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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 Stark Law is actually actually three separate provisions, and governs physician self-referral for Medicare and Medicaid patients. Here is a list of Stark Guidelines and their ramifications. The Self-Referral Regulations are available only to ACP members and requires a log in. Read the Regulations

It is important to note that there was an exception to this rule regarding the donation of electronic health records items and services. A final rule, approved by CMS in December 2013, extends the expiration date of this exception for an additional eight years to December 31, 2021. You can read more about the exception extension here and the full final rule 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

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 Bulletin

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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Final Rule Regarding Patients' Direct Access to Laboratory Results

A final rule was released on February 3, 2013 through the Department of Health and Human Services that provides individuals the right to receive their test reports directly from laboratories. Under this final rule, patients (and their authorized personal representatives) have the right to receive requested laboratory results within 30 days of making a request. This rule pre-empts all corresponding state laws, except those that require greater access (e.g. information needs to be provided in less than 30 days) than indicated in this final rule.

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Clinical Diagnostic Laboratory Test Payment System

The final rule, a provision of the Protecting Access to Medicare Act of 2014 (PAMA), establishes reporting requirements for certain physician office-based laboratories (POL).  The first data reporting period will be from January 1, 2017 through March 31, 2017.

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