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Nearly twenty years ago, Indira Feustel was playing in a tennis match when she noticed another tennis player in the next court collapse.

“I just thought ‘oh, someone had twisted their ankle or something’ but he never got up,” said Feustel. “It was a big enough tournament, with numerous courts that you would think someone would have started CPR and then I realized it was going to be me.”

Feustel had just renewed her CPR certification and was able to perform bystander CPR, with the help of a nurse, until help arrived.

“A constable called me from the hospital afterwards and said that the family was just so thankful for our efforts,” Feustel said. “He had passed away from a massive heart attack. It just stuck with me.”

The passion to help others continued to stick with Feustel throughout her life. In 1997, Feustel walked in her first American Heart Association Heart Walk, dedicating the walk in honor of that man’s memory.

But in 2000, heart disease hit close to home when Feustel’s father, Dr.

By Michelle Mason American Heart Association

CPR certification course. This year’s incoming seniors will be the first class required to complete this certification.

“That is phenomenal. I would love to see that expanded to every citizen someday. In that way, you would have the comfort of knowing that if you were ever in an emergency situation requiring CPR, there would be someone that could help you”, said Feustel.

Across the country, the bystander rate, which is the amount of people who could perform bystander CPR in an instance where someone collapsed, is at 40 percent. Whereas in the Houston area, that rate stands at 32 percent.

Through her work as a speech-language pathologist, Feustel says she is inspired by her patients with heart disease or who have suffered strokes. The memory of the collapsed tennis player, her patients, her amazing father and CPR education, are all the reasons that Feustel is driven to continue to raise money for the AHA, one person, at a time, she said.

Over the past 18 years, Feustel has used her passion to raise over $120,000

October Issue 2016

HOUSTON

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For All of Our Hearts: How One Local Woman is Fighting for the Hearts of Bay Area

see For All of Our Hearts page 20

Vijay Bhatnager, suffered a heart attack.

“My brother, Samir, a police officer, was picking up my parents after a dinner and my dad had collapsed on the side of the road,” said Feustel. “My brother started performing CPR. A doctor was actually watching across the street and helped so they did two person CPR for twenty minutes before the ambulance came.”

Feustel said if it had not been for her brother, the doctor’s CPR efforts and medical and technological advances supported by the American Heart Association, her father would not have survived.

“I thought I was going to call the hospital and hear that my dad was dead on arrival,” Feustel said. “My two boys, Ari and Aden, were six and four at the time. My father has now lived to see all ten of his grandchildren be born into his family and now he has also seen my boys go off to university. My dad is like our walking miracle.”

In 2012, the American Heart Association was instrumental in helping the State of Texas pass a new law that will require all high school students to graduate with at least one

Photo courtesy of Sandy Adams

Strong social support is related to shorter stay in inpatient rehabilitation

after hospitalization See pg. 16

Inside This Issue

New Treatment Helps Patients with Asthma Breathe Better

See pg. 18

INDEX

Mental Health...............pg.4

Legal Health .................pg.5

Oncology Research .....pg.8

Pharmacy Corner .......pg.10

Houston Medical TimesPage 2

October 2016 medicaltimesnews.com

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Your eyes begin to open after a good night of sleep, but something feels weird. You try to rub the tiredness out of your face but can’t lift your arms. In a panic you try to take a deep breath but can’t draw air. You can’t sit up, and you may even see a shadow in the corner of the room. This isn’t a nightmare or a medical emergency—you likely just had a case of sleep paralysis.

What is sleep paralysis?

Sleep paralysis is an episode where your brain tells the body that you’re still in the rapid eye movement (REM) stage of sleep in which the limbs are temporarily paralyzed (to prevent physically acting out dreams), heart rate and blood pressure rise,

and breathing becomes more irregular and shallow. This is the stage of sleep where your most vivid dreams occur, which can explain why some people may hallucinate during sleep paralysis.

