HEALTH SYSTEM REFORM: New Requirements Kick-In

Physicians are beginning to feel the effects of the healthcare reform law enacted in March of this year. For example, the PECOS registration requirement is driven by a CMS Interim Final Rule necessitated by the new law. (See the article below in Medicare.) At the same time, the law spawns a number of new requirements and rulemaking initiatives.

The intent of these laws was to prevent activities that undermine the financial integrity of Medicare, Medicaid, and state CHIP programs. Some new requirements follow:

  • Physicians relying on the in-office ancillary services exception to the prohibition on physician self-referral must inform patients in writing that they may obtain services elsewhere under certain circumstances.
  • Physicians must file Medicare claims within one calendar year of the date of service.
  • Physicians certifying eligibility for home health services and writing orders for durable medical equipment must comply with new requirements.
  • Physicians who believe that they may have received an overpayment from Medicare or Medicaid must report and return the payment within 60 days.
  • The anti-kickback statute not longer requires proof of intent and also makes a violation a fraudulent claim under the False Claims Act.
  • Similarly, the mail fraud statute no longer requires proof of actual knowledge of the healthcare fraud statute or specific intent to violate.

Physicians are urged to read the summary of these provision prepared by the American Medical Association. Practices should take steps to comply and to consult with legal counsel as necessary to avoid potential civil and criminal liability.

MSNJ is concerned about the interpretation of many of these new requirements and will work with the AMA to obtain clarification on how the Government intends to implement many of the provisions.

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About MSNJ

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

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