Robert Liles

Robert W. Liles is Managing Partner at the law firm of Liles Parker in Washington, DC. Prior to entering practice, Mr. Liles was an Assistant U.S. Attorney in the Southern District of Texas. Mr. Liles' background is in health care administration. Prior to becoming a lawyer, Mr. Liles worked in various management positions in hospitals in San Antonio and Houston, Texas.

Physician Accommodations in CMS’s Face-to-Face Encounter Rules

Home Health & Hospice /

(July 21, 2014): As a condition of Medicare payment, the Affordable Care Act (ACA) requires that prior to certifying a patient’s eligibility for the home health benefit, the certifying physician must document that he or an allowed non-physician practitioner (NPP) had a face-to-face encounter with the patient. This requirement ensures that the physician’s order is […]

Physician Accommodations in CMS’s Face-to-Face Encounter Rules Read More »

CMS Proposes Changes to Medicare Home Health Benefit Face-to-Face Encounter Requirement

Home Health & Hospice /

(July 18, 2014):The Centers for Medicare & Medicaid Services (CMS) has proposed several changes to the Medicare Home Health Prospective Payment System (HH PPS). Medicare pays Home Health Agencies (HHAs) through the PPS and pays higher rates for services furnished to beneficiaries with greater needs. One of the proposed changes to the HH PPS involves

CMS Proposes Changes to Medicare Home Health Benefit Face-to-Face Encounter Requirement Read More »

CMS Guidance on the Role of a Medical Director

Medicare, Medicaid & Private Payor Updates /

(July 16, 2014): In 2005, the Centers for Medicare and Medicaid Services (CMS) revised and implemented surveyor guidance pertaining to the role of medical directors in long-term facilities. This guidance gives surveyors and providers more information about the role of a medical director, which is outlined in regulation 42 C.F.R. §483.75 (i). It also helps

CMS Guidance on the Role of a Medical Director Read More »

The Changing Definition of Medical Necessity

Medicare, Medicaid & Private Payor Updates /

(July 16, 2014):The term “medical necessity” has varying definitions depending on who is using it. Providers, physicians, courts, private insurers, state governments, and the federal government all have their own interpretation of what constitutes medical necessity. This changing definition of medical necessity can be problematic when a provider’s claims are audited by a Zone Program

The Changing Definition of Medical Necessity Read More »

Hospice Providers – New HIS Record Requirements!

Medicare, Medicaid & Private Payor Updates /

(July 7, 2014): As of July 1, 2014, Medicare-certified hospices must directly submit a Hospice Item Set (HIS) (for Admission and Discharge) records for each patient admission that occurs on or after July 1. These HIS records must be completed on an ongoing basis and submitted electronically the Centers for Medicare & Medicaid Services. Any

Hospice Providers – New HIS Record Requirements! Read More »

Responding to a Texas Medical Board Complaint

Medicare, Medicaid & Private Payor Updates /

(July 7, 2014): The Texas Medical Board (Board) investigates complaints against physicians, physician assistants, acupuncturists and surgical assistants. A Texas Medical Board complaint can be filed by a patient, a patient’s family or a health care provider. On the average, the Board receives and evaluates over 7,000 complaints each year. The kinds of violations the

Responding to a Texas Medical Board Complaint Read More »

The Cloud Storage of Medical Records Presents a Number of Risks

Medicare, Medicaid & Private Payor Updates /

(July 3, 2014): The growing trend of storing all kinds of data in the cloud comes with benefits and risks. However, when it comes to storing medical records in to the cloud, patient privacy becomes a special concern. With a properly implemented cloud storage system, hospitals can share information far more efficiently. Prescriptions and test

The Cloud Storage of Medical Records Presents a Number of Risks Read More »

Physician Office OSHA Standards Present a Number of Compliance Challenges

Medicare, Medicaid & Private Payor Updates /

(July 2, 2014): The Occupational Safety and Health Administration (OSHA) is an agency of the United Stated Department of Labor. Its purpose is assure safe and healthy working conditions for all working men and women by setting and enforcing standards and by providing education, training, outreach, and assistance. OSHA creates standards and guidelines that apply

Physician Office OSHA Standards Present a Number of Compliance Challenges Read More »

Investigations of Medicaid Dental Fraud in Texas

Dental Audits & Compliance /

(July 1, 2014): Law enforcement authorities are actively investigating and prosecuting health care providers for crimes based upon allegations of Medicaid dental fraud in Texas. When looking for fake billing to the Medicaid program, investigators have historically targeted hospitals and doctors, but increasingly dentists have come under watch. In Texas, new measures have been adopted

Investigations of Medicaid Dental Fraud in Texas Read More »

Texas H.B.300 Imposes a Number of New Medical Privacy Requirements

Medicare, Medicaid & Private Payor Updates /

(June 30, 2014): The federal Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health Act (HITECH) work in conjunction to safeguard the privacy of patient health information. Concerned that HIPAA and HITECH did not provide enough safeguards for protected health information (PHI), the Texas legislature passed the Texas

Texas H.B.300 Imposes a Number of New Medical Privacy Requirements Read More »