“Sleep paralysis is a frightening event,” said Steven Bender, DDS, director of the Center for Facial Pain and Sleep Medicine and clinical assistant professor with the Texas A&M College of Dentistry. “Someone is awake, but they have no control of their body and might possibly even see things that aren’t there because their brain still thinks it’s in REM sleep.”

Sleep paralysis differs from dreaming and night terrors mainly due to the fact that the brain is awake, even if it hasn’t told the body just yet.

“When people have a nightmare,

they sleep, have a dream and then wake up,” Bender said. “When they’re experiencing sleep paralysis, they may have a dream when they are already awake.”

What can occur during sleep paralysis?

Spells of sleep paralysis last only a few moments—at most a couple minutes—and typically only occur when falling asleep or waking up. In addition to muscle atonia, someone

experiencing sleep paralysis can have the experience of dreaming with the added involvement of being conscious and aware of their surroundings.

“People who experience sleep paralysis can have vivid hallucinations because they are dreaming,” Bender said. “People have felt like they’re levitating or that someone is in their bedroom or a variety of other strange experiences—like alien abductions.”

Mental HealthSleep Paralysis: Fully Awake and Unable to Move

When your peaceful slumber turns into a haunting nightmare

By Dominic Hernandez

Physicians are on the medical staff of Behavioral Hospital of Bellaire but, with limited exceptions, are independent practitioners who are not employees or agents of

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see Mental Health page 20



Legal HealthCMS INCREASES THE USE OF REVOCATION AS AN

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Recent regulatory changes by the Centers for Medicare & Medicaid Services (“CMS”) have resulted in greater scrutiny of Medicare enrollment requirements. Since 2011, CMS has taken action to deactivate Medicare billing privileges for more than 543,000 providers and suppliers as a result of revalidation and other screening efforts and more than 34,000 providers

and supplier enrollments have been revoked. Providers or suppliers with Medicare billing privileges should fully understand Medicare’s enrollment rules and periodically review their enrollment data in order to prevent a revocation of their enrollment in the Medicare program.

A. Revocation.Currently enrolled providers or

suppliers may have their Medicare billing privileges revoked for the following reasons:

1. Noncompl iance wi th enrollment requirements;

2. Provider or supplier conduct, such as being debarred, suspended or otherwise excluded for any Federal health care program;

3. Conviction of a felony offense;

4. False or misleading

information on the Medicare enrollment application;

5. On-site review no longer operational to furnish Medicare-covered service;

6. Grounds related to Provider and supplier screening requirements;

7. Misuse of billing number;

8. Abuse of billing privileges, including a pattern or practice of billing for services that do not meet Medicare requirements;

9. Failure to report changes, including change of ownership,

adverse legal action or change of practice location;

10. Failure to provide CMS access to documentation;

11. Failure of home health agency to meet initial reserve operating funding requirements;

12. Suspension or revocation of prescribing authority; and

13. Improper prescribing practice.

42 C.F.R §424.535.

Revocation of Medicare billing practices results in the termination of any provider agreement in effect at the time of revocation. If a provider or supplier has its Medicare billing privileges revoked, it is not a temporary action; rather, the provider or supplier is barred from participating in the Medicare program from the effective date of the revocation until the end

Mark S. Armstrong, J.D.Epstein, Becker & Green, P.C.

see Legal Health page 20



Breast cancer patients in the U.S. will have a new surgical option that eliminates exposure to radioactive materials and offers a less invasive, more flexible alternative for cancer detection. Receiving FDA approval in April and a distribution deal this month, the new device will be used to locate early stage tumors that cannot yet be felt.

Co-invented by University of Houston physicist Audrius Brazdeikis and his collaborators at the University College of London, the Sentimag technology platform is a magnetic surgical guidance probe used with nanoparticle tracers and other magnetic devices to more safely and easily determine the spread of cancer. Its first introduction commercially in the U.S. will be its use with an implantable magnetic lesion marker, called Magseed, that easily guides surgeons to cancerous lesions. The

Sentimag+Magseed combination serves as a replacement for procedures involving surgical wire needles and radioactive seeds, which are the two standards of care currently in practice for finding a breast tumor in advance of a lumpectomy.

