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LEGAL EASE NUTRITION Member Scholarships REHAB Update CHIRO AssistLEGAL Q&A LEGAL QuestionsExecutive Directors Update and AnswersBy Jeffrey Randolph 2020 ANJC AWARDSANJC Legal Counsel Q Now that the healthcare State of EmergencyA The federal False Claims Act (FCA), 31 U.S.C.3729is over, do we no longer have to mandate3733, which governs potential Medicare fraud, imposes Legislative Update civil liability on persons who knowingly submit a false masks in our chiropractic office?INSURANCE Update INSURANCE Update A The state of requirements is ever changing, but as ofor fraudulent claim.While there may be a defense that the date of this writing the mask mandate is still inthere were no knowing submissions of false claims as place for outpatient healthcare offices.Division ofTECHNIQUE Update you relied upon advice of an outside billing company, as Consumer Affairs Order 2021-11, which governs chi- a licensed healthcare professional, this is not an absolute ropractic offices, expires on the later of the end of thedefense.A knowing intent does not only require actual public health state of emergency or the general state ofknowledge; if you should have known that the billing emergency.Governor Murphy ended the public healthwas improper you can still be held liable under the FCA. state of emergency a few months ago, but the generalIt is similar to advertising in your practice, even if you MedicareQ&AMedicare Update state of emergency remains in place.Thus, you mustoutsource the advertising to an outside company, you still comply with DCA Order 2021-11 until the generalOUR HEALTHremain ultimately responsible for the content and its state of emergency is lifted, which includes the maskcompliance with advertising regulations.In situations mandate, temperature checks, and other distancingwhere you use an outside billing company: i) Make sure requirements.You can access a copy of the order at: they are certified by the New Jersey Department of https://www.njconsumeraffairs.gov/COVID19/Docu- Banking and Insurance as a Third Party Biller (https://ments/DCA-AO-2021-11%20Superseding%20Office- www.state.nj.us/dobi/division_insurance/managedcare/Based%20Healthcare%20AO.pdf. tpblist.html); ii) make sure you have transparency on the claims they submit on your behalf and periodically I have multiple office locations but a singlereview the claims, CPT codes, and EOBs; and iii) if Q tax ID.Can I use the tax ID for all locations,you do find out about non-compliant billing, demand or do I need to set up separate entities withthat it be corrected, corrected claims be submitted on individual tax IDs? non-compliant billing, or terminate your agreement with the billing company if they refuse to do so.A There is no legal prohibition of one company/one tax ID having satellite locations.When you bill, though, theJeffrey Randolph, Esq. (the author of Legal Ease and Legal site of service in Box 32 of the CMS-1500 claim formQ&A) is an independent person of the ANJC and his views must list the actual site that the services were provided as reimbursement rates vary by location, and if youare not authorized, sponsored, or otherwise approved by dont list the actual site of service properly it could bethe ANJC. The information provided is for general guidance construed as a misrepresentation on the claim form. on matters of interest only and may not take into account From a risk management standpoint, it is sometimesparticular facts relevant to your individual situation. The best to have separate legal entities with different taxapplication and impact of laws and health care can vary IDs so that if there is an issue with one location, such aswidely based on the specific facts involved. Given the a post payment audit or legal judgment against it, it willchanging nature of laws, rules and regulations, there may not affect the other locations.In addition, billing forbe omissions or inaccuracies in information contained in multiple locations may also raise a red flag with carriersthese materials. Accordingly, the information you receive as the volume of billing will be higher than average ifis provided with the understanding that the author and you are billing for multiple locations under one tax IDthe ANJC are not herein engaged in rendering legal, while the other providers in your area are billing only foraccounting, tax, health care or other professional advice and one location.I advise you consult with your accountant/ services nor are they providing specific advice with regard to healthcare attorney to determine what is best for youryour practice, the treatment of any specific illness, disease, particular situation.deformity or condition, or any other matter that affects trade, commerce, or legal rights of others. As such, this Q Medicare is suspending my reimbursementsarticle should not be used as a substitute for consultation claiming there is evidence of fraud in mywith professional accounting, tax, legal, health care, or other billing.I use an outside billing companycompetent advisers. Before making any decision or taking who chose the CPT codes, so how can I beany action, you should consult an appropriately trained penalized if I relied upon them? professional. www.njchiropractors.com I 7'