Pinnacle Blog

  • Six Things Every Rural Hospital CEO Must Do: Part Two">

    Six Things Every Rural Hospital CEO Must Do: Part Two

    Rural hospitals are closing at a record pace, and many of the reasons why could have been avoided. This six-part, weekly series will identify critical steps CEOs can take to help keep their rural hospitals moving forward

    Six Things Every Rural CEO Must Do – Part 2 of 6 01 18 21

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  • Six Things Every Rural Hospital CEO Must Do: Part One">

    Six Things Every Rural Hospital CEO Must Do: Part One

    Rural hospitals are closing at a record pace, and many of the reasons why could have been avoided. This six-part, weekly series will identify critical steps CEOs can take to help keep their rural hospitals moving forward

    Six Things Every Rural CEO Must Do – Part 1 of 6 01.11.21

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  • Battle, Balance, and Benefits – New 2021 Evaluation and Management Guidelines">

    Battle, Balance, and Benefits – New 2021 Evaluation and Management Guidelines

    Beginning January 1, 2021, the new Centers for Medicare and Medicaid Services (“CMS”) Evaluation and Management (“E/M”) guidelines will take effect for Office and Other Outpatient codes *99202-99205 and 99212-99215.  Assignment of these codes will now be determined based on medical decision making (“MDM”) or time.  The need for an extended history and / or exam to support code assignment is eliminated.  The documentation of an appropriate history and examination is left to the performing provider’s judgement.  In this article, a comparison of the old vs. new guidelines for establishing medical decision making will be discussed, compared, and contrasted.  The PDF file is the American Medical Association’s table for reference.

    BBB of 2021

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  • Final Rules to the Stark Law & Anti-Kickback Statute Released">

    Final Rules to the Stark Law & Anti-Kickback Statute Released

    Final Rules to the Stark Law & Anti-Kickback Statute Released

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  • Posted by: Zach Stephens – 5th Circuit Decision on Materiality">

    Posted by: Zach Stephens – 5th Circuit Decision on Materiality

    News you can use….

    Fifth Circuit Affirms Dismissal of Qui Tam Complaint Due to Lack of Materiality in Significant False Claims Act Decision

    The U.S. Court of Appeals for the Fifth Circuit affirmed on April 15, 2020 the dismissal of a non-intervened qui tam action in United States ex rel. Porter v. Magnolia Health Plan1, because the relator failed to adequately allege that the defendant’s purported misrepresentations were “material” to the government’s payment decision. The health plan had a blanket statement regarding regulatory compliance and the court also took into consideration the fact that the health plan continued to renew their contract with the organization. The Fifth Circuit’s decision is an important application of Escobar at the motion to dismiss stage. Moving forward, the main takeaway is that Defendants will be able to cite this decision, as it applies to boilerplate certifications of regulatory compliance and materiality under the Escobar standard.

    Facts surrounding the case include the relator alleging that the health plan was required by state regulations to use specifically licensed nurses and was not, therefore receiving payments they were not entitled to. Essentially, alleging violation of the False Claims Act. In response, the court held that a vague certification of compliance with all regulations is too general to establish that compliance with every regulation is a condition of payment. In quoting the district court, the Fifth Circuit expounded: “Here, the district court concluded that the contracts between [the health plan] and [Mississippi] ‘contain broad boilerplate language generally requiring a contractor to follow all laws, which is the same type of language Escobar found too general to support a FCA claim.’ We agree.”

    The Court relied further on the fact that the health plan, once informed, took no further action. Of note, the Court stated that Magnolia “continued payment and renewed its contract with [the health plan] several times” and, even after the relator’s suit was unsealed, awarded the health plan a contract for a fourth time. Any case referencing Escobar is important to review and understand. Briefly stated again, this is a significant win for defendants as it relates to the motion to dismiss stage with regards to materiality, especially as the rate of Qui Tam actions continues to rise.

    https://www.jdsupra.com/legalnews/fifth-circuit-affirms-dismissal-of-qui-64074/

     

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  • Pinnacle Healthcare Consulting Continues to Expand With the Addition of Two Seasoned Executives">

    Pinnacle Healthcare Consulting Continues to Expand With the Addition of Two Seasoned Executives

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  • Pinnacle is proud to sponsor and will be exhibiting at ACCC’s 46th Annual Meeting & Cancer Center Business Summit">

    Pinnacle is proud to sponsor and will be exhibiting at ACCC’s 46th Annual Meeting & Cancer Center Business Summit

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  • Pinnacle will be speaking at the 2020 OR Business Management Conference in Florida. To register for the conference click on the link https://lnkd.in/gKgk-UQ">

    Pinnacle will be speaking at the 2020 OR Business Management Conference in Florida. To register for the conference click on the link https://lnkd.in/gKgk-UQ

    Business Management Conference January 27–30, 2020

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  • Pinnacle partners with The Hub Cycle to build bikes for a local charity">

    Pinnacle partners with The Hub Cycle to build bikes for a local charity

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  • Pinnacle is proud to be a sponsor and will be exhibiting at the conference">

    Pinnacle is proud to be a sponsor and will be exhibiting at the conference

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