Receiving 510(k) clearance from the U.S. Food and Drug Administration (FDA) in April, the Sentimag+Magseed breast cancer diagnostic system can now be marketed stateside. Thanks to the distribution deal unveiled this month between Devicor Medical Products and Endomag, a UH spinoff medical devices company co-founded by Brazdeikis, the technology will be immediately available for use here in the U.S. Devicor Medical Products, a division of Leica Biosystems, will be the exclusive distributor of Sentimag in the U.S. and Canada.

As breast cancer screening programs have advanced, tumors are

now detected much earlier, so they are smaller, less defined and harder to feel. In fact, 50 percent of all breast tumors cannot be felt at diagnosis. Since these small tumors are often impalpable, they are difficult for surgeons to locate during a lumpectomy.

“Magseed is designed to guide surgeons using Sentimag to locate impalpable tumors for biopsy and has many advantages over wire and radioactive seed localization,” Brazdeikis said. “Radiologists can place the Magseed magnetic markers up to 30 days in advance of surgery using X-ray or ultrasound guidance. This offers scheduling flexibility for surgeons and radiologists, as well as for patients, compared to wire-guided

localization.”Traditional guide wires, which

are inserted by a radiologist in a separate procedure prior to a patient’s lumpectomy, protrude from a patient’s breast, leading to potential discomfort and restricting the patient to the hospital. More critically, the protruding guide wires risk movement prior to surgery, requiring follow-up surgery in up to 55 percent of lumpectomy procedures. Conversely, Magseed is similar in size to a grain of rice and placed within the tumor, allowing the possibility for patients to return home before their operations. During the lumpectomy, the Magseed magnetic marker is located using audio-visual cues from the Sentimag device.

New Surgical Option for Breast Cancer Comes to the U.S.

Co-invented by UH Physicist, Device Replaces Invasive, Radioactive Procedures

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Head and neck cancer is one of the major cancer types and carries a poor prognosis, with low survival rates for advanced stages and minimal progress in survival trends through the last decades. New immune based cancer treatments are currently in development. While many different types of cancer can occur in the head and neck such as laryngeal and hypopharyngeal cancer, nasal and paranasal sinus cancer, nasopharyngeal, oral, oropharyngeal and salivary gland cancer, other types of cancer can be also located in the head and neck (brain cancer, parathyroid,

sarcoma and thyroid cancer) region but diagnosis and treatment are different. According to National Cancer Institute (NCI) in 2016, an estimated 61.760 people will develop one of these cancer and 13.190 will die.

Head and neck squamous cell carcinoma (HNSCC) represents a heterogeneous cancer type which involves about 90% of all head and neck cancers, originated from the squamous lining of the upper aero digestive tract, including the oral cavity, pharynx, larynx and sinonasal tract. Currently, it is known as the 6th most common cancer in the world and only 50% of patients will remain alive for 5 years post-diagnosis. Due to its accelerated spreading, treatment failures of its high occurrence, this kind of cancer has become, in the

last decades, one of the major threats to public health. Its development and progression has been gaining special attention, considering the new findings associated to the core instability of genetic and epigenetic, metabolomics, cellular remodeling and associated risk factors, especially with the involvement of viral infections and, more recently, to the immunological aspects inherent from the tumor microenvironment (TME) particularly cell profiles ( f ibroblast associated with cancer, regulatory T cells,

lymphocytes, and macrophages with immunosuppressive profile Th2 and M2, respectively, and neutrophils associated with tumor) and humoral profile (chemokines, immunosuppressive cytokines such as TGF-B, IL-13, IL-10, proteins responsible for the breakdown of extracellular matrix- metalloproteinase and factors that contribute to the development and tumor progression mediated by angiogenesis, such as EGF and VEGF). In the upcoming years,

