While no top ten list from the desk of a health lawyer could be complete given the ever-changing nature of the health care industry, here are a few significant legal issues to think about this year.

1. Health Reform

Even though the health reform frenzy of late 2009 was stopped in its path by a Senatorial election in Massachusetts, federal efforts at health reform are not quite over. Something, albeit a watered-down something, is bound to be passed by Congress, so stay tuned.

2. HIPAA Tweaks

The Stimulus Bill of 2009 provided a new HIPAA compliance deadline in February 2010. This marks the starting point at which business associates of covered entities will become directly obligated under HIPAA as though they were covered entities. This is a significant change to HIPAA law, and there likely will be a flurry of updates to business associate agreements.

3. Compliance Reviews

The lead federal health insurance reform proposals included provisions that would have mandated compliance programs for all providers, whether large or small in size. If a health care provider has never heard of a compliance program, it may be time to get initiated. The key for non-institutional providers is to tailor the program properly so it does not cause practical or legal problems.

4. Fraud and Abuse Enforcement

Much of the talk about cost savings in federal health reform centered on attacking the estimated $60 billion in health care fraud annually. While fraud can and should be prosecuted, the effect of ramped up enforcement efforts likely is to drag in many providers who simply are making a series of bad mistakes or may even be negligent in billing for services. The goal for providers should be to stay off the enforcement radar by taking reasonable steps to monitor and, if necessary, correct their billing practices.

5. Recover Audit Contractor (RAC) Requests

Providers in most states like Oregon and Washington now are potential targets for retrospective review of Medicare claims. RAC firms are paid a contingency fee based on the amount of overpayments they find. Be sure to check RAC websites for subject areas approved for review.

6. Credit Crunch

While the severely injured economy apparently is showing signs of recovery, many medical practices continue to find themselves in cash crunches due to lines of credit with banks being reduced or shut off altogether. Because cash flow crunches can lead to serious legal problems in the operation of a business, providers should work closely with their financial advisors to find alternate ways to weather credit shortages.

7. Imaging Services

Providers who own imaging equipment and bill for the technical component of imaging services should be mindful of upcoming efforts to require accreditation of those services.

8. Reimbursement Remodels

In the 1990s, health insurers gave us capitation and gatekeepers, now in 2010, we are hearing concepts such as the medical home model and Triple Aim. The goals of the new reimbursement models seem to remain the same: increase access and quality, and decrease costs. In health care, this likely remains an eternal struggle (which is what makes working in this field challenging and interesting).

9. Medicare Woes

Every few months, a physician will ask whether they have to keep seeing Medicare patients. The typical reasons are that the pay is low, the work is demanding, and there is fear that mistakes in billing will be treated as fraud. The typical response is that there is no legal requirement to see Medicare patients unless a contract says so, but can the practice really afford to stop doing Medicare work. Notably, just this month, and past the twelfth hour, Congress yet again pushed off a 21% cut to Medicare reimbursement. Congress needs to fix that problem permanently if only to prevent an exodus of providers from participating in Medicare who may just be sitting on the fence waiting for another excuse to leave the program.

10. Dispute Resolution

In economic slumps, businesses and people wrestle about money. Ask any litigator, and they will tell you they are busy these days. Health care providers should be wary of protracted legal disputes, and consider all options for resolving disputes. While litigation certainly serves its purpose, many disputes can and should be resolved through a business resolution.