Gwen Simons

Gwen Simons is a lawyer and physical therapist at Simons & Associates Law in Scarborough, Maine.

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

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

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 for Cash Practices RE: CMS 1490S form

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

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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Will working somewhere that requires me to enroll with Medicare cause issues for my cash practice?

Question:  I need to work at another private practice to supplement my income while building my cash practice.  The practice sees and bills Medicare under the practice’s NPI number.  They will require me to enroll as a Medicare provider to treat their patients. Will this cause any issues for my cash practice?  Will I have

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