Oncology ResearchEmerging strategies in the immunotherapy of Head and

Neck cancer

By Jorge Augusto Borin Scutti, PhD Houston Medical Times

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Within recent years, the prescribing patterns of psychotropic medications among the pediatric population has grown with this population being prescribed medications for a myriad of issues that can be attention, behavioral, or mood related to name a few. While there have been ethical issues related to prescribing psychotropic medications to children, there are currently evidence-based and well-researched guidelines in place that are designed to aid clinicians in the decision-making process. To date, there are more and more psychotropic medications being prescribed to children than there is consistent research to definitely support their utilization. The adverse effects associated with psychotropic

medications that can include mood stabilizers, antidepressants, and antipsychotics can be surmountable that it is difficult to come to terms with the fact that these medication are given to such a sensitive population. For instances, one British study found a link between the use of some psychotropic mediations and an increased risk tendency towards suicides in adolescents. The United States has already issued black-boxed warning against an increased risk of suicidality associated with antidepressant use in children, adolescents, and young adults (18-24) years of age so caution is to be strongly exercised when these medications are initiated in this particular population. It is advised that close monitoring and ongoing assessments are critical when initiating therapy and continuing therapy.

From an ethical standpoint it is important to realize that providers are expected to avoid inflicting harm on patients and if this cannot be

avoided they must take reasonable steps to minimize harm when it comes to treating their clients. These ethical standards should also apply to prescribing psychotropic medication to children. For instance if treatment with a psychotropic medication is causing a client harm, a provider must take the necessary steps to minimize or alleviate any further harm even if it means the discontinuation of the medication. Since there are very limited psychotropic medications that are approved by the Food and Drug Administration for use in children any psychotropic medication that is

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Harris County has highest rate of breast cancer diagnoses in women in

TexasYMCA offering free classes to cancer survivors to

improve quality of life and decrease fatigueDear Doctors and Staff,

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By far, Harris County sees the greatest amount of newly diagnosed breast cancer cases in women in the state. Every year, an average of 2,295 new cases are diagnosed, according to the National Cancer Institute and the Centers for Disease Control and Prevention.

As treatments for all types of cancer become more effective, the number of people living beyond a cancer diagnosis continues to grow rapidly. This is why various YMCAs

of Greater Houston are offering free, 12-week classes that have proven through studies with the Yale Cancer Center and the Dana-Farber/Harvard Cancer Institute to:

∙ Meet or exceed the recommended amount of physical activity for cancer survivors

∙ Help survivors significantly increase their cardiovascular endurance

∙ Increase cancer survivors’ overall quality of life and decrease cancer-related fatigue

Called LIVESTRONG at the YMCA, the evidence-based program is open to cancer survivors ages 18 and up currently in treatment or who have completed treatment. A YMCA membership is not required and the program is of no cost to the individual.

Two, 90-minute weekly sessions are modified to meet all participants’ needs. Some participants perform gentle stretching and low-impact exercises while sitting in a chair. Others

may lift light weights and engage in modified Zumba movements. Some use the treadmill and exercise bikes to build strength and balance.

“There is something about being physically active and having fun together that really bonds people in a special way,” said Lharissa Jacobs, director of Community Health at the YMCA of Greater Houston. “People feel their LIVESTRONG group can understand them in a way that their

friends and families might not be able to because they have all faced the same challenges.”

The LIVESTRONG program also includes a fellowship component that allows participants to share their stories. And, guest speakers discuss topics such as nutrition and mind-body connection.

“Our participants are so passionate about the program. Some say they couldn’t imagine getting up and leaving the house except for this program,” Jacobs said. “Now, here they are hanging out with their friends at the Y. After the program wraps up, they don’t want to stop. They want mentor the next group.”

Classes have a rolling start date, so please contact your local YMCA for more information. You can also contact [email protected] or Lharissa Jacobs at 713-758-9186 or [email protected].

A YMCA Wellness Center instructor encourages a cancer survivor on the exercise bicycle

Cancer survivors are able to build strength at their own pace in the LIVESTRONG at the YMCA program.



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Sometimes the best medicine is the care of family and friends.

