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Frequently Asked Legal Questions about Healthcare Law

As a healthcare provider, you have enough on your plate providing care and managing your practice without also having to become an expert on federal and California healthcare laws and regulations. At the Law Offices of Art Kalantar, we take care of the legal issues so you can focus on delivering quality care to patients in need. See below for answers to frequently asked questions about California healthcare law, and call our offices in Los Angeles for assistance with Medicare, Medi-Cal, license defense or other legal healthcare issues.

When are health care providers subject to the HIPAA Privacy Rule?

Health care providers who conduct certain financial and administrative transactions electronically are subject to the HIPAA Privacy Rule. Covered transactions include electronic billing, fund transfers and other aspects of claims transactions that are transmitted electronically. Call our office for more information or help with HIPAA compliance.

How can I check the status of a Medi-Cal claim?

Log in to Medi-Cal by selecting the Transactions tab on the Medi-Cal home page. Next, click on the Automated Provider Service link under the “Elig” tab. Select “Perform Claim Status Request” and enter the requested claim information. Click Submit to receive information on claim status.

Should I participate in managed care?

If you are just starting out in your healthcare practice or are located in a highly-competitive area, participating in one or more managed care plans can be an effective way to attract more patients and increase your income. It is important to find a well-run plan that eases your administrative burden without requiring you to sacrifice the quality of care you provide. Talk to an experienced healthcare law attorney for advice regarding the terms included in a managed care plan or to negotiate favorable terms that are important to you.

What if I am notified of a Medicare or Medi-Cal audit?

An audit can be triggered in many different ways, including simply the way certain items are coded or billed. An audit may mean the government agency suspects you are doing something incorrectly, or it may be totally random. The key to handling an audit is to understand what the agency will be looking for and to be prepared with the information they will want. The Law Offices of Art Kalantar has a great deal of experience and expertise handling Medicare and Medi-Cal audits. We can help you at any stage, including preparation before any audit has begun to assistance during an audit or investigation.

What is the “corporate practice of medicine” doctrine in California?

Also known as CPOM, this law says that persons without a medical license are prohibited from employing physicians or owning a medical practice with a physician to provide medical services. In other words, medicine is to be practice by licensed individuals and not corporations. The CPOM law, officially known in California as the Medical Practice Act, can be found in the Business and Professions Code section 2052. It basically says the following: “[A]ny person who practices or attempts to practice, or who advertises or holds himself or herself out as practicing…[medicine]…without having at the time of so doing a valid, unrevoked, or unsuspended certificate…is guilty of a public offense, punishable by a fine not exceeding ten thousand dollars ($10,000),…by imprisonment in a county jail not exceeding one year, or by both the fine and…imprisonment.”

Can I use a Management Services Organization without violating the Medical Practice Act?

For many healthcare practitioners, a management services organization (MSO) is a practical solution to managing the business side of a healthcare practice. An MSO can provide billing, collection and other important non-clinical administrative functions, helping you keep costs down and ensure your practice is professionally managed and efficiently run. The question is how one can enter into a contractual relationship with non-licensed persons without violating CPOM, the Stark Law or the federal Anti-Kickback Statute. Utilizing an MSO can certainly be useful, but it’s extremely important to have an experienced healthcare attorney carefully evaluate the proposed model to make sure it does not violate fee sharing or anti-kickback rules, or that it lies squarely within one of the allowable exceptions in the Stark Law.

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