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.
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This past November 19, New Jersey Gov. Chris Christie signed into law a bill that for the first time would require license suspension or revocation of certain health care professionals and medical waste facilities, generators, and transporters for illegal or improper medical waste disposal. The law went into effect immediately. 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. Many medical and dental boards, as well as professional organizations, received numerous questions from their members concerning the appropriateness of physician advertising on Groupon, LivingSocial or similar social marketers. Last year, the American Dental Association (ADA) warned its members of the potential legal pit-falls associated with groupon-type advertising. The ADA Council on Ethics has now amended its Code of Ethics to address such advertisement arrangements. In the winding days of 2012, the New York State Medicaid announced code changes for physicians and nurse practitioners as well as code changes and changes to the policy manual for New York dentists participating in the Medicaid program. We discuss some of those changes in this article. Recently, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) calculated the savings its programs brought to the Federal government in 2011. The statistics, which reveal recoveries in the billions, serve as a sobering reminder to providers of the increasing interest by the government in ensuring that providers are complying with the healthcare laws and regulations. In our prior articles, we discussed the far reaching impact of an Office of Inspector General (OIG) exclusion from the Medicare Program on providers and suppliers. Exclusion from the Medicare Program also impacts employers and we address some of those ramifications below. Deniza Gertsberg presented at the Joint National Medical and Scientific Conference organized by the Russian American Medical Association (RAMA) and the Russian American Dental Association in Philadelphia, PA, on November 10, 2012. The seminar was titled “The New Era of Medicare Enrollment and Revalidation.” Recently the New York. State Medicaid Program published an updated version of the Dental Manual as well as the fee schedule. We highlight some of those changes below and encourage all dental providers to analyze the revised documents. 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. Social media advertising continues to be a widely discussed topic in the dental and medical community with many providers wondering whether to Groupon or not to Groupon. Are companies like Groupon and LivingSocial adjusting to special concerns from the healthcare community? The Office of the Inspector General (OIG) within the Department of Health and Human Services (HHS) has broad authority to take measures such as excluding providers and suppliers from participating in the Medicare Program in order to protect the program and beneficiaries. There are a number of reasons why exclusions may be imposed and we summarize them below. Groupon-type advertising is all the rage now but serious legal, ethical and contractual questions exist for medical and dental practices that need to be examined prior to entering into such arrangements. We have previously addressed this evolving issue in several articles on this website by evaluating some of the implications such arrangements have for providers. One of our articles was just published in the American Association of Oral and Maxillofacial Surgeons’ (AAOMS) bimonthly publication, Practice Management Notes. We are pleased to bring it to you here. 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. This is the third and final article in the series evaluating the NYS Medicaid Compliance Program requirements. The previous two articles looked at those providers required to have a compliance program under the law and the annual certification requirement. In this article, we examine the core elements of a compliance program. 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. 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. There are at least 27 different basis for exclusion or denial of provider enrollment application in the New Jersey Medicaid Program. Some are not so obvious. Every year, the New Jersey Medicaid Fraud Division (MFD), the watchdog agency for New Jersey’s Medicaid program, releases a workplan which informs providers, suppliers and their advisers about the agency’s focus for the up-coming year. MFD’s 2012 workplan outlines a comprehensive audit and review agenda. We have summarized the agency’s audit criteria to help New Jersey Medicaid providers become aware of and stay prepared for scrutiny in 2012. 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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