The New York State Department of Health (DOH) announced a new, phased revalidation initiative requiring all enrolled Medicaid providers to complete revalidation by June 2028 using only the online New York State Medicaid Provider Services Portal (PSP).
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The Office of Inspector General (OIG) recently published a final rule that implements OIG’s expanded statutory exclusion authority. The final rule included a number of provisions that impact providers and suppliers. A recent report from the New Jersey Office of the State Comptroller indicates an expansion of the efforts of its Medicaid Fraud Division (MFD) to investigate fraud, waste and abuse in the New Jersey Medicaid Program. The report also highlights MFD’s expanded effort to exclude providers from the Medicaid Program. Read the latest Medicare updates impacting prescriber enrollment requirement for Part D drugs, billing for telehealth services, and DME prior authorization in 2017. 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 In a recent federal register publication the Centers for Medicare & Medicaid Services (CMS) announced the extension of temporary moratoria already in place on the enrollment of new Medicare Part B nonemergency ground ambulance suppliers and Medicare home health agencies (HHAs), subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey. Additionally, a statewide ban covering additional programs, Medicaid and Children’s Health Insurance Program (CHIP, was also announced. 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. Healthcare practitioners should be aware of important updates and changes to Medicare and Medicaid Programs of New York and New Jersey. We summarize some of these changes in the article that follows. 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. On May 16, 2016, a new rule went into effect that empowers the New Jersey Division of Taxation Director to notify a licensing State agency that a license issued by the agency to conduct a profession, trade, business, or occupation should be suspended where a license holder fails to pay a State tax indebtedness. The Centers for Medicare & Medicaid Services (CMS) has issued number of recent updates to the Medicare program which impact various providers and suppliers. The Centers for Medicare & Medicaid Services (CMS) has once again proposed new rules which would enhance the screening requirements for providers and suppliers. The rule proposals would ratchet up the scrutiny on provider enrollments and toughen suspension and revocation penalties. Each year certain providers attempt to enroll in the Medicare program to participate and bill for services. The Centers for Medicare & Medicaid Services (CMS), however, instructs the Medicare contractors that review and process enrollment applications, to deny applications from providers ineligible to participate with Medicare. The Centers for Medicare & Medicaid Services (CMS) recently announced another six month extension of moratoria on new home health agencies, home health agency sub-units, and Part B ground ambulance suppliers in certain locations throughout the country. Deniza Gertsberg, Esq. will be speaking during the upcoming NJSBA Health Law Section program on “Fundamentals of Medicare Provider Enrollment/Revalidation”. The program focuses on the steps in the Medicare enrollment/revalidation process and practical tips for successfully completing an enrollment/ revalidation, whether the attorney is submitting the 855 paper forms or using the Provider Enrollment Chain The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) made changes to the physician opt-out affidavit requirements. Mandatory Electronic Prescribing Effective in NY. While the mandatory electronic prescribing was extended by Gov. Cuomo until March 27, 2016, e-prescribing for controlled and non-controlled substances is already available in New York for those meeting the regulatory requirements. Since 2011, NYS Medicaid Electronic Health Records Incentive Program has paid over $660 million in incentive funds The mission of the Medicaid Fraud Division (MFD) within the Office of the State Comptroller is to prevent, detect, audit and investigate fraud, waste and abuse by New Jersey providers and recipients. As we look forward to the New Jersey Medicaid Fraud Division 2015 work plan, we look back at the agency’s activities in 2014. 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). New York Office of the Medicaid Inspector General’s (OMIG) 2013 annual report provides an important insight into the agency’s activities, recoveries and where it plans to focus its resources in the upcoming year. |
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