tci ED Coding & Reimbursement Alert - 2013 Issue 7

Check What the ACA Says About Compliance Programs

Review the following directive from the Affordable Care Act creating the requirement for formal compliance programs as a condition of participation with governmental insurers: Subtitle E—Medicare, Medicaid, and CHIP Program Integrity Provisions SEC. 6401. PROVIDER SCREENING AND OTHER ENROLLMENT REQUIREMENTS UNDER MEDICARE, MEDICAID, AND CHIP. ‘‘(7) COMPLIANCE PROGRAMS.— ‘‘(A) IN GENERAL.—On or after the date of implementation determined by the Secretary under subparagraph (C), a provider of medical or other items or services or supplier within a particular industry sector or category shall, as a condition of enrollment in the program...

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