Medicare Payment Resources
Ensuring you are properly reimbursed by Medicare can be challenging. ACP has provided a wealth of resources to guide you through the regulations on getting paid by Medicare.
Anti-Kickback Regulations and Self-Referral (Stark) Law
The physician self-referral and anti-kickback regulations (known as the Stark Law and Anti-Kickback Statute) were updated on November 20, 2020. These revisions seek to better accommodate value-based arrangements and to provide additional guidance on exceptions. The CMS announcement can be found here. For a summary of the rules, please see this article.
No Surprises Act
The No Surprises Act, which prohibits balance billing of out-of-network services, became effective January 1, 2022, and applies to all patients, including insured as well as self-pay and uninsured patients.
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.
Americans with Disabilities Act
This webinar explains how physicians should - or should not - respond to requests regarding patients’ disabilities for purposes of work accommodations.
Physician & Practice Timeline
A helpful summary of upcoming important dates related to a variety of regulatory, payment, and delivery system changes and requirements.
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.
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.
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.