Entries tagged: healthcare

Prepayment Review Deadlines Published for Medicare Providers

By: William McDonald, Esq.

Posted: April 20th, 2015

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As we recover from the cold winter, Medicare has prescribed a healthy dose of alphabet soup to Medicare providers and suppliers.  New Change Request 8583 to the Medicare Program Integrity Manual (“MPIM”) imposes a new deadline on Medicare providers and suppliers to provide requested documentation during a prepayment review. Effective April 1, 2015, the MPIM […]

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Medical Providers Must Take Steps to Protect Out-of-Network Reimbursements under New York’s “Surprise Medical Bills” Law

By: William McDonald, Esq.

Posted: February 25th, 2015

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Medical providers must plan now to comply with New York’s new “Surprise Medical Bill” law, which takes effect April 1, 2015. In short, for “surprise bills,” the law caps a patient’s financial responsibility for out-of-network medical services to an amount no greater than if the patient saw an in-network provider. Medical providers who do not […]

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Affordable Care Act

By: William McDonald, Esq.

Posted: December 9th, 2014

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Affordable Care Act (“ACA”) compliance remains a complicated process for most employers.  Starting January 1, 2015, Applicable Large Employers (“ALEs”) become subject to the Employer Shared Responsibility Provisions of the ACA, codified in Internal Revenue Code Section 4980H.  ALEs must offer their full-time employees the opportunity to enroll in affordable health coverage providing minimum essential […]

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Safe Harbor Update

By: William McDonald, Esq.

Posted: November 9th, 2014

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On October 3, 2014, the Office of the Inspector General for Health and Human Services (“OIG”) published a proposed rule that revises the Safe Harbor under the Anti-Kickback Statute concerning discounted or complimentary transportation services that medical providers can provide to patients. See 79 Fed. Reg. 59717 (October 3, 2014).  Medical providers should welcome this […]

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Due Process Upheld for Physicians Targeted for Termination from Medicare Advantage Plans

By: William McDonald, Esq.

Posted: August 9th, 2014

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Physicians who receive termination notices from insurers should learn about their rights from a recent case brought by the Fairfield County Medical Association.[1]  On February 7, 2014, the Second Circuit Court of Appeals upheld the District Court’s injunction[2] enjoining United Healthcare (“United”) from: 1) terminating affected physicians in its Medicare Advantage program; 2) notifying customers […]

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Office for Civil Rights Launches HIPAA Compliance Audits

Posted: December 1st, 2011

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In November 2011, The Department of Health and Human Services’ Office for Civil Rights (OCR) announced a new effort to audit covered entity and business associate compliance under Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act (HIPAA and […]

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