By Elaina Smiley

The Department of Labor (DOL) is putting a lot of focus on the Family and Medical Leave Act (FMLA) this year.   The FMLA allows employees to take unpaid, job-protected leave for covered family and medical reasons.

In January, the DOL released a new interpretation of the FMLA that now makes it easier for a parent to care for an adult child with a disability.  Previously, there had been controversy as to whether the FMLA applied when an adult child is diagnosed with a disability after the age of 18.  The new DOL interpretation specifically states that the onset of the child’s disability can come at any age, and that employees may take FMLA leave to care for an adult child who is incapable of self-care because of a serious health condition.

The DOL also released the long-awaited Final Rule in February, which addresses many of the issues surrounding FMLA leave for former and current military members and their families.  Significant changes detailed in the Final Rule include:
[Read more...]

By Carolyn McClain

The prospect of engaging a healthcare attorney can be daunting.  The heavy regulation of the healthcare industry has increased awareness of the need for legal and regulatory advice, so healthcare leaders know that it is no longer sufficient to open the local phonebook to find an attorney.  That being said, what is the best way to identify the appropriate attorney for a facility or provider?  Following are eight issues to think about when hiring legal counsel.

• First, consider the underlying reasons for hiring an attorney.  Is the facility or provider in need of on-going guidance or assistance with a single issue?  Are the circumstances urgent, for example, is there a need for an immediate response to a lawsuit or a governmental investigation?  Has the facility or provider identified the need for legal counsel on staff, also known as in-house counsel?  Understanding the length and extent of the engagement will assist in the search.
•  Identify the subject matter.  Many in-house counsel have an extensive understanding of healthcare law, but in some cases special counsel is needed to adequately address a specific issue.  The list of practice areas is extensive, for example, antitrust, mergers and acquisitions , employment, malpractice defense, peer review issues and regulatory compliance.

[Read more...]

By William H. Maruca

The long-overdue HIPAA/HITECH “Mega-Rule” has finally arrived.  The Department of Health and Human Services published the Omnibus Rule in the January 25, 2013 Federal Register after missing several predictions of its imminent release.   The four-part rule modified the HIPAA Privacy, Security, and Enforcement Rules mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act, adopted changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure provided by the HITECH Act, finalized the rule for breach notification of unsecured protected health information (PHI); and implemented the Genetic Information Nondiscrimination Act (GINA) to prohibit most health plans from using or disclosing genetic information for underwriting purposes.

The final rule takes effect on March 26, 2013, but healthcare providers and other covered entities (and their business associates) generally have until September 23, 2013 to modify their policies and meet new requirements.  Some of the more relevant features of the omnibus rule include:

Business associates will now be directly liable for compliance with the HIPAA Privacy and Security Rules. Further, more entities will be defined as business associates, including companies that maintain PHI, such as storage facilities and cloud computing/data storage vendors (but not those that only transmit the PHI and do not regularly access the content of the PHI, such as telecommunications providers or couriers).  Additionally, business associates’ subcontractors will be treated as business associates themselves, subject to primary liability exposure.   Business Associate Agreements must be updated by September 23, 2013 except where valid agreements were in place on July 25, 2013, in which case the deadline may be extended up to an additional year.

[Read more...]

By Debra M. Parrish

Most new medical technologies initially are billed to payers with a miscellaneous CPT code (those ending in “99”) or a category III CPT code (codes ending with a “T”).  Each January and July, the AMA issues new “T codes” to track the adoption of new technologies.

Many, if not most payers, have implemented billing software edits that automatically deny claims that are billed with a miscellaneous or T CPT code as experimental or investigational.  Although the AMA, the entity that issues the CPT codes, has stated it is unreasonable for any payer to assume a service billed with a T code is experimental  or investigational, the practice continues.

Thus, adopters of new technologies should anticipate denials of services provided with these codes.  Despite these initial denials, providers can not only get paid for individual claims, they can change payer policies.  The following describes how.

Novitas’ CPT Category III Non-Coverage

Novitas, the Medicare contractor for Pennsylvania (among other states and the District of Columbia), has a general policy, i.e., a local coverage determination (“LCD”)  that will deny coverage of a service billed with a category III CPT code as experimental and investigational.

See Local Coverage Determination 31686.  Thus, through this policy, Novitas immediately declares any T-coded service to be non-covered unless and until the policy is revised and the procedure is excluded from the list of non-covered services.

[Read more...]

By Jane Lewis Volk

When was the last time you really scrutinized your employee handbook?

For a growing number of employers, the answer is “the last time an employee used it to bring a lawsuit against us.”

Employee handbooks are essential to establish appropriate rules and procedures for the workplace.  But as unusual employee situations continue to pop up, many employers create overly broad policies that are meant to protect the company in any possible scenario, but may go too far, leaving an open invitation for an administrative charge or even a lawsuit.

[Read more...]

By Jane Lewis Volk

For decades, the pharmaceutical industry has sent sales representatives to hospitals and physicians’ offices to tout the benefits of their company’s prescription drugs and persuade doctors to prescribe the drugs to their patients.

And for decades, those sales representatives often have worked more than 40 hours a week without getting paid for overtime.

And until 2009, nobody said anything about it.

That’s when some pharmaceutical representatives sued their employer for a failure to provide overtime pay.  Under the Fair Labor Standards Act (FLSA), most employees who work more than 40 hours in a given week must be paid overtime compensation equal to one and a half times the employee’s normal hourly wages.

[Read more...]

