Start Now: Assess/Upgrade Compliance Before December

Posted by Linda Terner on July 13, 2012

checklistNew York’s Office of the Medicaid Inspector General (OMIG) recently issued Compliance Alert 2012-01, which identifies the providers who must present the annual certification of an “effective compliance program” (as that term is defined by regulation) in December, and reminds them of this year-end responsibility. 

Providers of goods and services, either directly to Medicaid or indirectly to Medicaid managed care organizations, who have submitted claims of at least $500,000 in any twelve-month period should review the regulations carefully to determine if they are required to make a certification. 

If certification of an "effective compliance program" is required, it is now time to evaluate (and improve) the provider's compliance program.   OMIG has provided a basic self-assessment tool to aid in that process. The assessment takes only a short time to complete and is worth doing sooner rather than later. By doing so, the compliance program can be upgraded if needed in order to meet “effective compliance program” standards by December.

Earlier blogs have discussed which providers must certify, and resources for compliance program gap analysis and review.

Helpful Online Resources for Health Care Providers

Posted by Rachel Ryan on January 05, 2012

Happy New Year!  To kick off 2012, I thought I would share a list of websites that I think every health care provider should bookmark.  The last two sites are specific to New York, but similar sites exist for other states. 

  1. http://oig.hhs.gov/compliance/.  OIG provides numerous resources on its website to help educate providers about federal laws designed to prevent fraud, waste, and abuse.  Over the years, I have found the advisory opinions to be particularly helpful.
  2. http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/index.html.  This is a great source for information on HIPAA.  It includes all the HIPAA regulations, FAQs, and  quick summaries of the Privacy, Security, and Breach Notification rules.
  3. https://www.cms.gov/PhysicianSelfReferral/.  If you are tackling a Stark question, CMS’s website is one you should check out.  Here you will find the Stark regulations, FAQs, advisory opinions, and the self-referral disclosure protocol.
  4. http://www.gpo.gov/fdsys/browse/collectionCfr.action?collectionCode=CFR.  The US Government Printing Office provides an online version of the Code of Federal Regulations.  This is a helpful resource if you need to review a regulation promulgated by CMS.
  5. http://webmd.com.  A leading source for trustworthy and timely health and medical news and information.
  6. http://www.healthcare.gov/law/full/index.html.   Check out this site for a copy of the Affordable Care Act.
  7. http://www.nydoctorprofile.com/.  Here you will find profiles for all licensed physicians who are registered to practice medicine in New York State. 
  8. http://www.health.ny.gov/.  This website provides a wealth of information on issues regulated by the New York State Department of Health from certificate of need applications to hospital profiles.