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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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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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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Medicare Enrollment Screening Tools Reviewed By OIG

The Centers for Medicare & Medicaid Services (CMS) views the enrollment process as an important gatekeeping tool for preventing fraud, waste and abuse. The passage of the Affordable Care Act (ACA) enhanced the ability of CMS to further this goal. Recently, the Office of the Inspector General (OIG) published a report analyzing the effectiveness of certain enhanced provider enrollment screenings.

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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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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.

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Why Medical Leases Are Different From Typical Commercial Leases

Medical space leasing requires more consideration and deeper analysis than typical commercial leases. Various federal and state laws regulate financial relationships of medical providers which in turn dictate the terms of a lease.

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New Medicaid Provider Enrollment And Revalidation Requirements

One of the changes brought about by the Affordable Care Act (ACA) is the enhanced enrollment and revalidation screenings for providers and suppliers not only under Medicare but also Medicaid and CHIP healthcare programs.

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Health Care Fraud Prosecutions On The Rise

In the last few years, many healthcare providers have come under increased scrutiny from federal and state investigative and auditing agencies. The recent USAToday article confirms that the federal government stepped up the prosecution of health care fraud. In fact, according to USAToday “[n]ew government statistics show federal health care fraud prosecutions in the first

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