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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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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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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NY Electronic Prescribing: Blanket Waivers Issued

Just days after the new e-prescribing rules went into effect, New York’s Commissioner of Health has issued ten blanket waivers that lift electronic prescribing requirements under exceptional circumstances. The waivers will be effective for a year, until March 26, 2017, when the Commissioner will re-evaluate provider and software feasibility and preparedness.

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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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A Tricky Balance for Online Coupons Advertising Medical Services

Recent guidance from the New York State Office of the Professions (OP) suggests that the agency did not entirely reject Internet coupons or vouchers that many refer to as “Groupons.” The OP did, however, affirm concerns previously expressed here that offering coupons for medical services requires careful consideration.

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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.

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New York’s Emergency Services and Surprise Bill Goes Into Effect

A new law impacting New York out-of-network providers, called the Emergency Services and Surprise Bill, went into effect on March 31, 2015, that will require providers to update their operations if they do not already comply with the legal requirements.

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I-STOP Implementation Delayed Until March 27, 2016

On March 13, 2015, Gov. Cuomo signed an amendment extending by one year, until March 27, 2016, the implementation date for the mandatory electronic prescribing.

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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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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.

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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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.

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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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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.

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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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