Ashley Morgan

HIPAA Security Risk Assessments are Essential

(September 29, 2014) In the last article, we discussed the importance of conducting HIPAA security risk assessments, as part of your obligations under the HIPAA Security rules. The importance of promptly conducting a risk analysis if it has not yet done cannot be overestimated, as the HHS Office for Civil Rights (OCR) has now announced […]

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Peer Review: How HCQIA Due Process is a Fiction

(August 31, 2014): The Healthcare Quality Improvement Act of 1986[1] (“HCQIA”, generally pronounced “Hick Kwah”), affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. Unfortunately, the provider peer review process is irrevocably

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A HIPAA Risk Assessment is Essential to Avoid Liability

(August 23, 2014): Almost all health care providers and suppliers qualify as a “covered entity” under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Together with the “business associates” with whom they work, these entities are responsible for ensuring that any protected health information (PHI) under their control has been properly secured and

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Medicare ALJ Appeals of Denied Home Health Claims

(February 11, 2014): Has a Zone Program Integrity Contractor (ZPIC) denied your home health claims? If you believe that these denials are unwarranted, your home health agency (HHA) may challenge the denials through Medicare’s administrative appeals process. Medicare’s appeals process provides five levels of appeal. The first four levels of appeal are before different administrative

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Is Your Dental Practice Prepared to Undergo a Medicaid Dental Audit?

(November 25, 2013): The link between oral health and overall health has been increasingly acknowledged over the years. Emphasis has been placed on children’s oral health in particular. In fact, the Children’s Health Insurance Program Re-authorization Act of 2009 (CHIPRA) mandates that “child health assistance provided to a targeted low-income child shall include coverage of

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Texas Medical Board Complaints are Serious Business!

(September 20, 2013): Like other physicians around the country, Texas physicians are currently facing increasing pressures to ensure that their medical necessity determinations, coverage assessments, documentation, coding and billing activities meet both Medicare’s requirements and those of private payors. While their duties and responsibilities have continued to increase, reimbursement rates have steadily fallen. Notably, Texas

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PERM Audits of Medicaid, Managed Care and CHIP Claims are Ongoing. Are You Prepared to Respond to a PERM Audit?

Author: Ashley Morgan, Annabella Denzel (September 28, 2023): Providers participating in the Medicare and Medicaid programs are currently subject to audit by numerous Federal and State regulatory and law enforcement agencies. Additionally, the Centers for Medicare and Medicaid Services (CMS) has entered several contractual arrangements with private contractors to handle various aspects of administrative integrity

PERM Audits of Medicaid, Managed Care and CHIP Claims are Ongoing. Are You Prepared to Respond to a PERM Audit? Read More »

Peddling and Soliciting, Municipal Regulations These Issues Can be Complex. Is Your City Clear on These Points?

(January 8, 2013): As a general rule cities can regulate hawking, canvassing, peddling and soliciting within city limits. International Society for Krishna Consciousness, Inc. v. Lee, 505 U.S. 672, 112 S. Ct. 2711, 120 L. Ed. 2d 541 (1992). The public policy that allows cities to regulate peddlers or the solicitation of contributions is to

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