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MiraMed’s eAlerts are distributed via email every Wednesday, and contains the latest industry information regarding business process outsourcing solutions, helpful coding news, or any number of relevant topics in the fast-paced, ever-evolving world of healthcare. To subscribe, simply complete the form below. Below the subscription form, you will find the archived eAlerts available.

September 18, 2013

The collection of payment data to physicians and teaching hospitals from pharmaceutical and medical device companies, as well as reporting of certain ownership interests, under the new Physician Payments Sunshine Act (PPSA) started August 1, 2013. The law covers meals, honoraria, travel expenses, and grants from manufacturers, as well as ownership or investment interests in group purchasing organizations (GPOs), by physicians or members of their immediate family. Information will be posted on a public website that will identify physicians who have received payments or hold ownership. While data collection is underway, public reporting does not start until 2014, under the National Physician Payment Transparency Program (NPPTP) of the Centers for Medicare and Medicaid Services (CMS).

Read more: Key Facts About the Physician Payments Sunshine Act

September 11, 2013

Recovery Audit Contractors (RACs) are designed to protect Medicare by identifying improper payments and referring potential fraud to the Centers for Medicare & Medicaid Services (CMS). In a September 3, 2013 report, the Office of Inspector General (OIG) found that prior OIG work has identified problems with CMS's actions to address RAC referrals of potential fraud were still outstanding. Further, OIG identified vulnerabilities in CMS's oversight of its contractors.

Read more: Medicare Recovery Audit Contractors Performance: Office of Inspector General Findings

September 5, 2013

Section 6401(a) of the Affordable Care Act (ACA) established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011.  Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are not impacted. Between now and March 23, 2015, Medicare Administrative Contractors (MAC) will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation only after being asked by their MAC to do so.  Please note that 42 CFR 424.515(d) provides CMS the authority to conduct these off-cycle revalidations.

Read more: Medicare Providers: Make Sure You Revalidate Your Enrollment When Medicare Asks!

September 4, 2013

On August 29, the Department of Health and Human Services (HHS) issued a memo clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives.  This is the first guidance issued by HHS in response to the recent Supreme Court ruling, which held Section 3 of the Defense of Marriage Act (DOMA) unconstitutional.  HHS, which oversees Medicare, has decided it will adopt the “place of celebration” standard when granting Medicare benefits to same-sex couples.  If the marriage took place in a state that recognizes same-sex marriage, then the couple is entitled to benefits, no matter where they live.

Read more: HHS Announces First Guidance Implementing Supreme Court’s Decision on the Defense of Marriage Act...

August 28, 2013

We have issued numerous alerts about compliance with the new Health Insurance Portability and Accountability Act of 1996 (HIPAA) omnibus regulations that were released on January 25 of this year (Omnibus Rule).  Although much has been released about them, many are still behind in ensuring compliance with the new provisions of the rule.  In a little over four weeks from now, covered entities must ensure they are complying with these new provisions or they could be leaving themselves exposed to potential liabilities of up to $1,500,000.  This is a friendly reminder that there is much to do between now and September 23.

Read more: HIPAA –The Countdown is On to September 23

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