Specialty Pages

Although WACHLER & ASSOCIATES, P.C. is a full-service healthcare law firm, the following is a sampling of WACHLER & ASSOCIATES, P.C.'s specialty areas. If you have any questions or would like to retain our services, please call (248) 544-0888.

Be sure to visit our Stark Law/Fraud and Abuse specialty page, our HIPAA specialty page and our Medicare & RAC Audits specialty page for background information, Web links, and the latest developments in these important areas of health law.

Anesthesia and Pain:

Attorneys in the firm specialize in the legal and regulatory issues surrounding the provision and billing requirements for anesthesia and chronic pain management services. Our firm has worked on the development and implementation of numerous anesthesia and pain management specific compliance programs for groups of all sizes across the country. We continue to provide counseling to anesthesia and pain management groups relative to maintaining the effectiveness of their compliance programs. We also work with billing companies that specialize in anesthesia and pain management billing with regard to billing compliance and contract matters. We regularly counsel and represent anesthesia and pain management groups with regard to contracting matters, audit defense, staff privilege matters and other healthcare matters.

Attorney Andrew Wachler regularly speaks and writes on anesthesia and pain management healthcare law topics.

Ambulatory Surgery Centers:

WACHLER & ASSOCIATES, P.C. has specific expertise in counseling and representing ASC clients, in all aspects of healthcare law, including:

fraud and abuse (including advising on structure and governance documents);
billing and compliance issues;
third party payor audits;
corporate formation;
CON;
licensure and certification;
HIPAA privacy and security; and
other healthcare legal matters.

Attorneys at WACHLER & ASSOCIATES, P.C. have authored a HIPAA privacy and security manual specific to the ASC market for the Federated Ambulatory Surgery Association (FASA). Andrew Wachler has presented for FASA numerous times in the area of HIPAA Compliance. Mr. Wachler has also presented on other billing and regulatory issues for ASCs.
For news and updates on ASCs, visit the Center for Medicare & Medicaid Services' ASC Quarterly Provider Update.

For information on Medicare certification, visit the Center for Medicare & Medicaid Services' ASC Certification in the Medicare Program page.

For information on ASC payments, visit the Center for Medicare & Medicaid Services' Ambulatory Surgery Center Payment Information page.

Hospice:

The attorneys of WACHLER & ASSOCIATES, P.C. have expertise in the legal and regulatory areas impacting hospice providers. We regularly assist hospice providers regarding:

compliance issues;
Medicare appeals and edits;
contracts;
Fraud and Abuse counseling; and
other health care law matters

For information on being certified as a Medicare or Medicaid hospice provider, visit the Center for Medicare and Medicaid Services' Certification and Compliance: Hospice page.

For amendments to coverage and payment regulations, click here.

For the Proposed Rule for Hospice Conditions of Participation, click here.

Corporate & Transactional Law:

The attorneys of WACHLER & ASSOCIATES, P.C. provide a wide variety of clients with advice and counsel regarding their corporate structure and business relationships. In addition to the fraud, abuse and compliance analyses we perform with respect to our healthcare clients' contractual relationships, we prepare, review, and negotiate corporate transactions for both healthcare and non-healthcare industry clients, including:

Joint ventures;
Mergers, acquisitions, affiliations and divestitures;
Sale and purchases of provider practices and healthcare entities;
Employment, independent contractor and management relationships;
Confidentiality and non-competition agreements;
Shareholder and partnership agreements; and
Equipment sales, leasing and financing.

Licensure/Medical Staff Privilege Matters:

Our attorneys counsel and represent healthcare provider clients in sensitive licensure and medical staff privilege matters. Our firm handles such matters on behalf of physicians, dentists, podiatrists, chiropractors, nurses and other healthcare providers, both in state and abroad. The consequences that State licensing actions or hospital adverse actions may have against a healthcare provider are numerous, including, but not limited to, criminal actions, additional actions by other states and/or hospitals, reports to state and national databanks, and third party payor de-participation. A healthcare provider facing a State healthcare investigation/administrative action or a potential adverse action by a hospital against his or her staff privileges cannot afford to take a myopic view of his or her predicament. Due to the domino effect that often accompanies the imposition of state-imposed sanctions and/or hospital disciplinary action, such providers are well advised to obtain experienced healthcare counsel who will take an expansive view of the matter in order to assess the collateral damage that could result from a proposed settlement. Any settlement strategy should take into consideration all of the collateral sanctions and enforcement actions that could arise as a result of a settlement. WACHLER & ASSOCIATES, P.C. understands this and has the experience necessary to resolve these matters with minimum collateral effect.

