Medicaid

On December 2, 2020, CMS published new provisions and exemptions related to the Stark Law (85 Fed. Reg. 77492) and HHS-OIG published new provisions and safe harbors related to the Anti-Kickback Statute (AKS) (85 Fed. Reg. 77684.

Code accurately with the appropriate documentation to substantiate medical necessity.

Only a quarter of Medicare and Medicare Advantage recipients receive an annual wellness visit.

If providers fail to follow these new rules, claims will be denied, and eventually, those who are outliers on adherence to appropriate use criteria will be subject to prior authorization.

Most physician compensation structures must comply with Stark laws. The danger is that practices may be in violation without realizing it, putting themselves at risk of fines and exclusion from Medicare and Medicaid.

New guidance unveiled this week would allow states to impose work requirements on Medicaid recipients, but one physician advocacy group is not on board.