By Deniza Gertsberg, Esq., on September 1st, 2016 A recent decision by a New Jersey Appellate Court confirmed an out-of-network provider’s right to collect from an insurance company for emergency services he rendered to patients covered by the insurance company.
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By Deniza Gertsberg, Esq., on August 24th, 2016 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 New Jersey, as well as Florida, Illinois, Michigan, Texas, and Pennsylvania. Additionally, a statewide ban for these providers and suppliers, which now also extends to not only Medicare but also Medicaid and Children’s Health Insurance Program (CHIP), was also announced.
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By Deniza Gertsberg, Esq., on August 3rd, 2016 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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By Deniza Gertsberg, Esq., on July 31st, 2016 The Centers for Medicare & Medicaid Services (CMS) recently launched a demonstration project that will initiate a pre-claim review for home health services. The project seeks to lower a nearly 60 percent claims error rate stemming largely from insufficient documentation.
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By Deniza Gertsberg, Esq., on July 11th, 2016 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 changes below.
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By Deniza Gertsberg, Esq., on July 5th, 2016 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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By Deniza Gertsberg, Esq., on June 9th, 2016 On May 16, 2016, a new rule went into effect that empowers the New Jersey Division of Taxation Director (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.
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By Deniza Gertsberg, Esq., on May 31st, 2016 The passage of the Protecting Access to Medicare Act (Act) of 2014 ushered in a new era for Medicare laboratory reimbursement rates not seen in three decades.
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By Deniza Gertsberg, Esq., on May 18th, 2016 The New Jersey State Board of Dentistry (Board), which licenses and oversees dentists and hygienists in the State, has recently proposed new regulations that will impact how hygienists and dentists practice.
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By Deniza Gertsberg, Esq., on April 28th, 2016 Just days after the new e-prescribing rules went into effect, New York’s Commissioner of Health has issued ten blanket waivers that lift electronic prescribing requirements under exceptional circumstances. The waivers will be effective for a year, until March 26, 2017, when the Commissioner will re-evaluate provider and software feasibility and preparedness.
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By Deniza Gertsberg, Esq., on March 24th, 2016 The Centers for Medicare & Medicaid Services (CMS) has issued number of recent updates to the Medicare program which impact various providers and suppliers.
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By Deniza Gertsberg, Esq., on March 4th, 2016 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.
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By Deniza Gertsberg, Esq., on February 24th, 2016 Every year the Office of the Inspector General (OIG) issues a workplan that identifies the agency’s planned audit activities for the upcoming year. The workplan offers valuable information for healthcare entities by providing them with an opportunity to conduct appropriate risk assessments, and, where indicated, to modify the entity’s compliance program.
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By Deniza Gertsberg, Esq., on February 11th, 2016 Recent results from the Comprehensive Error Rate Testing (CERT) Program revealed that the majority of improper payment for laboratory service result from insufficient documentation. This article summarizes important documentation recommendations from CMS.
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By Deniza Gertsberg, Esq., on January 29th, 2016 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 its contractors that review and process enrollment applications, to deny applications from certain providers ineligible to participate with Medicare.
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By Deniza Gertsberg, Esq., on January 18th, 2016 When closing a New Jersey pharmacy certain steps should be followed to protect patient access to medication and records and to minimize the disruption to continuity of care.
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By Deniza Gertsberg, Esq., on January 13th, 2016 Consistently over the years the Office of Inspector General (OIG) has targeted chiropractic services for audits. In fact, chiropractic services appear annually on the OIG’s workplan agenda. In September 2015, the OIG issued a report recommending that the Centers for Medicare & Medicaid Services’ (CMS) establish better controls and measures to prevent questionable payments, collect overpayments based on inappropriately paid claims and ensure that claims are paid only for Medicare-covered diagnoses.
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By Deniza Gertsberg, Esq., on December 24th, 2015 The Office of Inspector General (OIG) recently audited New Jersey’s personal care program and found deficiencies as a result of noncompliance with Federal and State requirements by some personal care agencies. Based on the audit result, the OIG asked the State to return $32,236,308 in Federal Medicaid reimbursement for personal care services that the OIG claimed did not meet Federal and State requirements.
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By Deniza Gertsberg, Esq., on December 4th, 2015 In a series of recent reports, the Office of Inspector General (OIG) noted a number of deficiencies and made a number of recommendations to improve and strengthen oversight of the HIPAA Privacy Standards and reduce the amount of inappropriate transportation billing.
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By Deniza Gertsberg, Esq., on November 19th, 2015 Recent guidance from the New York State Office of the Professions (OP) suggests that the agency did not entirely reject Internet coupons or vouchers that many refer to as “Groupons.” The OP did, however, affirm concerns previously expressed here that offering coupons for medical services requires careful consideration.
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