Tag Archive for: medicare/medicaid

ACA Non-Discrimination Notice, Statement, and Taglines [updated]

/1 Comment/in /by

[ this article was last updated on November 9, 2016 ]

The Department of Health and Human Services (HHS) has issued final regulations prohibiting discrimination (under Section 1557 of the Affordable Care Act or ACA) on the basis of race, color, national origin, sex, age, or disability. The requirements apply to all health programs and activities that receive federal funds or assistance.

Effective Date – Posting a non-discrimination notice or statement, together with non-English taglines in significant publications, physical locations, and on the practice’s website (if applicable) was required by October 17, 2016. Note that this regulation is not part of HIPAA and only applies to covered entities that receive federal funds or assistance (including EHR incentive payments).

There are three elements to meeting requirements for posting non-discrimination information (Notice, Statement, and Non-English Taglines). In addition, practices with 15 or more employees are required to have a civil rights grievance procedure, and an employee designated to coordinate compliance. All employees, regardless of the total number, should receive basic training. Please follow the steps below to comply with these requirements.

Quick steps to Compliance with ACA 1557

  1. Notice – Post the non-discrimination Notice in a conspicuous area of the practice, and on the practice website, if such is maintained. A sample Notice is available in English and in 61 other languages through the following link. Notices in non-English languages may be provided to patients upon request. Covered entities are only required to post the Notice in English. The sample Notices are available at this link.
  2. Taglines – The final rule requires that covered entities post taglines that alert individuals with limited English proficiency to the availability of language assistance services in the top 15 languages spoken in the State in which the entity is located or does business. The posting of taglines shall also be in a conspicuous location, such as the check-in or waiting area of the practice. In addition, small-sized, significant communications such as postcards must include taglines in at least the top 2 non-English languages spoken in the State.
    • Lists of the top 15 languages spoken in each state may be found at this link.
    • You may find the top 15 translated Taglines for your State with this link.
  3. Statement – A statement of non-discrimination must be included in all significant publications or communications of small size (if the material is too small to permit the full Notice to be included). Examples of such items include marketing brochures, bulletins or other announcements. You may use existing supplies of printed materials, and include the Statement as documents are reprinted. A sample Statement may also be found on this web page.
  4. Grievance Procedure – If your practice employs 15 or more people, a grievance procedure must be established. This link will take you to a model grievance procedure.
  5. Civil Rights Coordinator – If your practice employs 15 or more people, an employee must be designated to coordinate compliance with Section 1557 (i.e., to ensure that postings are made, employees are informed of the regulations, publications include required statements and taglines, and grievance procedures are followed).
  6. Employee Training – Have employees read your Notice and Grievance Procedure so that they are familiar with the rights afforded by Section 1557, and inform them of the Civil Rights/Compliance Coordinator designation so that they know to whom questions or complaints should be directed.
  7. Identify an Interpreter Service that you would use on an as-needed basis.  Additionally, you will need a Business Associate Agreement with each interpreter service you select.
  8. Assurance of Compliance – To attest that you have met the requirement, you may use this HHS link to electronically attest.

Medicare Overpayment

/in /by

On February 12, 2016, the Centers for Medicare and Medicaid Services issued a Final Rule that specifies the time frame for reporting and returning overpayments.  A new Section 1128J(d)(1) of the Affordable Care Act requires a person who has received an overpayment under parts A or B of the Medicare program to report and return the overpayment to the Secretary, the state, an intermediary, a carrier, or a contractor, as appropriate, at the correct address, and to notify the Secretary, state, intermediary, carrier or contractor to whom the overpayment was returned in writing of the reason for the overpayment.

Overpayment is defined as:

any funds that a person has received or retained under title XVIII of the Act to which the person, after applicable reconciliation, is not entitled under such title.”

The Rule states that providers receiving funds under the programs must return overpayments by the later of:

  • 60 days after the date on which the overpayment was identified; or
  • the date any corresponding cost report is due, if applicable.