A recent study from The University of Texas Medical Branch at Galveston showed that patients with strong social support from family and friends spend less time in an inpatient rehabilitation facility. This study is currently available in the Archives of Physical Medicine and Rehabilitation.

“When someone does not have the social support of family and friends, they take longer to return home to the community. We believe that support from loved ones may lead to better recovery and better quality of life,” said lead author Zakkoyya Lewis, a doctoral student in UTMB’s department of rehabilitation sciences. “Our study is one of the first to look at how level of

social support impacts how long patients need to spend in a rehab facility.”

Following certain injuries or surgeries such as a lower body joint replacement or fracture or when recovering following a stroke, patients are often sent to an inpatient rehabilitation facility, or IRF, before they return home.

Under the current Medicare payment system, Medicare agrees to cover a certain number of days for patients to stay in a rehabilitation facility, depending on their health situation. There is a financial incentive for facilities to discharge a patient earlier than his or her projected length of stay while still providing quality care. However, there is little information about variables such as a patients’ home life or support system that impact expected lengths of

stay. Some of those variables may affect discharge planning decisions and how well the patient does when they return home.

For 119,439 Medicare beneficiaries who spent time in a rehabilitation facility in 2012, the researchers compared the amount of time that Medicare determined patients would need to spend in rehab with the actual length of their stay. They also analyzed social support based on information that the patients provided.

The study showed that having strong social support influences how

long patients need to spend in rehab. Compared with patients who have strong support from family or friends, those with little social support were more likely to need extra time than predicted by Medicare.

“Our findings provide new information to the growing body of evidence that inpatient rehabilitation experiences can be substantially impacted by a patient’s level of social support,” said coauthor Catherine Cooper Hay, a doctoral student in UTMB’s department of rehabilitation sciences.

Strong social support is related to shorter stay in inpatient rehabilitation

after hospitalization





> 25 Million People in the US alone have asthma according to Asthma and Allergy Foundation. A new treatment is now available for people who suffer from asthma. The innovative treatment called, Bronchial Thermoplasty (BT) as safe and clinically proven procedure shown to reduce asthma attacks. Bronchial Thermoplasty is indicated for patients who are 18 years and older and who are not well controlled on their asthma medications.

> During the procedure a tiny, carefully controlled device delivers

mild heat to the smooth muscles of the airways in your lungs. No incisions are needed because the procedure is performed with a bronchoscope inserted thru the mouth. Bronchial Thermoplasty is performed in three separate sessions three weeks apart. Each treatment focuses on a different part of the lungs and usually last about 45 minutes per session.

> BT is performed by a specially- trained pulmonologists, who partners with your primary care physician or allergist to

deliver the BT procedure. Bronchial Thermoplasty was FDA approved in 2010 and has been clinically proven to decrease severe asthma attacks, reduce reduction in asthma related ER visits, and decrease the number of days lost from work, school and daily activities. Additionally patients who were treated with BT reported significant improvement in their asthma quality of life.

> Medications are commonly prescribed to treat asthma, but they often are not very effective at controlling symptoms in people with severe persistent asthma.

Bronchial Thermoplasty is a revolutionary treatment for these people who suffer from severe asthma. "I have found BT to be an exceptionally safe and effective treatment for asthma patients. It dramatically improves their lives", says Dr. Lisa Kopas a pulmonologist and Critical Care specialist affiliated with Pulmonary and Critical Care Sleep Associates.

> If asthma is limiting your life, you may be a candidate for Bronchial Thermoplasty.

New Treatment Helps Patients with Asthma Breathe Better

NOW LEASINGPHASE II

By Jose Melendez MD

Dr Melendez shown here with a bronchoscope



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of the reenrollment bar, which is

between 1 and 3 years, depending on

the reason for the revocation.