By Dennis Liotta, Esq., Partner at Edgar Snyder & Associates

If you’re a healthcare worker – whether you work in an office or have direct access with patients – you run the risk of being injured on the job. According to the U.S. Department of Labor’s 2010 Workplace Injuries and Illnesses Report, healthcare workers are more likely to suffer workplace injuries than people in other industries.

But if you’re injured on the job as a professional in the medical field, you may not want to report the accident. You may worry about your job security, or that your coworkers may treat you differently.

The Pennsylvania workers’ compensation system is designed to protect your rights, but the process can be very confusing. You need to understand your rights so that you can act accordingly if you’re hurt on the job.

[Read more...]

By Edgar Snyder, Esq.

People of all ages enjoy riding bicycles. As a healthcare professional, you may know – or even witness firsthand – that thousands of riders are injured every year in bicycle accidents. In 2009 alone (the most recent year for which data is available), about 51,000 pedal cyclists were injured in accidents involving motor vehicles.

Whether you or members of your family use a bicycle to get around, exercise, or enjoy being outside, know that there is a new bicycle safety law in Pennsylvania. By knowing what the law entails and sharing this information with other patients, visitors, colleagues, and friends, healthcare workers can help prevent bicycle accidents and injuries.

Details About the New Pennsylvania Bicycle Safety Law

Officials recently passed new legislation that puts a greater emphasis on bicycle safety – in particular, how motorists interact with bicyclists on the road. The new law took effect in April 2012 and includes the following regulations:

• Drivers must allow at least four feet between their vehicle and a bicyclist when passing them. Drivers are allowed to cross the center double yellow line if necessary to provide the required four feet, as long as it’s safe to do so.
• When traveling below the posted speed limit, cyclists must keep to the right side of the road. Exceptions to this rule include when a cyclist is making a left turn or riding on a one-way street.
• If a road has only one travel lane, bicyclists may use any portion of the lane to avoid road hazards.
• Drivers attempting to turn left must yield the right of way to bicyclists traveling in the opposite direction, just as they would for another motorist. Drivers can’t interfere with a bicyclist proceeding straight on a roadway when making a turn.
• Motorists can’t force a bicyclist off of the road. Violators may face criminal charges.

By Jane Lewis Volk

Most health care workers are no strangers to long hours and overtime.  But Pennsylvania health care employers should be warned that there are limits on their ability to mandate overtime.

Under the Pennsylvania Prohibition of Excessive Overtime in Health Care Act, commonly referred to as Act 102, health care employers are limited in their ability to require employees to work time beyond their predetermined shifts.  The law took effect in July 2009, but many health care employers are still struggling to understand how the law affects their overtime practices.

Act 102 applies to hourly, non-supervisory employees who are involved in direct patient care at health care facilities including hospitals, hospices, outpatient surgical facilities, long-term care facilities, cancer treatment centers, or inpatient drug and alcohol treatment facilities.  Private physicians’ offices are not included.  Employees who are covered do not include physicians, physician assistants or employees not involved in direct patient care, such as maintenance staff.

[Read more...]

 By Edgar Snyder, Esq.

As a healthcare worker, you and your colleagues may witness injuries from all types of accidents. Many people go on vacation during the summer. Injuries during vacation aren’t fun, but trips to the ER happen more often than you may think.

The best thing you can do is follow the proper safety tips to avoid these injuries, know what to do if you’re injured while on vacation, and act quickly to protect your legal rights.

Out-of-State Car Accidents

Summer vacations often involve travelling long distances by car. That means there’s always a chance that you may be in a car accident. Being injured in an out-of-state accident makes an already stressful situation even more difficult.

You need to follow the laws of the state where the car accident occurred, but your Pennsylvania auto insurance policy will almost always determine your rights. If you’re injured in an accident, your first-party medical benefits should cover your medical bills. However, out-of-state accident cases aren’t cut and dry – each state has its own set of conditions that could affect your claim. In rare instances, you may have expanded benefits available under the state law where the accident occurred. If you’re seriously injured, consider contacting a Pennsylvania attorney to protect your legal rights.

[Read more...]

By John W. Powell, Esq.

Successful parents know that treating children equally is often not a matter of giving them all the same thing.  One may want to go to chess tournaments, while another might prefer hockey or golf.  The summer trek across Europe on a bicycle that one teen yearns to complete might cost more than the outdoor camp another craves to attend.  And it would be foolish to set the same school goals for a daughter who always tests into gifted programs and one who is a star athlete with good grades

Estate planning requires the same approach, even for those with estates below the taxable minimum.  Even though it may seem much easier just to split things equally to avoid being seen as unfair by your children, an even split may not be the way to act in the best interests of them and other heirs.

Fortunately, while details may differ in every family situation, at the end of the day many people express similar goals when drawing up their wills and discussing wealth distribution.  Estates and trusts attorneys have therefore developed a number of fairly standard and inexpensive solutions to these generic challenges.

[Read more...]

Ralph Manning

Beth Pearson

By Ralph Manning and Beth Pearson

For most entrepreneurs, their retirement plan is to sell the business and use the proceeds to fund their retirement life style.  They don’t want to hear that their business isn’t salable.

What makes the difference between a company that can reward the owner for the years spent in building it and one which has a low value?  Think of it this way.  Do you have a company, or do you have a job with assistants?

A woman we know has built a human resources consulting company.  She now has 10 employees and was talking to me about her plans to grow the business to 25 employees and then sell it.  When I began to talk to her about the firm, it because clear that she doesn’t have a company, she has a successful job with assistants.

[Read more...]