida on the state of Florida's Division of Corporations website was “Administrative...

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Does My Website Have to be ADA Compliant?

 

Does my website need to be American Disabilities Act (ADA) compliant?  What does ADA compliance mean? How can you achieve it and avoid potential litigation that will bring frustration and additional costs? These are a few questions that come up when complying with the ADA. The ADA was first signed in 1990.  With the rise of the global Internet, it applies to websites since websites are now a place of public accommodation under the American Disabilities Act. Private businesses, as well as the government, must provide this for their website visitors. 

What is ADA Compliance?

The American Disabilities Act is a civil rights law that prohibits discrimination based on disability, but for a website to be compliant, it must be accessible to people who browse the web with assistive devices. To be compliant not only do people who are blind using text readers need access, but also it could be a color or contrast issue. If a website is not accessible to people with disabilities,...

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Can I Call Myself a "Consultant"?

 

Many education and business training programs purport to teach doctors and other health care professionals that they can expand their practice by practicing telemedicine across state lines, or even in other areas of the world, under the guise of calling yourself a “consultant” or “health coach” and by signing a fancy consultant agreement.

Planning to order tests, diagnose illnesses, treat ailments, and prescribe medication (whether taking insurance or not, or getting paid or not), without a license, is a clear violation of the law. License and medical boards, as well as prosecutors, see through this deception and will prosecute you to the fullest extent of the law whether you harm someone or not. If you are participating in medical practices that a doctor is licensed to do, then you need a license to practice medicine. It’s simply not a good idea for you to call yourself a health consultant and practice medicine across state lines at the same time.

...

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FOUR Necessary Insurance Policies...

 

Not only do you need malpractice insurance, which is something you would not start your practice without, but you also need three other types of insurance in your practice and business. There are differences between each, and so you need to be sure you are covered in the various areas they address. Today, doctors are not recommended to be self-insured, so talk to an insurance agent you trust in regards to that.

Malpractice Insurance

Malpractice is the first insurance you want to get quotes on from your insurance company, making sure that coverage is in place in your practice. As you probably know, malpractice will cover you for your clinical decisions.  There are all kinds of malpractice: claims made, occurrence-based, and tail, etc.  A conversation with your insurance agent will provide the details you need to make informed decisions.

Telemedicine Malpractice Coverage

Practicing telemedicine is common today. So if your malpractice coverage does not already include...

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Can I Deduct Start-Up Costs?

 

Pre-LLC or PC

You don’t have to wait until your LLC or your PC is actually formed in order to start
incurring expenses that are deductible on your taxes. If you are getting ready to
start a business, the IRS knows that some of those initial start-up costs or
preparation costs are going to come from your own personal funds or that of the
other owners in the business. They’ve allowed for that and have rules on what can
and cannot be deducted prior to the date of incorporation. A lot of the start-up costs
are definitely deductible.

Allowable Expenses

Allowable pre-formation expenses include those related to investigation, such as
traveling to look at different office locations, even if you have to fly there, other
preparation costs like employee training or purchasing inventory. Organizational
costs are another category, like fees you pay the state for forming your business, or
legal fees, such as hiring an attorney, or money spent for other help to actually form
the business or...

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7 Legal Errors You Must Avoid

 

Dealing with medical records is a complicated subject, with many areas where mistakes are possible. When it comes to HIPAA, there are many preconceptions that some practices have that are not only incorrect, but can often lead to larger problems which can be very costly for the practice as a whole. In my time dealing with HIPAA regulations, I have seen a great deal of misconceptions that exist surrounding HIPAA, and several of them appear quite frequently. There are seven major examples of legal errors that I have seen, and I will break them down for you to help make sure that you don’t fall into the same traps that others have. 

Misconception #1

  • A noncustodial parent does not have the right to access their child's records. 

That is false. Unless there's a state specific law that says otherwise, both parents have a right to have access to their child’s medical records, unless there is a court order barring one parent from...

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Website Terms and Conditions: A MUST Have!

 

This week I want to share with you how we have saved around $60-$70,000 in potential HIPAA fines— just based on having a good, quality, working knowledge of how website Terms and Conditions work and what content to put in a website Terms and Conditions.

I have always said that forms, documents, and templates are just tools, but they are important tools that are necessary for success. It's also crucial to understand that you have to know how to use these tools correctly, much like a stethoscope.

 Potential Spam?

Case in point--this week, I received an email that, at first, looked like spam. It had come through my webpage and at first sight seemed alarming. This email would have been convincing, had I not understood my terms and conditions on my own website. Here is what the email stated:

 

Hello, Your website or a website that your organization hosts is violating the copyright-protected images owned by our company (intuit Inc.). Take a look at this doc with the...

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