Recent Changes to New York State Medicaid Program

Recent changes to the New York State Medicaid Program affect vaccine administration for pharmacies, claiming process for nurse practitioners, documentation requirements for transportation providers, and prior authorization for physical and occupational therapists. We summarize these changes.

Continue reading »

Goodbye eMedNY, Hello Xerox

New York State Medicaid has a new vendor to implement the new Medicaid Management Information System (MMIS) that will eventually replace the current vendor (eMedNY). The new vendor, Xerox State Healthcare LLC, won a five year contract with the State. Implementation of the new system will occur in two phases over an eighteen month period.

New York OMIG’s Activities By The Numbers

New York Office of the Medicaid Inspector General’s (OMIG) 2013 annual report provides an important insight into the agency’s activities, recoveries and where it plans to focus its resources in the upcoming year.

Continue reading »

Clarifying Pharmacy Billing of Claims Under OPRA

New York State Department of Health (DOH) recently issued a clarification concerning certain pharmacy claims that were rejected because the ordering/prescribing/referring/attending (OPRA) provider was an unlicensed resident, intern or a foreign physicians in training programs.

Continue reading »

Annual Medicaid Certification Requirement

It’s that time of the year when qualifying providers enrolled with the NYS Medicaid Program must certify that they have a adopted, implemented and maintained an effective mandatory compliance program. The NYS Office of the Medicaid Inspector General (OMIG) is tasked with responsibility of overseeing that providers meet this requirement.

Continue reading »

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.

Continue reading »

NY Medicaid: OPRA Provider Requirements and Impact on Pharmacies

The NYS Medicaid recently informed referring and servicing providers that, effective for services provided on and after October 1, 2013, claims will be denied if they include the NPI of non-enrolled ordering, prescribing, referring or attending provider (OPRA). Below we discuss some of the changes.

Continue reading »

New York OMIG’s Focus In 2013-2014

Every year the New York State Office of the Medicaid Inspector General (OMIG) publishes a work plan that outlines the agency’s focus in the coming year. As in previous years, the targets of agency’s audits and investigations this work plan cycle remain physicians, dentists, laboratories, transportation providers, pharmacies and DMEs, as well as hospitals and home and community health service providers. Below we discuss some of OMIG’s planned integrity activity.

Continue reading »

Non-Billing Ordering Providers Must Be Enrolled In Medicaid

New York State Medicaid Program posted new applications on April 1, 2013 for non-billing providers that order, prescribe, and/or refer beneficiaries with fee-for-service Medicaid coverage. New Jersey Medicaid required all such providers to be enrolled an “non-billing” providers by Jan. 1, 2013.

Continue reading »

Private Contracts With Medicaid Beneficiaries

Most providers know that fees paid by the New York State Medicaid program are considered to be payment in full. This means that as a requirement of participating with Medicaid, and with the exception of co-payments, providers may not bill Medicaid beneficiaries for covered services. Providers may, however, enter into private pay agreement with Medicaid beneficiaries and the article below addresses certain important aspects of that relationship.

Continue reading »

New York Medicaid Program Prohibits Billing Beneficiaries

When a provider participates in the New York State Medicaid Program, a provider agrees to accept payment as payment in full for the provided services. The same applies to providers who accept Medicaid Managed Care or Family Health Plus (FHPlus) plans.

Continue reading »

New York to Reduce All Medicaid Payments to Docs by 2%

The final 2011-12 New York State budget (Chapter 59 of the Laws of 2011) requires a 2% across the board reduction to most Medicaid payments for dates of service on or after April 1, 2011. The reduction will remain in effect for dates of service through March 31, 2013. These provisions were enacted to meet

Continue reading »