Durable Medical Equipment:

WACHLER & ASSOCIATES, P.C. regularly works with DME and other suppliers with regard to their health care legal needs. This includes:

corporate matters;
compliance and regulatory;
contracts;
HIPAA; and
Fraud and Abuse counseling.

To view the DMEPOS Brochure, click here.

For an explanation of information that will be used to evaluate the financial stability of bidding suppliers, visit the Center for Medicare and Medicaid Services' Competitive Acquisition for DMEPOS page.

For information on Special DME Review Considerations, See Chapter 5 of the Medicare Program Integrity Manual, and for information on the Comprehensive Error Testing Rate Program, see Chapter 12.

Radiology and Diagnostic Imaging Centers:

Our attorneys counsel and represent radiology providers, including physician groups and diagnostic imaging centers, in all aspects of healthcare law. We represent radiology providers in the areas of fraud and abuse and Stark laws; billing and compliance issues; third party payor audits; corporate formation; and other healthcare legal matters.

Attorneys at WACHLER & ASSOCIATES, P.C. counsel clients on legal issues associated with the development, acquisition, and operation of imaging centers. Imaging centers may be furnished through facilities owned by radiologists, non-radiologists, hospitals, management companies, individuals and other joint venture arrangements. The legal issues affecting the imaging center will vary depending upon the ownership interests in the center. The modalities offered at the imaging center may also implicate State CON and licensure laws.

The Final Anti-Markup Rule

The Anti-Markup Rule prohibits the mark up of certain diagnostic tests. The prohibition traditionally applied only to the mark-up of the technical component (TC). However, CMS recently expanded the scope of the Anti-Markup Rule's prohibition to include both the Technical Component (TC) and the Professional Component (PC).

In the 2009 Final Physician Fee Schedule Rule, CMS adopted two alternative tests to determine when the final anti-markup payment limitation will not be applied:

Alternative 1- "Substantially All Test." This alternative should be analyzed first as follows: where the performing physician (i.e., the physician who supervises the TC or performs the PC, or both) performs substantially all (i.e., at least 75 percent) of his or her professional services for the billing physician or other supplier, the services will not be subject to the anti-markup rule payment limitation.
Alternative 2- "Site of Service Test." If the physician does not meet the "substantially all" test set forth above, an analysis will be made under Alternative 2 on a case-by-case basis as follows: Only TCs conducted and supervised in, and PCs performed in, the "office of the billing physician" (which is expanded to include testing performed in the "same building" under Stark) by an employee, owner, or independent contractor physician will avoid application of the anti-markup payment limitation.

The Anti-Markup Rule's Payment Limitation and Significance of "Net Charge"

If the anti-markup payment limitation is applied, then the payment to the billing entity will be limited to lowest of: (1) the performing physician's or other supplier's "net charge" to the billing entity; (2) the billing entity's actual charge; or (3) the fee schedule amount for the test that would be allowed if the performing physician or supplier billed directly.

If limited to the "net charge", the billing entity cannot take into account any charge that is intended to reflect the cost of equipment or space leased to the performing supplier by or through the billing physician or other supplier. The "net charge" is limited to the salary and benefits paid to the performing physician or supplier and is intended to be a punitive provision which does not allow the billing physician or supplier to earn more than the cost of providing the diagnostic testing services.

IDTF Enrollment

Mobile entities are required to enroll and bill Medicare directly for Technical Component (TC) services that they provide, except for those provided "under arrangements" to a hospital.

There have been some inconsistencies in CMS guidance and interpretations regarding this requirement, especially as it applies to mobile leasing companies. For the most recent information, please contact us.

Significant Changes to the Stark Regulations

Recently there have been significant changes to the Stark regulations that will impact Radiology and Diagnostic Imaging Centers. For more information, please visit our Stark page or contact awachler@wachler.com