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Pathology Compliance Update: Legal Insights on Billing, HIPAA, and Recent Developments

Join Bridget Cougevan, Esq. from McDonald Hopkins LLC for a comprehensive update on compliance in pathology services. This presentation covers vital topics including recent legal developments in pathology billing, audit activities, and HIPAA regulations under HITECH. Learn about critical issues such as Medicare regulations, Stark law exceptions, and EHR donation requirements. Gain insights into research study arrangements and the implications of new compliance standards. This informative session is essential for anyone involved in the legal and operational aspects of pathology services.

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Pathology Compliance Update: Legal Insights on Billing, HIPAA, and Recent Developments

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Presentation Transcript

  1. Pathology Services:Legal Compliance Update Presented By: Bridget Cougevan, Esq. McDonald Hopkins LLC 600 Superior Avenue, East, Suite 2100 Cleveland, OH 44114 216-348-5842 direct dial 216-348-5474 facsimile bcougevan@mcdonaldhopkins.com October 5, 2013

  2. COMPLIANCE Topics Covered: • Recent Developments • Research Study Arrangements • Pathology Billing and Audit Activities • In-house laboratories • Account billing • EHR donations • HIPAA: HITECH Final Rule

  3. RECENT DEVELOPMENTS • Stark in-office ancillary services exception: • Removal of anatomic pathology professional and technical services • Physician fee schedule • OPPS/APC fee schedule • Coding

  4. RESEARCH STUDY ARRANGEMENTS • Privacy considerations • HIPPA • Institutional Review Boards • Legal Issues • Data ownership • Publications • Inventions • Material Transfer Agreements

  5. Pathology Billing and Audit Activities • Medicare RACs, ZPICs • EHR Considerations

  6. ACCOUNT BILLING Account Billing/Client Billing Arrangements: Physician purchase professional and/or technical component pathology services at a discount and bill the payor. Typically excludes government work. • Medicare Anti-Markup Regulations • Other Payers • State Prohibitions

  7. EHR DONATIONS • Stark law exception & AKS safe harbor • Permitted for a narrow range of donations • Must not take into account the volume/value of referrals • May not have protection after December 31, 2013 • State Restrictions • Donation Requirements

  8. HIPAA: HITECH Final Rule • Business Associates • Agreements • Notice of Privacy Practices • Restrictions on disclosure of PHI • Security Breaches and Breach Notification • Enforcement

  9. Questions? Contact Information Bridget Cougevan, Esq. McDonald Hopkins LLC 600 Superior Avenue, East, Suite 2100 Cleveland, OH 44114 216-348-5842 direct dial 216-348-5474 facsimile bcougevan@mcdonaldhopkins.com

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