We are pleased to announce that attorney Deniza Gertsberg, founder of the East Brunswick, NJ law firm that bears her name, has been named to the 2014 New Jersey Rising Stars list. This is an exclusive list, recognizing no more than 2.5 percent of the lawyers in the state.
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Every year the U.S. Department of Health and Human Services Office of the Inspector General (OIG) publishes a work plan that provides industry stakeholders with insight as to the OIG’s new and ongoing auditing and investigative activities in the upcoming year. 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. New Jersey governor Chris Christie recently signed into law changes to existing legislation that would allow qualified pharmacists to administer influenza vaccines to children seven years of age or older. The New Jersey Board of Dentistry (Board) adopted a rule in November 2011 that allows dentists who meet specific requirements to administer botox and fillers. The New Jersey State Board of Dentistry received a petition late last year from New Jersey Dental Association requesting additional rules be implemented to strengthen the corporate practice of dentistry laws in the State. A recent decision from the New Jersey Appellate Division serves as reminder of the importance of maintaining effective infection control measures in a provider’s office or face the harsh consequences of the licensing board. National Government Services Durable Medical Equipment Medicare Medical Review Department (NGS) has recently published the results of its third quarter prepayment medical review of high-error audit claim. In total, NGS reports, more than half of claims were denied, results in a 65 percent of claims error rate for failing to the required coverage criteria and documentation. 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. In August, the New York State Inspector General (OMIG) denied enrollment to a pharmacy after an on-site inspection revealed several deficiencies. An apparent egregious case of non-compliance serves as a vivid reminder of why providers must comply with their professional requirements as well as why they must observe NYS Medicaid rules and regulations at all times. The second alternative treatment center recently became operational in New Jersey under the state’s Compassionate Use Medical Marijuana Act. We review some of the legal requirements that impact participating physicians. 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. The Office of the Civil Rights (OCR) of the Department of Health and Human Services announced recently that it will delay enforcement of a new requirement that certain HIPAA covered laboratories revise their notice of privacy practices to comply with changes made by the Omnibus Rule until further notice. The Centers for Medicare & Medicaid (CMS) is updating the CMS 1500 claim form in anticipation of the upcoming changes to the International Classification of Diseases (ICD) system. 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. Providers beware – even an unintentional omission on a New Jersey Medicaid enrollment application can lead to denial of enrollment. Such was the holding of a recent New Jersey Court of Appeals decision. 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. |
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