Mutual Matters

Reducing Medical Errors by Improving the Diagnostic Process

Posted by Marshaleen King, MD on Nov 16, 2017 1:30:00 PM

Introduction

Medical errors remain a major cause of morbidity and mortality and recent estimates indicate that it is likely the third leading cause of death in the US, [1] with some sources reporting an incidence of 210,000 to 400,000 deaths annually due to errors among hospitalized patients.[2]

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Topics: Patient Care and Interaction

Billing Under Another Provider's Number Can Land Physicians in Hot Water

Posted by Emma Cecil on Nov 7, 2017 11:29:00 AM

An Oklahoma physician agreed on August 28, 2017 to pay the government $580,000 to resolve allegations that he violated the False Claims Act by submitting claims to the Medicare program for services he did not provide or supervise. According to the government, the physician allowed a company that employed him and in which he had an ownership interest, to use his national provider identification (NPI) numbers to bill Medicare for physical therapy evaluation and management services that he did not provide or supervise. The government further alleged that after he separated from the company and deactivated his NPIs associated with the company, he reactivated those NPIs so that the company could use them to bill Medicare for services he neither performed nor supervised.

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Topics: Billing and Reimbursement

Lack of Medical Necessity & the Criminalization of Clinical Decision Making

Posted by Emma Cecil on Oct 31, 2017 11:00:00 AM

In 2010, Georgia nursing home owner and operator, George Houser, was charged in a federal indictment with conspiracy to commit healthcare fraud on the theory that he had billed Medicare and Medicaid for services that were so inadequate or deficient that they were essentially “worthless.”

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New GA Controlled Substances CME Requirement – Effective Jan. 1, 2018

Posted by Carrie Lowe, J.D. on Oct 19, 2017 1:00:00 PM

Georgia physicians who have an active DEA certificate and prescribe controlled substances are now required to complete, one time, three hours of CME that are designed to specifically address controlled substance prescribing, including:

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Hospital Pays $42 Million to Resolve False Claims Act Allegations

Posted by Emma Cecil on Oct 12, 2017 1:00:00 PM

Los Angeles-based acute care hospital, Pacific Alliance Medical Center (PAMC), has agreed to pay $42 million to resolve whistleblower allegations that it violated the False Claims Act (“FCA”) by submitting, or causing to be submitted, false claims to Medicare and MediCal for services rendered to patients who had been referred by physicians with whom PAMC had improper financial relationships.

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Costly Genes: Genetic Testing and Patient Care

Posted by Marshaleen King, MD on Oct 5, 2017 12:23:00 PM

Case scenario

A 28-year-old woman presented to a primary care physician for a new patient visit. The physician conducted a fairly thorough history; however, he obtained the patient’s family history from a patient intake form, which only included questions about hypertension, heart disease and diabetes in family members. The physician neglected to ask the patient about any family history of cancer and failed to revisit her family history at any point during her subsequent follow-up visits.   

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Case Study: Wrong Site Surgery

Posted by Hall B. Whitworth, Jr., MD on Oct 3, 2017 12:08:00 PM

A 49-year-old man underwent a colonoscopy by a colorectal surgeon who identified a large, firm tumor causing partial narrowing, approximately 60-70 cm from the entry site. Pathology of this tumor was suspicious for carcinoma. In addition, a polypectomy was performed at a different location, and the site was tattooed. Pathology of this second site was consistent with tubulovillous adenoma.

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OIG Estimates Medicare Paid Over $700 Million in Noncompliant EHR Incentive Payments

Posted by Scott R. Grubman, Esq. on Sep 26, 2017 1:00:00 PM

Scott R. Grubman, Esq. Gregory A. Tanner, Esq. Chilivis, Cochran, Larkins & Bever, LLP

On June 7, 2017, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a report estimating that Medicare paid over $729 million in improper EHR incentive payments to healthcare providers who did not meet meaningful use requirements. 

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The Challenge of Noncompliance with Medical Recommendations Part 2

Posted by Hall B. Whitworth, Jr., MD on Sep 21, 2017 1:00:00 PM

 

The assessment of patient compliance is very difficult. Many patients may not want to disappoint their physician and will not be completely accurate about their degree of compliance. Other patients are not able to accurately evaluate or do not know their degree of compliance. In one study, 10% of patients reported that they were 100% compliant with their medication use. Using pill count methods, however, the use of the prescribed medications ranged from 2% to 130% of the prescribed pills.

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Opioids – The North Carolina STOP ACT

Posted by Blake Fagan, MD on Sep 14, 2017 12:30:00 PM

In the fight against the opioid epidemic, The North Carolina STOP Act (Strengthen Opioid Misuse Prevention) is a start.

As you may have heard, the STOP Act bill was signed into law on June 29, 2017. Here are some facts about how it will affect providers.

The following prescribing limits go into effect January 1, 2018:

  • If you are going to prescribe opioids for acute pain, you will be limited to a five-day supply or less with the initial prescription.
  • If you are going to prescribe opioids for post-operative pain, you are limited to a seven-day supply or less with the initial prescription.
  • Further opioid refills require a subsequent consultation. The provider may issue an appropriate refill with the consultation.
  • Providers should review a patient’s 12-month history in the NC Controlled Substance Reporting System (CSRS) prior to providing any opioid for pain and, if providing opioids on an ongoing basis, like for chronic pain, should review the patient’s history in the CSRS every three months thereafter. The review must be documented in the chart, or when applicable, document the technical reason that kept the provider from reviewing the CSRS.

The above rules are not required for hospice, palliative care, patients with cancer, patients in the hospital or in long-term care facilities.

So, now you know the summary of the law and how it affects us, but why did the government pass this law? Four people die every day in North Carolina from an opioid overdose. In 2015, patients in NC were dispensed 660 million opioid pills. We, as a medical community, were asked to prescribe less opioid pills. In 2016, patients in NC were dispensed 700 million opioid pills.  Furthermore, data shows that if an opioid naïve adult is prescribed a 30-day supply of an opioid prescription, he/she has a 35% chance of being on an opioid at one year and a 20% chance of being on an opioid at three years. The data shows that the increased risk of staying on an opioid starts to rise after five days of taking an opioid prescription.

To read the North Carolina Medical Board’s summary of the STOP Act, click here. To read the full text of the STOP Act, click here.

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Here we share some basic insights on matters that are important to physicians, hospitals and healthcare professionals.

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  • MACRA
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