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APR
03
0

TOWARDS INCREASED PBM TRANSPARENCY

Is Increased PBM Transparency on the Way? Newly proposed Federal legislation would increase PBM transparency regarding aggregate rebates and "spread pricing".An oft-controversial issue, independent pharmacy associations have long lobbied for greater disclosure of the rebates that PBMs receive from drug companies, which can have a significant effect...
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  2603 Hits
2603 Hits
APR
03
0

INSURANCE PLAN NOT PERMITTED TO “CROSS-PLAN” RECOUP AGAINST PROVIDERS

A Federal District Court in Minneapolis has issued a highly favorable decision for physicians and healthcare providers on the limits of an insurance plan's ability to recoup.  Specifically, the court ruled that insurers can only recoup against providers from the same health plan that the alleged overpayment was issued under, even if the insure...
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  2471 Hits
2471 Hits
MAR
31
0

MDRXLaw 2017 Q1 Newsletter - Focus on PBM Audit Practices

We are pleased to announce the publication of our 2017 First Quarter Newsletter devoted to the issues facing pharmacies in connection with PBM audits. Please read it here.
  3557 Hits
3557 Hits
MAR
28
0

MFCU Takes Recoupment Actions Against Providers in Connection With Percentage-Based Billing Arrangements

Calling the attention of every New York Medicaid provider reimbursing its billing/collection agents on a percentage basis, the New York State Medicaid Fraud Control Unit (MFCU) has recently sent out recoupment letters demanding repayments of Medicaid funds paid to billing companies under fee-splitting arrangements. Notably, the recoupments actions ...
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  2756 Hits
2756 Hits
DEC
29
0

MEDICARE APPEALS BACKLOG MUST BE CLEARED, RULES COURT

In a groundbreaking decision addressing one of the most pressing issues currently faced by Medicare providers, the U.S. District Court for the District of Columbia ordered CMS to clear the lengthy backlog of Medicare appeals at the administrative law judge (ALJ) level. Under the Medicare Act, CMS must provide an ALJ hearing and decision within 90 d...
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  2113 Hits
2113 Hits
DEC
29
0

PROTECTING ACCESS TO PHI

As providers continue to rely on software vendors to maintain protected health information ("PHI"), a well-drafted business associate agreement ("BAA") becomes increasingly important. The BAA will set forth the obligations between providers and business associates such as software vendors with respect to the PHI. Software vendors will often attempt...
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  2083 Hits
2083 Hits
MAY
16
0

PAYING OVERTIME WAGES TO PROFESSIONAL EMPLOYEES

Medical practices, urgent care centers, and other healthcare facilities often employ clinical practitioners, such as physician assistants or nurse practitioners, who frequently work over 40 hours per week.   Whether these employees need to be paid overtime wages is a question our clients frequently ask us in our role as employme...
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  2960 Hits
2960 Hits
MAR
25
0

E-script Requirements Going Into Effect

Effective March 27, 2016, a new law will require New York State prescribers to issue prescriptions electronically directly to a pharmacy, with limited exceptions. The new law requires electronic prescribing for all types of medications (controlled substances and non-controlled substances) and for syringes and other medical devices dispensed at a ph...
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  2843 Hits
2843 Hits
JAN
28
0

Abbott Issues a New Round of Subpoenas to Many Pharmacies

​Pharmacies and pharmacists across the country are receiving subpoenas in a federal case filed in the Eastern District of New York.  In this case, a manufacturer of diabetic test strips, Abbott  Laboratories, is suing distributors and pharmacies accusing them of importing and selling diabetic test strips intended for sale i...
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  4845 Hits
4845 Hits
JAN
07
0

Medicare Appeals - New Developments, Old Delays

Office of Medicare Hearings and Appeals (OMHA) recently created a new website to facilitate monitoring of ALJ appeals. Physicians, DME suppliers & other providers can now check on the status of filed Medicare reimbursement appeals, find useful documentation as well as other information pertinent to the appeal. OMHA also launched listserv websit...
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  3697 Hits
3697 Hits
NOV
24
0

MEANINGFUL USE AUDIT: HOW CAN A PRACTICE PREPARE?

While the stated goals of meaningful use compliance include terms such as empowerment, improvement and efficiency, for many participating physicians the possibility of a meaningful use audit just adds another level of anxiety to the already stressful and increasingly time-consuming burden of administrating a medical practice in the current regulato...
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  3045 Hits
3045 Hits
NOV
24
0

THE INDEPENDENT PHARMACY’S GUIDE TO SURVIVING A PBM AUDIT

Nothing is as critical to the economic health of an independent pharmacy as successfully resolving inevitable audits by Pharmacy Benefits Managers ("PBMs"). While the PBM concept originated as a measure to cut back on fraud, waste and abuse, the current role played by a PBM can often be perceived as antagonistic to the interests of independent phar...
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  4811 Hits
4811 Hits
OCT
06
0

NEW YORK PHYSICIANS COMPLIANCE PROGRAM MANDATE

The New York State Office of Medicaid Inspector General ("OMIG") has long required Medicaid providers to implement compliance programs as a condition of enrollment with Medicaid. However, now under Federal law, practitioners, regardless of the size of their practice, will have to develop a comprehensive compliance program. Under Section 6401 of the...
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  3522 Hits
3522 Hits