Other Legal Information
UPDATE: Ambulatory Surgery Facilities - New Licensure and Regulation Requirement (you must be licensed by July 1, 2009!)
- Distinct entities which provide outpatient surgical services, either specialty or multispecialty, in which patients are admitted to and discharged from the facility within 24 hours must be licensed by the Department of Health (DOH) by July 1, 2009.
- Excluded from this requirement are surgical procedures not requiring general anesthesia done in a physician's office. However, the Medical Quality Assurance Commission is the process of adopting rules that will address office based surgery within the next few months. We recommend you review these rules. [PDF]
- Note: The Department of Health acknowledges that there is not a clear line between facilities which must comply with the new ASF rules and those which do not. In order to avoid confusion and possible penalties for failure to comply with ASF rules, medical practices which perform office-based procedures may wish to consult the Department of Health regarding their status. If you have questions regarding whether your facility will need to be licensed by these rules, contact Byron Plan at 360.236.2916
- The Department of Health has a new web page devoted to ambulatory surgery facilities, found at: http://www.doh.wa.gov/hsqa/FSL/AmbulSurgFac/Default.htm. The Department plans to close the website which addressed the development of the ASF rules.
- Licensing process begins on June 1, 2009:
- Applications will be available from DOH beginning on May 15. Applications can be found at: http://www.doh.wa.gov/hsqa/FSL/AmbulSurgFac/Default.htm
- A license is good for three years
- Inspection is required once every 18 months (either by a recognized accrediting body or the DOH).
- The initial licensing fee will range between $1,400 and $2,400.
- Licensing requires:
- Receipt/approval of initial licensing application
- Receipt of correct licensing fee
- Receipt of completed/accepted inspection
- Facilities may comply with the licensing/inspection requirement if accredited/certified by one of the following:
- Centers for Medicare and Medicaid Services (CMS)
- Joint Commission
- Accreditation Association for Ambulatory Care
- American Association for Accreditation of Ambulatory Surgery Facilities
- These are very comprehensive regulations and we strongly suggest you review the underlying statute and regulations:
- Questions:
- For questions please contact Tim Layton, Director of Legal Affairs at tim@wsma.org.
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AMA offers guidance in developing code of conduct (disruptive physician policy)
The new Joint Commission leadership standard covering code of conduct LD.03.01.01 took effect Jan. 1. The standard's Elements of Performance requires, among other things, that hospitals have a code of conduct that defines acceptable, inappropriate and disruptive behavior, and that leaders create and implement a process for managing disruptive and inappropriate behaviors.
In response to these actions, the AMA adopted policy that calls for medical staffs to develop and implement their own code of conduct in the medical staff bylaws. Under the policy, hospitals should also have a code of conduct applicable to members of the board, management and all employees.
To assist medical staffs with the implementation of a code of conduct in accordance with AMA policy and consistent with the Joint Commission leadership standard, the AMA Office of the General Counsel, in conjunction with the AMA Organized Medical Staff Section (OMSS), drafted a model code of conduct for insertion in medical staff bylaws.
Access the AMA's model code of conduct.
The WSMA is in the process of updating its model medical staff bylaws and will post them as soon as they are available. In the meantime, AMA members can access the Physicians' Guide to Medical Staff Organization Bylaws.
For more information email Tim Layton.
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Physicians hail Arkansas court victory against Baptist Health
An Arkansas state court ruled last week that Baptist Health, Arkansas' largest hospital system, acted improperly by inappropriately restricting hospital-admitting privileges and interfering with the continuity of patient care.
The ruling in Baptist v. Murphy permanently prohibits an economic credentialing policy adopted by Baptist Health in 2003, which would have allowed the hospital system to interfere in the patient-physician relationship by denying hospital-admitting privileges to medical staff members based on financial concerns.
"This important court victory demonstrates that economic policies that restrict physician credentialing are really intended to prevent patients from choosing medical facilities that might compete with large hospitals," said Rebecca Patchin, MD, chair-elect of the AMA Board of Trustees. "Hospitals cannot use their financial interest to justify policies that interfere with patients' health care choices."
