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11/11/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Michael L. Wodka, DPM
OPEIU Guild 45 was first chartered on October 24, 1996, as the "First National Guild of Healthcare Providers of the Lower Extremity" and appeared on the front page of The New York Times the next morning. This endeavor was in large part due the insights of Dr. John Mattiacci, who is the President of Guild 45.
We have had many successes over the years with different Legislative and Insurance issues. OPEIU Guild 45 currently represents 36% of the practicing podiatrists in the U.S.
To learn more about our "Podiatry Union", check out opeiu.org, or call Mike Davis (717) 763-7665.
Other messages in this thread:
07/05/2024
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Name Withheld (FL)
Name Withheld, I commend you for the way you will be handling a difficult situation. This was an honest mistake on your part, and you are trying to remedy the situation. The most important advice I would give you is to contact a medical consultant to guide you along this process. Hopefully, you are with a malpractice company that provides you with legal defense. If so, they will talk you through the process of reporting these errors to insurance companies. Several years ago, I had a circumstance where I misinterpreted the regulation of taking x-rays in my office. I thought the rules stated that as long as the practicing podiatrist is in the office the assistant can take an x-ray without being certified. I unfortunately found out this wasn’t the case.
Although we did not take many x-rays in our office, enough were taken through the years that would have put me in a difficult situation had that not been reported. I did have legal defense through PICA and they put me in contact with a healthcare consultant. It turned out to be an expensive mistake. Working with the healthcare consultant, they contacted Medicare to explain my circumstance. Medicare appreciated our transparency, but still asked for a refund of $10,000 dollars. This amount was based on three years' worth of billing. Obviously, this was not a slap on the wrist, but if they would have discovered this error themselves via a whistle blower or disgruntled employee, they could have gone back, I believe, seven years or more if fraud was suspected.
You are doing the right thing by reporting this unfortunate situation but you must go about it the right way.
Name Withheld (FL)
03/19/2019
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Elliot Udell, DPM
On the surface it may appear that unless you write prescriptions for narcotics, spending close to a thousand dollars to renew a DEA number seems unnecessary. The problem is that certain states will require a DEA number in order to prescribe other non-narcotic medications. At the SAM meeting, one of the speakers said that in the state of Florida, one must have a DEA number in order to prescribe Lyrica. Double check this if you practice in Florida. In New York, Ketamin trochies require that the prescriber have a valid DEA number. The bottom line is that you should survey what medications you prescribe and then ask the local pharmacy whether you need a DEA number to prescribe them in your particular state.
Elliot Udell, DPM, Hicksville, NY
09/26/2015
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: William Deutsch, DPM
I have two suggestions for the DPM considering selling his practice and retiring.
1. Do not ratchet down your practice. Instead try increasing your income and patient load.
2. Market your practice to a podiatrist contented to do only forefoot/mid-foot surgery. After all, how many rear foot surgeries come breaking down your door?
As an alternative, market your practice to an enterprising orthopedist specializing in foot and ankle disorders and willing to open a foot treatment/wound clinic. Forget the hospital cutting podiatry a break. You might have to put your retirement off by a decade.
William Deutsch, DPM, Valley Stream, NY
12/22/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Jim DiResta, DPM, MPH
It has been my experience that credentialing committees will accept activity at another facility where you maintain privileges in lieu of not seeing enough patients at their particular facility where you lack the minimum 20 patient encounters over the 2-year period. This is a fairly common occurrence and protects the hospital in recredentialling you for medical staff membership. Often there are two parts to this. One is hospital membership where you need patient contacts, i.e. inpatient consults, out patient treatments, OR procedures, or activity in the hospitals wound care center. The second is surgical privileges. Many surgical departments are now requiring certain volume thresholds of surgical procedure activity to renew providers privilege cards. Satisfying that request is more daunting.
The other issue Dr. Borreggibe raises as to whether you should voluntarily relinquish your privileges or allow the facility to not renew them is a question that I would seek out legal counsel as you will be asked this question on numerous renewals for third-party payer contracts, ACO involvement, healthcare privilege applications and license renewals, etc.. and it would appear taking a proactive course of voluntarily giving up your membership and privileges would be wiser with a reason that you simply no longer need use of that facility for non-renewal rather than allow them to "take your privileges away" and have to continually explain that to other parties in the future.
