McGeehan Law
McGeehan Pascale, PLC
Attorneys & Counsellors at Law​
3554 Chain Bridge Road, Suite 205
Fairfax, VA 22030
​703.273.5303
 
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McGeehan Law

balance billing for medical providers AND flsa exemption for administrative personnel

1/18/2021

 
Starting January 1, 2021, Virginia adopted new laws and rules for “balance billing”. 

Duties of Healthcare Provider
:

If the health plan’s enrollee is treated by an out-of-network provider for emergency services or an in-network facility for scheduled services covered by Virginia law and rules, the provider or facility that is out of net work will submit the claim to the enrollee’s health plan.  The amount the health insurer pays the facility or provider must be “commercially reasonable amount based on the same or similar services in a similar geographic area.  If the health care provider and plan cannot agree on the amount, either party can start the arbitration process.
The Virginia of Department of Health provides a data set of what is a commercially reasonable payment data and Protocols. 
If health care providers have a pattern of violations under the new law without attempting corrective action, they are subject to fines or other remedies by the Virginia Board of Medicine or the Virginia Commissioner of Health. Similarly, insurance companies that are found to engage in a pattern of violations of the new law are subject to fines or other remedies by the SCC. Neither insurance companies nor health care providers may use arbitration as a general business practice for resolving claims payments.

Right of patient:

A patient has a right to be informed if the provided is in-network or out-of-network before being treated.  And the conditions when they can and cannot be balanced bill.
Not all health care providers are subject to this law.  However, when a patient schedules a medical service, they should ask their health care provider if they are in-network. Insurers are required to tell them that (on their websites or on request). Hospitals and other health care providers also must tell you (on their websites or on request) which insurance plans they contract with as in-network providers.
When a patient receives an explanation of billing (EOB) it must state what they must pay.  If they have a high deductible, they must pay the balance up to their deductible. If there is a dispute, the patient may file a complaint with the Virginia State Corporation Commission, Bureau of Insurance.

Classification and Exemptions of Administrative Workers under FLSA

            Misclassification of a worker can carry serious consequences to an employer.  In an opinion letter, dated January 8, 2021, the Secretary of Labor considered whether account managers are exempt from the minimum wage and overtime rules under the Fair Labor Standards Act (FLSA) and Portal to Portal Act.  As with all FLSA questions, the answer mostly depends of the facts.  In this case the facts were the account managers were given flexibility and autonomy to develop account plans and explaining how the product will benefit a prospective client and follow through helping client develop a plan.  The account managers are paid above the weekly salary threshold.  They perform non-manual work and primarily office work.  They exercise discretion and independent judgement with respect to matters of significance.  The Director of WHD held they were exempt as administrative employees. 

    Author

    John P. McGeehan is the managing member of McGeehan Pascale, PLC. His practice focuses on business structures, especially new, emerging, small businesses and not for profit organizations, all business transactions, employment law, real estate, commercial leasing, estate planning and litigation before administrative agencies and all courts.

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we COVID 19 VIRUS PROCEDURES

mCgeehan pascale, plc IS TAKING PRECAUTIONS IN LIGHT OF THE CDC ADVICE FOR THE CORONAVIRUS.  WE ARE WORKING EVERY DAY TO ANSWER QUESTIONS, DRAFT DOCUMENTS AND OTHERWISE TO SERVE OUR CLIENTS' LEGAL NEEDS.   ALL OF OUR STAFF ARE IN GOOD HEALTH AND OUR WISH FOR OUR CLIENTS IS THAT THEY ALSO REMAIN IN GOOD HEALTH.   IF THE NEED ARISES, OUR EMPLOYEES HAVE PAID SICK LEAVE AVAILABLE TO THEM.  IF THAT OCCURS, WE MAY TAKE A BIT LONGER FOR SOME THINGS, FOR WHICH WE ASK YOUR UNDERSTANDING.   IF POSSIBLE, WE ASK THAT OUR CLIENTS AND ATTORNEYS WITH WHOM WE DEAL DO SO BY TELEPHONE OR EMAIL TO AVOID PERSON TO PERSON CONTACT.  IF YOU SUSPECT YOU HAVE BEEN EXPOSED TO THIS VIRUS AND WE HAVE HAD PERSON TO PERSON CONTACT IN THE PRIOR 14 DAYS, PLEASE LET US KNOW THAT.

WE DISINFECT, THROUGHOUT THE DAY, ALL AREAS IN OUR OFFICE THAT MAY BE TOUCHED BY PEOPLE.  THE NEW ENGLAND JOURNAL OF MEDICINE PUBLISHED AN ARTICLE SAYING THAT SOME SURFACES MAY HOLD THE CORONAVIRUS VIRUS FOR UP TO 72 HOURS and UNVERIFIED SOURCES REPORT IT CAN BE LONGER.   OUR BUILDING ALSO HAS ESTABLISHED PROCEDURES DESIGNED TO PROTECT PERSONS COMING INTO THE BUILDING.   ALL COURTS IN WHICH WE REGULARLY PRACTICE HAVE ESTABLISHED PROCEDURES THAT RESCHEDULE OR POSTPONE HEARINGS, GENERALLY, UNTIL AFTER MID-APRIL OR MID-MAY AND LEGAL TIMELINES HAVE BEEN ADJUSTED. 

we concluded that we are exempt from the mandates announced for virgina on March 23, 2020, provided we continue the sanitation procedures outlined above and do not have more than 10 people CONGREGATED AT the same time.  however, we prefer contacts by phone or email.  if you must meet in person, please call first so we can determine if some or all of the matters can be handled by phone or email.
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