Client Alerts, News Articles & Blog Posts

Everything you need to know about BMD and the industry.

CLIENT ALERT: Medicare Providers having multiple locations should verify and revalidate their address information to avoid claim denials

MLN Matters SE19007 “Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations” notifies providers that Medicare is now requiring the exact match of all addresses for practice locations that are listed on provider claim submissions to Medicare. (See attached)

Medicare began auditing in July 2018 for purposes of reinforcing Chapter 1, Section 170 of the Medicare Claims Processing Manual “Payments on the MPFS for Providers with Multiple Service Locations.”  The exact address match will be in full and effect once the July 2019 quarterly release is implemented.

Claims that do not have an exact address match will be returned to the provider.  Providers can make corrections to their service facility address for a claim submitted in the DDE MAP 171F screen for DDE submitters.

It is recommended that providers review their Medicare enrollment record and billing practices to ensure compliance with the exact address match requirement.  Medicare recommends that all providers update their billing records to match Medicare enrollment records.  Providers should verify and submit changes through the CMS-855A or CMS-855B application through the Provider Enrollment, Chain, and Ownership System (PECOS) as soon as possible.  Changes and updates to an address or the addition of a new location typically take Medicare 30–60 days to process.

If you would like copies of the regulations, need legal assistance with updating your Medicare enrollment information, or have any questions concerning these matters, please contact Amanda Waesch at 330-253-9185 or via email at alwaesch@bmdllc.com.

We are Working in a Virtual, Video-Conferencing World – But What About Wiretapping?

Businesses and other organizations often have a need or desire to record telephone conversations related to their business interests and customer dealings; however, this practice is not always permissible as federal and state laws vary on this issue. Knowing and understanding your jurisdiction’s rules and regulations on this practice is essential to remaining in compliance with the law.

President Trump Signs Executive Orders that Enable Access to Affordable Meds

On Friday, July 24, 2020, President Trump signed four Executive Orders concerning prescription drug pricing which collectively direct the Secretary of the Department of Health and Human Services (HHS) to take following actions: 1. Increase Patient Access to Insulin and Injectable Epinephrine 2. Facilitate the Importation of Certain Prescription Drugs 3. Remove the Anti-Kickback Safe Harbor Protection for Prescription Rebates 4. Implement the “Most Favored Nation” Order to Lower Medicare Part B Drug Cost

Guidance for Employers Receiving HHS Funding During COVID-19 on Civil Rights Protections

On July 20, 2020, HHS OCR issued guidance to help employers receiving federal financial assistance understand their requirements to comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19; specifically, Title VI of the Civil Rights Act of 1964 (“Title VI”). Title VI states that “[n]o person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”

Ohio Businesses Required to Post Exceptions to State-wide Mask Mandate at all Entrances

On July 22, 2020, in conjunction with the state-wide mask mandate instituted by Governor Mike DeWine, Lance D. Himes, Interim Director of the Ohio Department of Health, issued an order requiring Ohio businesses to post any permitted exceptions they provide to customers, patrons, visitors, contractors, vendors and similar individuals to use facial coverings at all business entrances.

ODM and OhioMHAS Continue to Expand Telehealth

On July 17, 2020, Governor DeWine signed Executive Order 2020-29D, which allowed the Ohio Department of Medicaid (“ODM”) to immediately rescind old provisions and file a new rule (5160-1-18) and the Ohio Department of Mental Health and Addiction Services (“OhioMHAS”) to amend their current rule (5122-29-31), both expanding telehealth and introducing even more flexibility into Ohio’s healthcare system.