The Final Rule is effective March 14, 2016. Please refer to the April issue of the American Practice Advisor for more information.

New OIG Compliance Program Available!

/in /by

As a condition of enrollment in Medicare, Medicaid and/or the Children’s Health Insurance Program (CHIP), the Affordable Care Act requires providers to establish a compliance program to prevent fraud, waste and abuse.

While Eagle Associates has had an OIG Compliance Program available for many years, we have completely revised the program to provide a more complete and user-friendly compliance system. Please review the features of the OIG Compliance Program below and feel free to contact us to discuss how this program could benefit your practice.

Program Features

Our OIG Compliance Program includes the following benefits and services:

  • American Practice Advisor subscription, including an annual OIG Fraud & Abuse Prevention training module.
  • A complete review of various fraud, waste and abuse laws.
  • A written policy manual to address fraud and abuse prevention methods, such as screening procedures, auditing and monitoring policies, reporting and investigation procedures, disciplinary actions and more.
  • An Implementation & Review Guide to help you implement policies, and conduct an annual review of program elements.
  • OIG orientation materials for initial training.
  • Our live support feature provides your practice access to our Compliance Consultants, who will answer any questions that you have about your compliance program.

In addition, we have recently partnered with a company that offers a unique and powerful tool for internal audits of patient encounters, ICD-10 code look-ups, coding guidelines and more.  SpringSoft Medical offers their cloud-based program, Swiftaudit, to improve revenue and compliance through objective auditing procedures.  All data is securely stored and accessible only to your practice for review and documentation purposes.  This program is offered as an optional companion tool with the OIG Compliance Program at a substantial discount.

If you need assistance establishing an OIG compliance program, please contact us for more information at (800) 777-2337 or email:  info@eagleassociates.net.

CMS Fraud, Waste and Abuse Training Requirement for Medicare Advantage Participants

/in /by

Medicare Advantage organizations are required to ensure that “first tier, downstream and related entities” complete CMS general compliance and fraud, waste and abuse (FWA) training.  Practices are considered to be downstream entities of Medicare Advantage organizations, and the CMS training module must be provided as written, without modification, to all employees of a downstream entity.

The memo from CMS states:

First tier, downstream and related entities and their employees can complete the general compliance and/or FWA training modules located on the CMS Medicare Learning Network (MLN).”

To minimize the burden on downstream entities, CMS permits the standardized training modules (from its website) to be incorporated into an organization’s existing compliance training materials or training systems, as long as the CMS training content is not modified (to ensure the integrity and completeness of the training).

To provide a convenience to our subscribers, we will provide the CMS general compliance and fraud, waste and abuse training (without modification) in the November 2015 Compliance Training module (and online E-Compliance Training module).

If you are not a subscriber, or prefer to access the CMS training module directly, you may locate it at:

Then, the title you are looking for is:

  • “Medicare Parts C and D Fraud, Waste, and Abuse Training and Medicare Parts C and D General Compliance Training [ZIP, 2MB]”

This is a download, and once downloaded, users will not need Internet access to use it.

Certificate of Completion/Attestation of Training 

Medicare Advantage sponsors are required to validate that the general compliance and fraud, waste and abuse training requirements are met by their downstream entities.  CMS accepts validation in the form of certificates of completion, or an attestation confirming completion of appropriate training (i.e., training documentation).

If your practice participates in our E-Compliance (online) Training program: 
Each employee will have the option to print a certificate of completion following submission of his/her test answers.

If you provide training through the American Practice Advisor Compliance Training module:
Maintain employee training tests to serve as documentation of training completion.

If a Sponsor specifically requires the CMS certificate of completion (although not required by CMS):
Navigate to the last page of the CMS training module and complete the certificate with each employee’s name before printing the document.  (Directions to the document are provided in the previous section.)

Please contact Eagle Associates at (800) 777‑2337, or email info@eagleassociates.net if you require further clarification.