Jim DiResta, DPM, MPH, Newburyport, MA
12/18/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Elliot Udell, DPM
A friend of mine called me over the weekend asking me about similar paperwork she had to sign in order to gain admission to a motivational seminar in New York City. I could not imagine anyone suing them over not "being motivated"; however, what they may be concerned with is if she is not happy with the program, leaves early, and wants her six hundred dollars returned.
This would go to arbitration. This might be what is so with the orthopedic group. With high co-payments with the new insurance plans, many patients might run up a bill for a couple of thousand of "out-of-pocket" dollars and look for ways to not pay the bill. Some patients truly believe they are covered for all services, and then refuse to pay even though the visits went toward a four thousand dollar deductible. In other cases, the patients might claim they do not owe money because their knees or shoulders did not feel better. I cannot see a court allowing a patient to sign his or her rights to sue for professional negligence.
Elliot Udell, DPM, Hicksville, NY
09/02/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Seth J. Steber, DPM
There is a group you can join called Doctor's Advocate: doctorsadvocate.org. For less than your state and national dues, you can become a member. Their attorneys and staff will handle independently any potential lawsuit, PR issues, threats, slander, etc. Since they are not an insurance company, they can contact your potential plaintiff and their attorney directly to discuss the matter and "educate" them on frivolous lawsuits and potential for counter-suits.
08/29/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Elliot Udell, DPM
Dr. Jacobs is correct when he states, "In-office compounding has been around a long time." My dad is a retired pharmacist. When I was little kid in the 1950s, I remember visiting his drug store. In those days, pharmacists were not highly educated professionals. Their roles were often reduced to taking pills out of a stock bottle, counting them out into a small plastic bottle, and slapping a label on it. In those days, all physicians wrote for compounds, and my father showed me how he would hand-make ointments, cough syrups, pills, and suppositories based on physicians' prescriptions (which were always written in Latin). With compounding pharmacies, the profession has come full circle and pharmacists are once again doing the work that measures up to their years of intense training.
07/22/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Peter Bregman, DPM
It is possible that the patient had an underlying tarsal tunnel syndrome that was exacerbated by this injury. It will be difficult to prove this. It is also important not to rely on EMG/NCV studies and document the clinical presence by Tinel's sign and by provocation. Is also important to look more proximately at the soleal sling as well for tibial nerve entrapment.
07/18/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Brian Kashan, DPM
One of the factors in repeated treatments and visits, in my opinion, is if it is for a covered service or not. If it is not a covered service, i.e., routine care in a non-diabetic, I do not believe that repeated notes are as much of an issue. If it is for a covered and billed treatment, I believe there is a definite need for different documentation.
While most repeated visits can be 95% exactly the same, there are small variants from visit to visit. A note of social changes, illnesses, medication changes, or the lack thereof, can be noted. The size and severity of the lesion from visit to visit may change. Some skin irritation or nail subtlety may be present. It doesn’t have to be a huge difference, but just a few words that make that day's visit somewhat different, so someone can determine that day was different from any other day. Patients relate all kinds of things to us during their visits. I suggest jotting down a few words that they relate happened, or that you observe from visit to visit.
06/27/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Alec Hochstein, DPM
Anti-kickback laws at both the federal and state level make it illegal for a prescriber to benefit financially from referring a patient to a specific pharmacy or other medical service. The federal laws and many states include specific provisions to create a “Safe Harbor” exemption to the anti-kickback laws. Physician Specialty Compounding, LLC (PSC) has worked with a number of law firms to document the steps for creating the “Safe Harbor” required for a prescriber-owned pharmacy. After the signing of a mutual Non-Disclosure Agreement, PSC is happy to share our lawyers’ legal analysis. PSC strongly recommends that you consult with your attorney to protect your interests and to verify full compliance with all federal and state laws.
Disclosure: I am a medical consultant for Physicians Specialty Compounding, LLC.
04/16/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Pete Harvey, DPM, Jack Kay, PhD
Isn’t your info backed up on a cloud or hard drive? The emails should be there even if they were deleted by Google. If it is not backed up, then start TODAY! A forensic Information technologist might be able to recover the data if your own IT team can't.
I am not an attorney; I do not dispense legal advice. But allow me to offer the following — In Massachusetts, to cite only one example, there is something called the Massachusetts Wage Act, which subjects an employer and its entire board of directors to three times the amount of wages withheld. I doubt very much that the Massachusetts judges who administer this court would care a whit as to the rationale for withholding such wages; as a group, they tend to be employer-hostile. All podiatrists should seek legal counsel before embarking on a risky course of action such as this.
