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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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

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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 Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey. Additionally, a statewide ban covering additional programs, Medicaid and Children’s Health Insurance Program (CHIP, was also announced.

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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 Changes That Will Impact Your Practice

The Centers for Medicare & Medicaid Services (CMS) has issued number of recent updates to the Medicare program which impact various providers and suppliers.

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Medicaid Audit: Lessons for NJ Personal Care Agencies

The Office of Inspector General (OIG) recently audited New Jersey’s personal care program and found certain deficiencies as a result of noncompliance with Federal and State requirements by some personal care agencies. Based on the audit result, the OIG asked the State to return $32,236,308 in Federal Medicaid reimbursement for personal care services that the OIG claimed did not meet Federal and State requirements.

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Part B Ambulance and Home Health Agencies Moratoria Extended in Parts of NJ

The Centers for Medicare & Medicaid Services (CMS) recently announced another six month extension of moratoria on new home health agencies, home health agency sub-units, and Part B ground ambulance suppliers in certain locations throughout the country.

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Which New York Providers Need a Compliance Program?

New York State Social Service Law §363-d and implementing regulations at 18 NYCRR §521 require that certain healthcare providers adopt and implement an effective compliance program and certify their compliance with the law every December.

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CMS Extends Freeze On New Home Health Agencies and Ambulances

On July 29, 2014, the Centers for Medicare and Medicaid Services (CMS) announced an extension on the temporary moratoria on new provider enrollment applications as well as on applications adding additional practice locations for Home Health Agencies (and related sub-units) and Part B ambulance suppliers. The temporary moratoria is for an additional six months.

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Fingerprint Requirement for DMEs and HHAs Goes Into Effect

The Centers for Medicare & Medicaid Services (CMS) announced that it will begin implementing the fingerprint-based background checks for providers and suppliers in certain risk categories.

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NJ Medicaid Provider Audits: Preparedness Checklists

Every year, the New Jersey Medicaid Fraud Division (MFD), the watchdog agency for New Jersey’s Medicaid program, releases a workplan which informs providers, suppliers and their advisers about the agency’s focus for the up-coming year. MFD’s 2012 workplan outlines a comprehensive audit and review agenda. We have summarized the agency’s audit criteria to help New Jersey Medicaid providers become aware of and stay prepared for scrutiny in 2012.

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