New York Dentists Face New Dental Anesthesia Requirements

New sweeping regulations went into effect on July 1, 2017 for dental anesthesia services in New York. The regulations, among other things, would require dentists to have additional and specific continued education courses, meet specific practice requirements and maintain more exacting records than previously required. The regulations will also impose more stringent requirements on dentists providing dental sedation to patients 12 years old and younger. We provide a summary of the new requirements in the article that follows.

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NYS OMIG Focuses on Compliance, Fraud, Waste & Abuse and Detection

New York State Office of the Medicaid Inspector General (OMIG) annual 2018-2019 Work Plan highlights three areas of concern for the agency: (1) provider compliance; (2) identifying and addressing fraud, waste and abuse in the program; and (3) improving methods of detecting fraudulent activities.

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CERT Audit Finds Insufficient Documentation Results in Improper Payments

Recent analysis by the Comprehensive Error Rate Testing (CERT) initiative of physical therapy claims revealed that insufficient documentation contributed to improper payments issued to providers.

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Pharmacies Beware of Potential Gabapentin Reporting Requirements

New Jersey’s Division of Consumer Affairs is proposing to amend the Prescription Monitoring Program (PMP) to require pharmacies to electronically transmit information about prescriptions filled for gabapentin.

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NJ’s New Rules for Companion Service

The New Jersey Division of Consumer Affairs (“Division”) recently proposed amendments and a new rule to implement a 2014 law concerning health care service firms.

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NY’s OMIG Finds Basic Compliance Program Gaps

The Bureau of Compliance (BOC) within the New York State Office of the Medicaid Inspector General (OMIG) recently performed an assessment of providers’ compliance programs. The results indicate that providers sometimes fail in relatively less complicated and readily addressable ways.

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New Jersey Places New Limitations on Opiod Prescriptions

Several of New Jersey’s professional licensing Boards recently adopted new controlled dangerous substance prescription requirements. Prescribers should be aware of the changes to avoid running afoul of the new regulations.

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New Blanket Waivers for Electronic Prescribing Approved in NY

In recognition of limitation of certain electronic prescribing software the NYS Health Commissioner approved a new blanket waiver for electronic prescribing requirements.

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Billing for Dually Eligible Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) has once again issued guidance reminding providers that federal law bars Medicare providers from billing a Qualified Medicare Beneficiaries (QMB) under any circumstances.

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NY Watchdog Releases Its Annual Fraud Fighting Plan

The New York State Office of the Medicaid Inspector General (OMIG or agency) has recently issued its 2017-2018 Workplan. The Workplan identifies key areas of OMIG’s focus impacting health care providers and suppliers.

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Recent Medicare Program Changes

Providers, suppliers and their billing staff need to be aware of the following recent changes to the Medicare program.

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OIG’s Strengthens its Exclusion Authorities

The Office of Inspector General (OIG) recently published a final rule that implements OIG’s expanded statutory exclusion authority. The final rule included a number of provisions that impact providers and suppliers.

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NJ Dentist Beware – When Administering Botox May Lead to Board Troubles

Scope of practice matters and New Jersey dentists who fail to comply with the requirements for administering injectable pharmacologics such as Botox or Restylane may be subject to discipline.

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NJ’s Medicaid Watchdog Expands Audit and Exclusion Efforts

A recent report from the New Jersey Office of the State Comptroller indicates an expansion of the efforts of its Medicaid Fraud Division (MFD) to investigate fraud, waste and abuse in the New Jersey Medicaid Program. The report also highlights MFD’s expanded effort to exclude providers from the Medicaid Program.

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Late Breach Notification Leads to Half a Million Dollar HIPAA Settlement

Failure by a covered entity to timely report a breach of protected health information (PHI) resulted in the first of its kind settlement in the amount of $475,000.

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Changes to New York’s Medical Marijuana Program

New York State is working to expand the State’s medical marijuana program.

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Recent Medicare Updates for Healthcare Providers

Read the latest Medicare updates impacting prescriber enrollment requirement for Part D drugs, billing for telehealth services, and DME prior authorization in 2017.

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MACRA Explained: New World of Medicare Reimbursement

Many healthcare providers and suppliers cheered when Congress did away with the sustainable growth rate (SGR) formula by passing the Medicare Access and CHIP Reauthorization Act (MACRA). No longer did they have to worry on an annual basis if a patch to prevent double digit cuts to reimbursement will be passed. But a new reimbursement methodology under MACRA leaves many practitioners wondering if they will meet the metrics or face payment cuts.

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Section 1557 – ACA’s New Non-Discrimination Final Rule

The Office of Civil Rights (OCR) within the U.S. Department of Health and Human Services, recently issued a Non-discrimination in Health Care Programs and Activities rule. This final rule implements Section 1557 of the Patient Protection and Affordable Care Act (ACA). Section 1557 builds on existing civil rights laws and prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities and applies broadly to many providers and suppliers.

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Overpayment Audit: Medicaid is Serious About Excluded Providers

Under the Affordable Care Act (ACA), providers and suppliers who bill for services furnished by an excluded or an unlicensed person are considered to have received and overpayment from Medicare which must be reported and returned within 60 days of “identifying” the overpayment (claims-based overpayment). New Jersey Medicaid recently reminded providers that a similar requirement for Medicaid and Medicaid Managed Care providers exists in New Jersey and will be enforced.

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