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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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. 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. 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. 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. Many of our clients have been unable to contact representatives of the Health Commerce System (HCS) to establish or resolve problems with their Prescription Monitoring Program Registry (Registry) log-in for compliance with the new I-STOP law. Recently, the Department of Health (DOH) commented on the delay. New York’s Internet System for Tracking Over Prescribing (I-STOP) legislation that, among other things, mandates prescribing practitioners to consult with the prescription monitoring registry prior to prescribing a controlled substance, will go into effect on August 27, 2013. Below we discuss some of the I-STOP implications for pharmacists. Round 2 competitive bidding program (Program) went into effect as of July 1, 2013 in 91 Metropolitan Statistical Areas (MSAs). At the same time, Medicare began the national mail-order program for diabetic supplies. Below we discuss some of the features of the Program and what this may mean for DMEPOS suppliers and those healthcare providers who refer patients for durable medical equipment and supplies. Whether you are considering full-time or part-time employment, a newly minted doctor leaving a residency program or a more seasoned practitioner joining a group practice, the following key aspects of an employment relationship should be considered before agreeing to any arrangement. Provider Alert: New York has a series of drug prescription laws that impact medical and pharmaceutical providers. We highlight those provisions below in chronological order. 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. 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. |
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