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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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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$6.49 Billion Paid to Doctors by Medical Manufacturers in 2014

The Centers for Medicare & Medicaid Services (CMS) published full year of 2014 financial data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion.

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Proposed Changes to Sunshine Act

The Centers for Medicare & Medicaid (CMS) is proposing rule changes to streamline the implementation of the Sunshine Act.

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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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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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Did You Know About New Physician Payment Transparency Program?

Section 6002 of the Affordable Care Act requires manufacturers of pharmaceuticals, biologicals, medical devices or supplies to publicly report payments made to physicians and teaching hospitals. This article reviews some of the implications the new requirement has on physicians and their relationships with the industry.

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Sunshine Act Worries Some Providers

Section 6002 of the Affordable Care Act (a.k.a. “Sunshine Act”) imposes new reporting requirements on financial relationships between medical and pharmaceutical makers and physicians and teaching hospitals. While lauded for its attempts to bring greater transparency to industry financial relationships some wonder whether the implementation methods planned by the Centers for Medicare & Medicaid Services (CMS) would expand the Act beyond the boundaries envisioned by Congress.

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Far Reaching Impact of Medicare Exclusion

In our prior articles, we looked at the basis for Medicare exclusion and how the Office of the Inspector General’s (OIG) powers to exclude providers has been recently enhanced by the passage of the Affordable Care Act. In this article we focus on the sweeping impact that exclusion has on providers and suppliers.

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Medicare Exclusion

One of the most powerful tools the Office of Inspector General (OIG) within the Department of Health and Human Services has in safeguarding the integrity of the Medicare Program is the ability to exclude providers and suppliers from participation. It is the proverbial hammer that, when brought down, could severely hamper a physician’s ability to practice medicine and a healthcare facilities’ ability to stay operational.

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NYS Medicaid Compliance Program: Annual Certification Requirement

This is our second article in a series discussing the New York State Medicaid’s compliance program requirements. In our first article we focused on which providers are required by law to have a compliance program. In this article, we turn our attention to the annual certification requirement.

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Mandatory Compliance Program for New York’s Healthcare Providers

The necessity of having a compliance program is no longer a requirement providers can ignore. In the next series of articles, we briefly address the compliance program requirements for New York State Medicaid providers, starting with the overview of the regulations below.

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NJ Medicaid Enhanced Enrollment Requirements

The Affordable Care Act (ACA) imposed certain enhanced Medicaid enrollment requirements for State Medicaid programs to follow. Recently, the NJ Medicaid Fraud Division Unit (MFD), in consultation with the NJ Division of Medical Assistance and Health Services (DMAHS), described how it plans to comply with the ACA’s enhanced provider screening requirements.

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Wading Through The Medicare Alphabet Soup

The Medicare and Medicaid programs provide health insurance for tens of millions of people. According to Centers for Medicare and Medicaid Services (CMS), the Medicare program alone has 47.5 million beneficiaries and, in 2010, had total expenditures of $523 billion. It is not surprising, therefore, that such large programs invite scrutiny from government auditors and

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