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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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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Healthcare Providers Beware: Failure to Pay State Tax Could Lead to License Suspension

On May 16, 2016, a new rule went into effect that empowers the New Jersey Division of Taxation Director to notify a licensing State agency that a license issued by the agency to conduct a profession, trade, business, or occupation should be suspended where a license holder fails to pay a State tax indebtedness.

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Proposed New Regulations Impacting NJ Dentists and Hygienists

The New Jersey State Board of Dentistry (Board), which licenses and oversees dentists and hygienists in the State, has recently proposed new regulations that will impact how hygienists and dentists practice.

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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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CMS Documentation Reminder to Physicians Ordering Lab Services

Recent results from the Comprehensive Error Rate Testing (CERT) Program revealed that the majority of improper payment for laboratory service result from insufficient documentation. This article summarizes important documentation recommendations from CMS.

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NJ Prescription Monitoring Program Updated for Prescribers and Pharmacists

The New Jersey’s Prescription Monitoring Program (NJPMP), aimed at halting the abuse and diversion of prescription drugs, was substantially updated recently to impose new requirements on prescribers of Schedule II drugs and, separately, to stiffen penalties for pharmacists failing to timely report information about dispensing of the controlled dangerous substance (“CDS”).

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Changes to Medicare’s Physician Opt-Out Affidavit Requirements

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) made changes to the physician opt-out affidavit requirements.

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Beware of Inappropriate Physician Compensation Arrangements

“Physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide,” warns the new fraud alert published by the Office of Inspector General (OIG).

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Concierge Medicine: A Legal Analysis

With labels such as “concierge medicine,” “VIP medicine,” “boutique medicine,” “exclusive practice,” “premium practices,” or “platinum medicine,” direct patient-doctor contractual arrangements have received their share of negative attention from the press as well as certain lawmakers since their inception in 1996. Perceived as medicine for the rich, some academics and ethicists worry that such “elitist” practices may cause access to care problems and would further “exacerbate the already tiered healthcare system, accelerate the fragmentation of insurance risk pools through cherry picking of the healthier patients, and promote the nonmedical services and amenities.”

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6 Medicare Reimbursement Issues on OIG’s Radar in 2015

In 2014, the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) reported “expected recoveries of over $4.9 billion.” The agency also excluded 4,017 individuals and entities and took 971 criminal actions. Similarly, the OIG pursued 533 civil actions against individuals and entities. According to the agency’s 2015 work

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New Rule for Part D Prescribers: Enroll or Opt-Out

Last year, CMS issued a final rule which requires prescribers of Part D drugs to be either enrolled with Medicare or have submitted an opt-out affidavit to their Medicare Administrative Contractor (MAC) in order for a prescription to be eligible for coverage under the Part D program. See 42 CFR § 423.120(c)(5) and (6).

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Demystifying Professional Assistance Program of New Jersey

Stress, financial difficulties, effects of aging, declining health and a myriad of other pressures could lead to poor work performance and imperil the license of healthcare professionals. A program designed to assist healthcare professionals in recovery may help. The New Jersey Professional Assistance Program (NJPAP or the Program) monitors and provides support in the recovery of physicians, pharmacists, dentists, nurses and other health care professionals. The Program not only assists in the recovery from drug or alcohol use or dependence but also from other health impairments, such as cognitive impairments, hypertension, diabetes, physical disabilities or depression. NJPAP can also play an important part in protecting a professional’s license.

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NJ Eases Rules for Prescribing Opioid Antidotes

Earlier this year, the New Jersey Board of Medical Examiners (BME) issued a Certificate of Waiver to all New Jersey licensed physicians waiving enforcement of rules requiring a prescription to be written in the name of a person to whom a drug is administered (allowing prescription to be written to friends, family or first responders), examination before and follow-up after the issuance of a script. The Waiver is in effect for a year or until the BME adopts revised regulations.

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NJ Medicaid Providers Get Ready For Revalidation

Pursuant to the requirements imposed by the Affordable Care Act (ACA), New Jersey Division of Medical Assistance and Health Services is beginning a revalidation process of all NJ FamilyCare (NJFM) fee-for-service (FFS) providers.

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New Mandatory Security Requirements for NJ Prescription Scripts

In an effort to curb black market sale of prescription painkillers New Jersey is implementing changes to its paper prescription blanks. These changes represent the first change to the State’s prescription blanks since 2004.

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Who is a Business Associate under HIPAA?

Last year’s passing of the new HIPAA requirements signaled the government’s concern that individually identifiable health information needs stronger protection beyond the borders of the healthcare industry. HIPAA already recognized this need by imposing obligations on covered entities and their business associates in prior versions of the rule. In the latest rule update, however, the US Department of Health and Human Services, among other things, expanded the definition and responsibilities of business associates and now made them directly liable for HIPAA noncompliance.

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Pharmacists May Vaccinate Children Under Revised NJ Law

New Jersey governor Chris Christie recently signed into law changes to existing legislation that would allow qualified pharmacists to administer influenza vaccines to children seven years of age or older.

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New Jersey Dentists Can Administer Botox

The New Jersey Board of Dentistry (Board) adopted a rule in November 2011 that allows dentists who meet specific requirements to administer botox and fillers.

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Balance Billing Under NJ Medicaid

Can a provider bill a beneficiary all or part of the difference between the provider’s charged fees and the payment received from NJ Medicaid or managed care plan? The NJ Department of Human Services, Division of Medical Assistance & Health Services (Department) recently answered that question.

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