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Regulatory Compliance

Medicare Payment Resources

Ensuring you are properly reimbursed by Medicare can be challenging. CPII has provided a wealth of resources to guide you through the most recent regulations on getting paid by Medicare.

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The Stark Law - Self-Referral Regulations

The physician self-referral and anti-kickback regulations (known as the Stark Rule and Anti-Kickback Statute) were updated on November 20, 2020, to accommodate value-based arrangements and to provide additional guidance on exceptions. CMS announcement is here. For a summary of the rules, see this ACP summary and this article. More in-depth guidance regarding these complex rules is in development by ACP staff and will be posted here. 

Avoiding Medicare & Medicaid Fraud & Abuse

The U.S. Department of Health and Human Services has published a comprehensive booklet A Roadmap for New Physicians - Avoiding Medicare and Medicaid Fraud and Abuse. Read the Booklet.

Medicare Compliance Action Plan

ACPs Action Plan adheres to the Office of the Inspector General's (OIG) basic adage “Do what’s good for business and you’ll do what’s good for compliance.” It provides a systematic process to follow and a record of what you have accomplished. This resource is available only to ACP members and requires a log in.

Download the Action Plan

Americans with Disabilities Act

This webinar explains how physicians should - or should not - respond to requests regarding patients’ disabilities for purposes of work accommodations.

Watch Webinar

Physician & Practice Timeline

A helpful summary of upcoming important dates related to a variety of regulatory, payment, and delivery system changes and requirements.

View Timeline

OSHA Bloodborne Pathogens Requirements

The standard’s requirements state what employers must do to protect workers who are occupationally exposed to blood or other potentially infectious materials (OPIM), as defined in the standard.

Read the OSHA Fact Sheet

Physician Payment Sunshine Rule - Open Payments

This provision of the Affordable Care Act requires the public reporting by applicable manufacturers and Group Purchasing Organizations (GPO) of defined transfers of value to physicians and teaching hospitals. The Act also requires reporting by applicable manufacturers and GPOs of designated physician ownership and investment interests in their entities. Only applies to manufacturers and GPOs of drugs, devices, biologicals or medical supplies in which payment is available under Medicare, Medicaid or CHIP and, which requires a prescription to be dispensed. While physicians and teaching hospitals have no reporting obligations under this regulation, they do have the right to review and dispute all required information being reported about them by the applicable entity prior to this information being placed on a public website.

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Clinical Diagnostic Lab Test Payment System

The Protecting Access to Medicare Act of 2014 (PAMA) required changes to how Medicare pays for clinical diagnostic laboratory tests under the Clinical Laboratory Fee Schedule (CLFS). Effective January 1, 2018, the payment amount for most tests equals the weighted median of private payor rates. View the FAQs.

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