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Attorney urges physicians to take hands-on, proactive approach to compliance
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NEW YORK — Meticulous compliance is the best strategy for physicians to weather regulatory requirements related to federal health care reform legislation, an attorney said here.
"I have never been busier, I am sad to say, where I have been working defending physicians, hospitals and health care entities against alleged fraud. It's absolutely over the top right now," Alan E. Reider, JD, MPH, OSN Regulatory/Legislative Section Editor, said at OSN New York 2011.
Mr. Reider urged physicians to take an active role in developing and implementing a compliance plan to prepare for requirements included in the Patient Protection and Affordable Care Act.
A compliance plan should include an annual billing and coding review. However, physicians should seek advice from professionals who specialize in such services and not from fellow physicians or drug or device companies, Mr. Reider said.
In addition, physicians should purchase fine and penalty coverage, taking care to select an appropriate policy.
Mr. Reider also advised physicians to review their financial relationships with pharmaceutical and device companies. Starting Jan. 1, 2012, payments made by pharmaceutical and device companies to physicians will be reported to the secretary of the Department of Health and Human Services and publicly disclosed on a government website after March 31, 2013, Mr. Reider said.
Additionally, physicians may bill Medicare patients for non-covered services but not services for which Medicare does not reimburse, Mr. Reider said.
"That's a very fine distinction but it's a very important one," he said.
As accountable care organizations prepare to enter the Medicare arena on Jan. 1, 2012, many private insurers are developing similar health care delivery templates, Reider said.
"The private side has said, 'This makes sense. We want to change the paradigm. We want to change the way health care is delivered. We're going to empower physicians to make decisions about how it's being delivered and we're going to reward them as long as the care is right and if we can save money,'" he said.
- Disclosure: Mr. Reider is a partner with the law firm Arnold & Porter LLP. He has no financial interest in matters that he addressed during his presentation.