Pack of THREE : Most Popular Healthcare Courses

Overview: Under the Social Security Act, reimbursement for telehealth under Medicare has been subject to stringent restrictions. Under the Social Security Act, reimbursement for telehealth under Medicare has been subject to stringent restrictions.

Only patients in certain identified practice settings in rural, physician-underserved areas were eligible. Care into the patient's home was not covered.

Only certain providers were eligible. With rare exceptions (demonstration sites in Hawaii and Alaska), only real-time, audio-video communications were eligible. And, only a rather modest number of CPT codes were eligible. These provisions are still good law. In 2015, however, the first modification of these rules appeared, allowing reimbursement, still subject to extensive restrictions, for chronic care management. Because a co-pay had to be charged, patient consent was required, for services that the patient had previously received at no charge.

Plenty of other limitations were imposed as well. For example, the patient has to have access to care management services 24/7, a comprehensive care plan has to be developed, only 1 practitioner/month is eligible for reimbursement, and providers have to document that clinical staff spent 20 minutes of non-in-person time in a given month.

For the first time, however, distance care services provided by staffers, as opposed to qualified HCPs, and delivered by email or phone, for example, as opposed to by videoconferencing, could satisfy Medicare's requirements for reimbursement. In 2018, CMS developed the highly creative concept of communication technology-based services ("CBTS"), distinguished from telemedicine on the theory that these are not simply substitutes for in-person care, but are inherently electronic in nature and thus outside the scope of the telemedicine reimbursement rules of the Social Security Act.

Consent and co-pay provisions attend these services also, as well as somewhat onerous "related visit rules" that to some degree limit the value of this new opportunity. Nevertheless, it is now possible to be reimbursed for remote evaluation of patient images and videos; for so-called "virtual check-ins," designed to determine whether an in-person evaluation is necessary; and for interprofessional consultations. In addition, reimbursement for remote patient monitoring ("RPM") is both more generous and easier to obtain under CBTS reasoning than it had been before this innovation. In particular, originating site and geographic restrictions on RPM reimbursement are now things of the past. By no means are these the only changes of note.

The Bipartisan Budget Act of 2018 and the SUPPORT Act have also expanded reimbursement opportunities as well. Under the BBA, Medicare Advantage plans may offer "additional telehealth benefits" as part of "basic benefits" not otherwise available in Original Medicare under Part C, and may "treat them as basic benefits for purposes of bid submission and payment by CMS." Renal dialysis facilities and a beneficiary's home may now serve as originating sites for dialysis and monthly ESRD-related clinical assessments.

Coverage is now available for acute stroke telehealth services in any hospital, CAH, mobile stroke unit, or any other site determined appropriate by the Secretary, in addition to the current telehealth originating sites. Under the SUPPORT Act, CMS adjusted the telehealth reimbursement rules for treating individuals anywhere in US with substance use disorder or a co-occurring mental health disorder.

The Agriculture Improvement Act of 2018 provides funding for both telehealth grants and for broadband expansion. In short, the reimbursement landscape has changed substantially, and these developments augur well for potential growth in telemedicine and all the benefits it will bring to both patients and providers.

Overview: Classically, the law reasons by analogy, and from precedent. The theory is that the law should deal with like situations in like ways. Classically, the law reasons by analogy, and from precedent. The theory is that the law should deal with like situations in like ways.
Classically, the law reasons by analogy, and from precedent. The theory is that the law should deal with like situations in like ways. In some respects, however, Artificial Intelligence, especially the concept of machine learning, is virtually unprecedented, so the law is struggling with how to deal with it, or will be soon. Consider a few of the difficulties that the law will probably need to address:
Who will pay for healthcare services dependent on AI, and who will be entitled to such payments? Will those payments be keyed to "value," the currently orthodox yardstick? If so, by what means will “value” be measured, especially if, as many predict, outcomes may change unforeseeably?
Who will own the massive trove of data AI learns from and bases decisions on, and how will the rights of the owner be protected?
What governmental agencies will have a voice in regulating the use of AI in health care, and how will they rule? How will federalism issues be addressed?
Who will own the AI system’s intellectual property, and how will that owner’s rights be protected? Can a machine that has learned, as it was programmed to do, and then acted upon its learning, be seen as a creator, or as an inventor? If so, can it hold intellectual property rights in its own creations, and if so, how will those be protected, and for whose benefit? If not, who does hold such rights?
What are the implications of AI on competition law, and will antitrust authorities be implicated?
What happens if a patient is injured, or even killed, while getting AI-influenced or AI-controlled diagnosis or treatment? Will the owner of the AI system face liability in such circumstances? If so, under what theories? Fundamental to product liability claims is the proposition that the allegedly defective product reached the consumer in substantially the same condition as it was in when it left the hands of the manufacturer. How can we evaluate products claims when, as a result of machine learning, the product will not be in the same condition as it was at manufacture, and will in fact be in a condition that no one, including the programmers who created the AI, can foresee?
Will health care professionals, or institutions, face liability for unexpected outcomes alleged to have resulted from deployment of AI? If so, under what theories? Is it possible for an AI system, which theoretically is based on and improves upon the best care known, ever breach the standard of care? Will early adopter doctors be accused of breach because AI is not yet used by their “reasonably prudent” colleagues? Will the late adopter be liable because he waited too long to jump on the bandwagon?
What defenses, if any, will be available to defendants?
Could AI aggravate health disparities, or itself be a source of bias, and if so, what if anything should or can be done about it?
Can AI be deployed in those jurisdictions that prohibit the corporate practice of medicine? If so, what are the implications for patients in those jurisdictions?
This list is intended to be illustrative, not comprehensive. And it is US-centric. The complexities grow exponentially when one thinks about issues arising when AI is exported across national borders, as it almost certainly will be.
Historically, the genius of the common law has been its ability to adapt to circumstances unseen when it arose. We can be confident it will do so again. It is much harder to be confident in predicting how.

Overview: In this session Mr. Wolfe will provide an overview of the Stark Law, including its recent changes. In this session Mr. Wolfe will provide an overview of the Stark Law, including its recent changes.

He will also discuss best practices for auditing physician compensation arrangements on behalf of health systems, hospitals, medical groups and physician practices. The webinar will focus on regulatory requirements, key provisions, valuation considerations and potential pitfalls that should be avoided.

Why you should Attend: This webinar will offer best practices for implementing and auditing physician compensation arrangements to minimize liability exposure and penalties, including conducting compliance audits, instituting policies, and establishing ongoing monitoring and reviews.