02/14/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Paul Kesselman, DPM
According to the Provider Outreach and Education Department for DME MAC A, they are adding a feature on their website which should address some of the questions raised by Dr. Schaffer.
DME MAC A is adding a "physicians only" portal to its website. This will list the documentation requirements for physicians for various DME products. Echoing the posting by David Mullens, DPM, Esq, the DME MAC cannot list requirements which are contrary to Stark or other CMS requirements.
Check your DME MAC website within the next 3-4 weeks for this information.
02/13/2014
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Paul Kesselman, DPM
My classmate and colleague asks several questions which are actually quite more complicated than they appear. First off, the issue of Stark and signing off on a podiatric diagnosis are two separate issues, which apparently he/she is confusing as are other MDs/DOs and DPMs.
The Stark issue is one that I would defer to an attorney to provide a formal legal response. In lieu of that, I have personally spoken with several healthcare attorneys who are well-versed in Stark and I can provide you with a brief explanation. In most cases, as long you are...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
11/23/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Philip J. Shapiro, DPM
With regard to Dr. Udell’s question about documentation on referrals for outside of the scope of podiatry practice, the answer is yes. Any time that a medical professional makes a referral, regardless of the reason, that needs to be noted in the progress notes. The underlying issue of liability is that the patient asked you based on your professional status and knowledge; it was not a casual inquiry of general public conversation.
You are to some degree liable for the referral. If you know the practitioner to be unprofessional or impaired or controversial, that referral could come back to haunt you if your patient experiences an adverse outcome linkable to the referral. Again, the patient asked you for referral advice based on your professional status. If you are unsure whom to refer to, advise your patient to communicate with his/her primary care physician or to obtain a referral from the local hospital – and even then, document that into your progress notes.
11/20/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Ron Werter DPM
We have podiatrists worried that that they have to accept these patients, yet I just received a letter from Empire Blue of New York telling me that they will not let me accept exchange patients. They let me know in no uncertain words that "according to the terms of my contract," I will not be participating in the exchange plans that they are coming out with. I'm not really sure what to think.
11/09/2013
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
From: Martin V. Sloan, DPM
Clearly, there is a tremendous amount of misinformation out there. In our community, there will be two carriers offering "Obamacare", Blue Cross Blue Shield and Firstcare. Both are HMO models requiring a PCP referral to the podiatrist. Each community will have carriers unique to their region (e.g. Aetna will be a provider in the Houston market). They WILL have their own fee schedules just as other companies have. They've told us the reimbursement will be somewhere between Medicare and PPO rates (a pleasant surprise because I anticipated it would be Medicaid rates). Providers CAN opt out or in to treat these patients. The KEY caveat to Obamacare patients with subsidized plans is this: if the patient is delinquent in paying for his/her premium, the insurance company might pay the doctor and subsequently demand a refund.
Specifically, if the delinquency goes into a second or a third month, the insurance will pay the provider. But they will recoup their money if the delinquency continues. The good news is this information will be made available and the provider, aware of the delinquency, can either stop providing care or hold the patient financially responsible as a "non-insured entity". In short, each community will have specific insurance carriers which offer "Obamacare". They will have a specific fee schedule. And the doctor can either accept or not accept these patients at his/her discretion.
09/24/2012
RESPONSES/COMMENTS (MEDICAL/LEGAL) - PART 1B
RE: Stark Violation (Michael M. Rosenblatt, DPM)
From: Dan Klein, DPM
I agree with Dr. Rosenblatt about podiatrist audits for routine care and billing CMS for this service. I have advised nursing home (NH) families and administrators that I refuse to bill insurance for this service and refer them to the Medicare statement about routine foot care. The majority of NH residents do not qualify under CMS guidelines, and I charge for the service. I have even seen and spoken with CEOs of companies that solicit for podiatrists to work for them doing routine service and billing insurance for this service. I refuse to give into coercive efforts by NH administrators to reference so and so podiatrist who bills insurance for all services.
I have told these administrators that my integrity for honest billing practices cannot be changed through coercion. Let those other podiatrists provide this service, bill insurance for routine care, and be subject to fraud investigation. Most families of NH residents understand and agree to have routine foot care provided on a re-occurring basis for a fee. They are glad not to have to transport their family member to the podiatry office for this service. If a service is deemed to be billable, I bill the appropriate insurance. This is done in concert with consults by the primary physician for these services.
Dan Klein, DPM, Fort Smith, AR, toefixer@aol.com
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