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 an 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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Warning: Medicare Contractors Enforcing Fingerprint Requirements

The passage of the Patient Protection and Affordable Care Act (ACA) heralded a new era for provider enrollment and revalidation by enhancing provider and supplier screenings. The Centers for Medicare & Medicaid Services (CMS) now requires certain providers to be fingerprinted in order to continue participating in the Medicare program. Medicare contractors (MACs) have been sending notices to impacted providers and suppliers advising them to complete fingerprinting within a specified time-frame.

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Out-of-Network NJ Cardiologist Wins a Case Against Aetna

A recent decision by a New Jersey Appellate Court confirmed an out-of-network provider’s right to collect from an insurance company for emergency services he rendered to patients covered by the insurance company. 

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CMS Announces Moratoria on Non-Emergency Ground Ambulance Suppliers in Parts of NJ

In a recent federal register publication the Centers for Medicare & Medicaid Services (CMS) announced the extension of temporary moratoria already in place on the enrollment of new Medicare Part B nonemergency ground ambulance suppliers and Medicare home health agencies (HHAs), subunits, and branch locations in specific locations within designated metropolitan areas in New Jersey, as well as Florida, Illinois, Michigan, Texas, and Pennsylvania. Additionally, a statewide ban for these providers and suppliers, which now also extends to not only Medicare but also Medicaid and Children’s Health Insurance Program (CHIP), was also announced.   

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Medicaid Enrollment For Providers Got Tougher, But Many States Lack Enhanced Screening

The Affordable Care Act (ACA) heralded a new era of provider enrollment screenings not only in the Medicare program but also in States’ Medicaid programs. A series of new Office of Inspector General (OIG) reports reviewed the effectiveness of the States’ implementation of the new screening requirements in the Medicaid programs and found areas in need of improvement.

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CMS Implements Home Health Pre-Claim Review in 5 States

The Centers for Medicare & Medicaid Services (CMS) recently launched a demonstration project that will initiate a pre-claim review for home health services. The project seeks to lower a nearly 60 percent claims error rate stemming largely from insufficient documentation.

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Latest Medicare and Medicaid Provider Program Updates

Healthcare practitioners should be aware of important updates and changes to Medicare and Medicaid Programs of New York and New Jersey. We summarize some of these changes changes below.

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Medicare Enrollment Screening Tools Reviewed By OIG

The Centers for Medicare & Medicaid Services (CMS) views the enrollment process as an important gatekeeping tool for preventing fraud, waste and abuse. The passage of the Affordable Care Act (ACA) enhanced the ability of CMS to further this goal. Recently, the Office of the Inspector General (OIG) published a report analyzing the effectiveness of certain enhanced provider enrollment screenings.

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