Gwen Simons – Simons & Associates Law, P.A.

Security Issues: Website CRM Vendors/Services

Security Issues: Website CRM Vendors/Services Quick Reference: Security Issues with CRM Vendors/Services You are ultimately responsible for security breaches by any vendor you share your data with, so do your due diligence before giving any vendor your data! Customer Relationship Management (CRM): Customer data that you use in your marketing efforts Companies/Vendors who are soliciting PTs to […]

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Do I have to provide an interpreter even if there I can’t get reimbursed for it?

FAQs / Gwen Simons

Answer: Yes. It is required under the ADA and the ACA. Please see this letter to providers from the National Association of the Deaf. This applies to all providers, regardless of whether you are a cash or insurance practice. Some payers may cover interpreter services, but if they don’t, you are still required to provide

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Can a Medicare Advantage Plan patient submit my claims for out of network benefits if I’m not enrolled as a Medicare Provider?

FAQs, Medicare / Gwen Simons

Answer: No. Medicare Advantage Plans (MAP) are not supposed to reimburse patients for services by unenrolled providers even if the MAP offers out of network. That said, MAPs sometimes erroneously reimburse patients. If your patient submits a claim and is reimbursed, that doesn’t necessarily mean it is ok. Medicare patients should always go to Medicare

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Non-compete Agreements

Client Alerts_All States, Client Alerts_Maine, Employment Laws, FAQs, Independent Contractors, Practice/Employee Management / Gwen Simons

Non-compete agreements are increasingly viewed as non-competitive and many states are starting to prohibit them. The Federal Trade Commission (FTC) is expected to promulgate a final rule that will likely prohibit non-compete agreements in all 50 states in the near future. (See the FTC’s Proposed Rule at https://www.ftc.gov/legal-library/browse/federal-register-notices/non-compete-clause-rulemaking). Before inserting a non-compete clause in an

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Client Alert: New MaineCare “Rounding” Rule

Client Alerts_Maine, Legislative & Regulatory Issues / Gwen Simons

Effective Jan 1, 2023, MaineCare implemented a new “rounding” rule for billing timed codes. In order to bill for a 15-minute timed code, you must perform the intervention for 80% of that 15 minutes (12 minutes). (Old rule allowed you to bill if you provided the treatment for more than 50% of the time). Please

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Client Alert: Maine Prior Auth Questionnaire

Anthem BCBS, Client Alerts_Maine, Legislative & Regulatory Issues / Gwen Simons

Attention Maine Providers: Please complete our Prior Authorization Questionnaire on your experiences with AIM/Anthem prior authorizations. We need this information for the bill we have in the Maine Legislature to regulate prior authorization practices by payers.

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Managing Security/Privacy Breaches – Webinar

Rants & Raves (Blog) / Gwen Simons

Managing Security Breaches Member Webinar, January 27, 2023 It can happen to anyone. Your EMR company reports a security breach exposed some of your patient records. You accidentally send a group email to patients without using the Blind Copy box. You disclose records to someone without having a signed HIPAA Authorization. All of these accidental

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Guide to Hiring New Employees

Employment Laws, Webinars / Gwen Simons

Guide to Hiring Employees We offer the following Employee hiring guidance_2022-11-17as a checklist when you start to hire employees, whether they will be PRN, part-time or full-time. We do not guarantee that this Guide covers everything you need to do. Always check for state laws that might apply to you depending on the size and

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Client Alert for Cash Practices RE: CMS 1490S form

Cash Practice, Client Alerts_All States, Client Alerts_Maine, Medicare / Gwen Simons

11/11/2022: This Client Alert_RE CMS 1490S form instructions & sample form_2022-11-11 provides new instructions on how patients can submit a claim to CMS on form 1490S just to get a denial so a secondary or supplemental payer will reimburse claims they cover. Follow these new instructions instead of the instructions in the 9/15/2022 webinar.

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Can cash provider treat workers comp patient

Cash Practice, FAQs, Workers Compensation / Gwen Simons

Can a cash practice see a workers’ compensation patient? Maybe. State laws govern workers’ compensation. If your state laws allow the employee to choose their heath care providers, versus allowing the employer to direct what providers see their injured workers, then you should be able to see the patient. State work comp laws may

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