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Significant Changes to NYS Mandatory Compliance Program Requirement
By Deniza Gertsberg, Esq., on May 18th, 2021
Last year, as part of the 2020-2021 budget, the New York State Legislature made significant changes to the NYS Mandatory Compliance Program requirement.
Topics: New York Medicaid, New York Medicaid Audit, New York Medicaid Payments, New York Physician Guidelines, New York State Social Services Law, OMIG
New OPMC Requirements
On October 7, 2020, New York State Public Health 230 was amended to require every physician's "practice setting" to post a conspicuous sign regarding where to report professional misconduct.
Topics: Healthcare Professional Discipline, OPMC
NYS Medicaid Implements 1% Across the Board Payment Reduction
By Deniza Gertsberg, Esq., on January 6th, 2020
Beginning with dates of services of January 1, 2020, all non-exempt New York State Medicaid payments to providers will be uniformly reduced by 1%.
Topics: Medicaid Payments, New York Medicaid, New York Medicaid Payments, New York Physician Guidelines
Similar to other licensed healthcare professionals, New Jersey's ophthalmic dispensers and ophthalmic technicians have to follow certain rules and regulations when it comes to adverting their practice. New Jersey's State Board of Examiners of Ophthalmic Dispensers and Ophthalmic Technicians ("Board"), the state licensing and governing agency, has extensive regulations governing the do's and don'ts of advertising for ophthalmic dispensers and technicians. Below we summarize a subset of those rules.
Topics: Healthcare Advertising Rules
The Centers for Medicare & Medicaid Services ("CMS") announced in April of this year that it is adding 12 new HCPCS codes to the Required Prior Authorization List of DMEPOS items that require prior authorization as a condition of payment. Prior authorization for Pressure Reducing Support Surfaces will be implemented nationwide in October.
Topics: DMEPOS, DMEPOS Compliance
5 Ways In Which the New Law Expands New Jersey's Medical Marijuana Program
By Deniza Gertsberg, Esq., on September 9th, 2019
On July 2, 2019, New Jersey's Governor, Phil Murphy, signed into law the Jake Honig Compassionate Use Medical Cannabis Act ("Act") which greatly expands and reforms New Jersey's Medical Marijuana program.
Topics: Medical Marijuana, New Jersey Medical Marijuana
Responsibilities of New Jersey's Pharmacists In Charge
By Deniza Gertsberg, Esq., on August 8th, 2019
New Jersey pharmacy owners know that every New Jersey pharmacy must appoint a Pharmacist-in-charge ("PIC") and a pharmacy cannot operate without a PIC for longer than 30 days. Below we review some of the many responsibilities that go with the title.
Topics: Opening a Pharmacy, Opioid Prescribing, Pharmacy Guidelines, Pharmacy Law
OCR Proposes Changes to the Civil Rights Enforcement Section of the Affordable Care Act Section 1557
By Deniza Gertsberg, Esq., on July 16th, 2019
The Department of Health and Human Services ("HHS") and the Office of the Civil Rights ("OCR") recently proposed changes to Section 1557 of the Affordable Care Act ("Act"). This Section of the Act prohibits civil rights discrimination in certain health programs or activities. Some of the major changes, include, among others, revising the regulatory definition of what constitutes discrimination on the "basis of sex". The proposal also includes healthcare conscience protections. Additionally, the proposed rule would eliminate taglines and notices requirement and it would revise the language access and grievance procedures of the rule.
Topics: Healthcare Compliance, OCR and Healthcare
Electronic Medical Records Company Settles with OCR for HIPAA Violation
By Deniza Gertsberg, Esq., on June 23rd, 2019
An electronic medical records company recently settled with the Office of the Civil Rights ("OCR") for violating the Health Insurance Portability and Accountability Act ("HIPAA") following a discovery of a cyberattack on its servers which contained the protected health information (PHI) of approximately 3.5 million individuals.
Topics: Healthcare Provider Mistakes, HIPAA Compliance, HIPAA Violation
Recommendations from DOH Biannual Medical Marijuana Report
The New Jersey Department of Health's recent biannual report recommended ways to improve the New Jersey's Medical Marijuana Program in three key areas.
Topics: Alternative Treatment Centers, Medical Marijuana, New Jersey Medical Marijuana
Recent Expansion of Scope of Practice for Dental Hygienist in New Jersey
By Deniza Gertsberg, Esq., on September 25th, 2018
The New Jersey Board of Dentistry (Board) recently expanded the scope of practice of licensed dental hygienists, limited registered dental assistants in orthodontics and registered dental assistants. Effected providers should become familiar with these expanded parameters.
Topics: Dental Assistants, Dental Board; Dentists, Dental Hygienists, Scope of Practice
Expanding Role of Pharmacists and Certified Medical Assistants in New Jersey
The New Jersey Board of Pharmacy and the New Jersey Board of Medical Examiners recently adopted new regulations and amended existing ones that effect the way providers practice. The changes concern pediatric immunizations performed by pharmacists and the administration of subcutaneous and intramuscular injections and venipunctures by certified medical assistants. We briefly summarize these recent changes below.
Topics: CMA, Immunization, New Jersey Physician Guidelines, Pharmacy Guidelines, Pharmacy Law, Scope of Practice
CMS Proposes Sweeping Changes to E/M Service Codes and Telemedicine
By Deniza Gertsberg, Esq., on August 27th, 2018
The Centers for Medicare & Medicaid Services (CMS) recently published a proposed rule that, if codified, would bring about sweepings revisions to many Medicare payment policies under the physician fee schedule. Among many other changes CMS is proposing to simplify the documentation requirement for evaluation and management (E/M) code levels 2 through 5 but also proposes a flat fee for those levels of services. These and certain other proposed policy changes are briefly summarized below.
Topics: Centers for Medicare & Medicaid Services, E/M Services, Medicare Billing, Telehealth, Telemedicine
New York Dentists Face New Dental Anesthesia Requirements
By Deniza Gertsberg, Esq., on July 31st, 2018
New sweeping regulations went into effect on July 1, 2017 for dental anesthesia services in New York. The regulations, among other things, would require dentists to have additional and specific continued education courses, meet specific practice requirements and maintain more exacting records than previously required. The regulations will also impose more stringent requirements on dentists providing dental sedation to patients 12 years old and younger. We provide a summary of the new requirements in the article that follows.
Topics: Board of Dentistry, Healthcare Provider Mistakes, New York Dentist Defense
NYS OMIG Focuses on Compliance, Fraud, Waste & Abuse and Detection
New York State Office of the Medicaid Inspector General (OMIG) annual 2018-2019 Work Plan highlights three areas of concern for the agency: (1) provider compliance; (2) identifying and addressing fraud, waste and abuse in the program; and (3) improving methods of detecting fraudulent activities.
Topics: Heath Care Fraud, Medicaid Fraud Control Unit, New York Medicaid, New York Medicaid Audit, OMIG
CERT Audit Finds Insufficient Documentation Results in Improper Payments
By Deniza Gertsberg, Esq., on May 31st, 2018
Recent analysis by the Comprehensive Error Rate Testing (CERT) initiative of physical therapy claims revealed that insufficient documentation contributed to improper payments issued to providers.
Topics: Centers for Medicare & Medicaid Services, Healthcare Record Keeping, Medicare Audit, Medicare Audit Contractors, Medicare Claims, Physical Therapy