CMS has recently revoked

provider and supplier billing privileges for various purported administrative oversights, including the following: (1) the supplier’s failure to report a change of location within 30 days of the

relocation, therefore CMS concluded that the supplier was not “operational” at the time of the site visit; (2) the supplier’s designating a practice location as a post office address when

the supplier practiced exclusively in nursing homes; and (3) the supplier’s submitting claims with billing errors. Once the provider’s billing privileges

REM sleep occurs in cycles of about 90 to 120 minutes throughout the night, and it accounts for up to a quarter of total sleep time in adults—particularly towards the latter end of sleep. Because rapid and irregular breathing occurs in REM sleep, people who experience sleep paralysis may

struggle to breathe properly, which can feel like suffocation.

Who is at risk for sleep paralysis?

This phenomenon may happen more often than you’d think, as seven to eight percent of the population may experience sleep paralysis. It is more

frequent in African-Americans, young adults and females. Those who have bad sleep habits, such as napping during the day or being on their phone or laptop in bed, can potentially increase their risk for sleep paralysis.

People who have narcolepsy, a

chronic sleep disorder that causes overwhelming drowsiness, or other sleep disorders have an increased risk for sleep paralysis. Other mental health disorders, such as depression and anxiety, have also been linked with greater chances of sleep paralysis.

for the American Heart Association’s Heart Walk. In 2015, Feustel raised over $20,000 and is hoping to raise $21,000 for the Bay Area Heart Walk.

“My father is truly a huge

inspiration; one of the main reasons

why I continue to fundraise year after

year,” said Feustel. “Heart Disease is

the No. 1 killer of men and women

in North America. This is a very

important fight and I am trying to get as many people involved in supporting—for all of our hearts!”

The Bay Area Heart Walk is set for Saturday, November 12 at Kemah

Boardwalk from 7:30 – 10:30 a.m.

To sign up for the Heart Walk or to

donate to Feustel’s personal goal, visit

www.bayareaheartwalk.org

For All of Our HeartsContinued from page 1

Mental HealthContinued from page 4

Legal HealthContinued from page 5

“Let’s give cancer the boot”

MD Anderson Cancer Center Ranked one of the top cancer centers in the nation for 27 years by U.S. News & World Report.

Put on your favorite boots and join us at the Boot Walk to End Cancer™, a family-friendly fundraiser in the Texas Medical Center.

Every dollar raised helps us end cancer. Together, we can give cancer the boot for good.

Visit mdanderson.org/bootwalk for event information and fundraising details.

Diamond Sponsors

Register. Donate. Volunteer. Saturday, Nov. 12, 2016

mdanderson.org/bootwalk

16MDA_GN_1929_1_Houston Medical Times Print Ad_10x6.485_3.indd 1 6/24/16 4:31 PM

see Legal Health 22



Leading an anti-inflammatory lifestyle is a goal for most people these days. In the past, I have mentioned the role that healthy fats play in an anti-inflammatory diet. This time I will be discussing how fruits and vegetables also aid in lowering inflammation.

Fruits and vegetables are loaded with phytochemicals and antioxidants.

What is a phytochemical? They are chemicals found in plants. We now know that when we consume these plants, their phytochemicals

include benefits linked to reducing our risk of cancer, heart disease, and diabetes.

Let’s look at how phytochemicals protect the plants that contain them:

1. Plants rely on phytochemicals for their own protection and survival.

2. They help plants resist attacks from bacteria or fungi.

3. Phytochemicals protect plants against the potential havoc from free radicals.

4. They protect plants from constant exposure from the sun’s UV rays.

When we consume plants, the same protection they get from phytochemicals, is passed on to us.

What is an Antioxidant? Antioxidants are substances which remove potentially damaging oxidizing agents in a living organism. Basically they protect your cells from damage, such as the damage from pollution. Antioxidants are found in plant-based foods. Eating your fruits or vegetables give your body the necessary antioxidants that halt or even repair damage brought on by free radicals. The most potent antioxidants include vitamins A, C, and E along with selenium.

