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Emily A. Johnson, Associate, McDonald Hopkins

Balance Billing: What Providers Need to Know


By Emily A. Johnson
Associate
McDonald Hopkins LLC


The topic of balance billing has become a top draw in the media, with headlines shouting "surprise" or "hidden" medical bills, and has been described as an "unfair medical practice" and even "the ugly beast of medical insurance." At the same time, waivers or reductions of patient out-of-network balances can present false claims of liability for the provider under both federal and state law. Moreover, private payors are becoming increasingly more likely to sue and cease paying such providers who routinely waive or reduce patient out-of-network balances or are ceasing to pay such providers altogether. How do we as medical professionals guide ourselves through the waters of potential out-of-network status, and the extremities portrayed in these consumer issues? In this article, we explore the challenges and risks associated with balance billing (regardless of whether balance billing is done by choice or out of legal necessity), the potential impact of both local and national legislation, and ideas on how to educate patients and manage their responses.  Read article
Auditor going over results with health care staff

Health Care Organizations: Are You Prepared for an I-9 Audit?


By Marsha T. Mavunkel
Attorney, Ryan, Swanson & Cleveland, PLLC

U.S. Immigration and Customs Enforcement (ICE) has focused on creating a ‘culture of compliance’ by heavily relying on I-9 inspections to find and fine employers who do not follow immigration laws regarding employment eligibility verification. Immigration law (8 U.S.C. § 1324a (b)) requires organizations to verify the employment eligibility of each employee by completing and maintaining Form I-9. ICE’s Homeland Security Investigations (HSI) unit can audit any health care organization on a random basis or by following a lead from the public, other businesses, disgruntled employees at the workplace, or through tips from other government agencies. The number of businesses subjected to I-9 audits has soared from a couple hundred less than 10 years ago to thousands today. HSI continues to issue Notices of Intent to Fine (NOFs) at an unprecedented rate for Form I-9 related violations. Read article
Teen Being Counseled by Behavioral Therapist

A Vision for the “Next Generation” Community Behavioral Health Center


By Patrick Evans
CEO, Sound Mental Health

All too often, behavioral health is viewed as a secondary health care segment, incorrectly perceived as ancillary to larger health care quality outcomes and measures. The nonprofit community behavioral health sector is encumbered by these perceptions, struggling to stake its claim as a valid contributor to the business and health care communities. Yet, as part of a larger system dedicated to the integration of health care (and, therefore part of the solution in improving health care outcomes, reducing runaway costs and bringing greater efficiencies), the next generation behavioral health providers should find these perceptions changing.  Read article
Calculator with Financial Graphs and Images on Chalkboard

Health Plans Report Financials Through June 30, 2016


By David Peel
Publisher and Editor, Washington Healthcare news

Fourteen of the largest Washington health plans recently reported financial information through June 30, 2016. Eight of the plans were profitable while the other six were not. See how all the plans did by reviewing our interactive "Plan Financials" page.  Review Financials
HIPAA regulations folder on desk with pen

U.S. Office for Civil Rights to step up investigations of small HIPAA breaches


By Richard S. Cooper, Esq.
Member, McDonald Hopkins LLC

In mid-August 2016, the U.S. Department of Health and Human Services Office for Civil Rights (OCR) announced its new initiative to investigate breaches of protected health information (PHI) affecting fewer than 500 individuals. Read article
Physician in Handcuffs

Minimizing Healthcare Regulatory Risk


By Michael Reph, CLCS, MBA
Account Executive, Parker Smith Feek

Regardless of your role within the healthcare space, everyone can have an impact on how an organization minimizes regulatory risks. Healthcare executives need to understand the trending regulatory claims, the best way to partner with insurance associates, and how varying policies interface with the associated liabilities. Read article
Dental patient in Chair

When Dental Work Doesn’t Work: Fixing Problems Caused by Subpar Dentistry


By Jonathan Everett, DDS
Dentist, Kirkland Family Dentisry

Many people dread going to the dentist, but the one consolation they have is that they can usually be sure that the procedure they’ve had will help them in the long run and is beneficial to their overall dental health. Unfortunately, this is not always the case. Instances of subpar dentistry causing problems or exacerbating existing problems are common. However, we all have a right to great dental care which we have paid for with our time, money, and energy. Thankfully, it is possible to fix most of the problems that subpar dentistry causes. If you have a patient who has been negatively impacted by poor dental work, you can guide them through many options for solving these problems. Read article
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