The combined resources of organized medicine were brought to bear on this case through the Litigation Center of the AMA and State Medical Societies, which provided substantial financial support and, along with the Arkansas Medical Society, worked in support of the physicians who were subjected to Baptists' inappropriate credentialing policies.
View an AMA news release on the details of this case's outcome.
View a copy of the court's decision. [PDF]
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BCBS settlement update: How to file a billing dispute
The Blue Cross Blue Shield Settlement Billing Dispute External Review Board (BDERB) will be operational beginning November 21, 2008. The dispute process is available to MDs and DOs who are class members (and did not opt out) of the Love, et al v. BCBSA, et al Settlement dated April 27, 2007.
Beginning Friday, November 21, 2008, access the relevant instructions and forms online.
The BDERB is a national independent review organization contracted to review billing disputes submitted by an MD or DO. You do not have to participate with a settling Blue Cross Blue Shield Plan to submit a billing dispute to BDERB (view a complete list of settling Blue Cross Blue Shield Plans); however, your billing dispute must arise from services provided to members of a settling Blue Cross Blue Shield Plan.
Requirements to dispute a Blue Cross Blue Shield decision using the BDERB:
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You must be a class member who did not opt out of the Love, et al v. BCBSA, et al Settlement.
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You must have exhausted all internal billing dispute processes of the settling Blue Cross Blue Shield Plan including appeals.
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Your dispute must arise from denial of payment for services provided to members of a settling Blue Cross Blue Shield Plan.
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Billing dispute amount must:
- exceed $500 as a single dispute; OR
- be multiple disputes filed within a 1-year period from the filing of the original billing dispute must exceed $500 as an aggregate amount (for more information about this process, see section 7.10(c) of the Settlement Agreement).
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You must have initiated a provider billing dispute with your Blue Cross Blue Shield Plan and received a written response that you wish to have reconsidered.
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The dispute must be filed within 90 calendar days of the date of the final Blue Cross Blue Shield denial notification letter.
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You must complete the Blue Cross Blue Shield Dispute Form and the BDERB Dispute Resolution Agreement for each dispute and return to the settling Blue Cross Blue Shield with all required documentation including the original denial notification.
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You must submit the proper filing fee (payment methods include American Express, MasterCard, Visa (debit or credit), and check). Please note the filing fee will not be charged until the $500 threshold billing dispute amount is reached.
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New mandatory reporting rules now in effect
On March 31, 2008 the Department of Health (DoH) adopted uniform mandatory reporting rules for all health professionals (including physicians and physician assistants). The rules went into effect on May 1.
The rules were adopted pursuant to legislation passed in 2006 (HB 2974) authorizing the DoH to adopt rules requiring every license holder to:
- Report any conviction, determination, or finding to DoH that another license holder has committed an act which constitutes unprofessional conduct, or
- Report information to DoH or an approved impaired practitioner program, like the Washington Physicians Health Program, that a license holder may not be able to practice with reasonable skill and safety.
The rules (which provide the details about what, when and where to report) are codified under Washington State Administrative Code 246-16-200 through 265.
View the new rules here.
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Payout to doctors pending in BCBS settlement
Several provisions in the national Blue Cross and Blue Shield (BCBS) settlement took effect April 21, after a final order was filed by the federal court in Miami. The development brings the $128 million payout to eligible physicians one step closer and allows the American Medical Association (AMA) to commence enforcement of the national BCBS settlement as an additional signatory medical society. The AMA joins 27 other participating medical societies that are able to provide direct assistance to physicians when a BCBS plan or subsidiary has failed to honor its commitments under the settlement.
The final order comes almost a year after 23 BCBS plans settled a class action lawsuit brought by 90,000 physicians against the BCBS Association and more than 30 affiliated plans and subsidiaries. The settlements are designed to curb contentious business practices that have long frustrated physicians and jeopardized the delivery of quality patient care. If a BCBS plan chooses to not hold up its end of the bargain, physicians have a free, simple enforcement process that can resolve the matter.
There are special provisions in the settlements that are specific to particular states. Access the AMA’s online interactive map that lists which BCBS plans and subsidiaries have settled, the state-specific provisions of the agreement and a flyer containing the key provisions of the BCBS settlement.
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