How can you get more antioxidants and phytochemicals? It’s always best to acquire these nutrients from food. In order to reach the amounts you need on a daily basis, the recommendation is at least 5-9 servings of fruit or vegetables per day. I know it sounds like an overwhelming amount but it can be done by simply remembering to include 1 serving of fruits or vegetables (or both) at each meal.

Nutrition CornerInflammation and Diet, Part 2

By Denise Hernandez,MS, RD, LDHouston Medical Times

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understanding the immunobiology of head and neck squamous cell carcinoma will be accompanied simultaneously by important advances in the early detection of high-risk patients, based on the identification of biomarkers, on the manipulation of the immune system and on the understanding of the pharmacogenomics. Strategies based on immunotherapy, which has been successfully used in numerous types of cancer, can contribute positively to the rehabilitation of some microenvironment components and reduce the serious consequences associated with this type of malignancy. A promising path of clinical research in HNSSC is the use of immune checkpoints inhibitors. On August 5th, 2016 FDA approved Pembrolizumab

(Keytruda®), a PD-1 inhibitor for the treatment of patients with recurrent or metastatic HNSCC with disease progression on or after platinum-containing chemotherapy.

Currently, there are more than 50 clinical trials on HNSSC immunotherapy. Among them the most important are: checkpoints i nh i b i t o r s (Du r va lumab, Tremelimumab and Nivolumab) and immune modula tors (Epacadostat and Selumetinib), adjuvants (Multikynes, IRX2, poly

ICLC and toll like receptor agonist), cancer vaccines (DNA-based IL-12), adoptive cell transfer (TILs – tumor infiltrate lymphocytes), monoclonal antibodies (anti-HER3, anti-EGFR

a n d a n t i - H G F ) oncolytic virus therapies (Enadenotucirev) and cy tokines ( IL -15) . Unfortunately, the tumor progression and prognosis of patients with advanced HNSCC is gloomy, and despite aggressive management, a substantial percentage of patients will develop relapse.

F u r t h e r m o r e , f u t u r e investigations are required to find novel combination strategies of immunotherapy, molecularly targeted agents, and conventional therapies while ensuring acceptable tolerability of these treatments.

are revoked, the provider is prohibited from billing or participating in the Medicare program until the end of the re-enrollment bar.

Providers and suppliers whose billing privileges are revoked cannot receive payment for any services provided to Medicare beneficiaries during the period of revocation. Therefore, even if the provider appeals the revocation, it can expect significant payment delays lasting several months to more than a year. The reimbursement delay alone can pose a very challenging obstacle for the survival of many providers.

B. Deactivation.

A complete revocation of billing privileges is not the only remedy authorized by the regulations. CMS may also elect to deactivate a provider’s Medicare billing privileges as a prophylactic measure for several reasons, including a failure by the provider to:

“report a change of information supplied on the enrollment application within 90 calendar days of when the change occurred. Changes that must be reported include, but are not limited to, a change in practice location, a change of any managing employee, and a change in billing services.”

42 C.F.R. § 424.540(a)(2).

CMS has explained that the deactivation of Medicare billing privileges is a “temporary action” that is used to protect the provider or supplier from misuse of their billing number and also to protect the Medicare Trust Funds from unnecessary overpayments. The deactivation of a billing number does not affect a provider’s participation agreement or the conditions of participation. In order to reactivate a deactivated Medicare billing number, the provider or supplier must complete and submit a new enrollment application. Unlike a revocation, there are no appeals rights for a provider or supplier whose

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Oncology ResearchContinued from page 8

billing privileges were deactivated.

C. ConclusionSignificant consequences to a

provider’s Medicare billing privileges may result from simple administrative oversights, including failing to timely file a change in a provider’s address. In order to guard against revocation or deactivation, Medicare providers and suppliers should:

∙ Fully understand Medicare’s enrollment rules,

∙ Periodically review their enrollment data to confirm complete and accurate information is on file,

∙ Timely update any changes to the enrollment,

∙ Develop a comprehensive compliance program, and

∙ Establish effective internal controls that promote adherence to regulatory requirements.

Legal HealthContinued from page 20



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