Fierce Healthcare

JANUARY 10, 2024

Elevance Health is launching a new initiative that aims to put smartphones in the hands of Medicaid members who otherwise cannot connect to virtual services. In the wake of the COVID-19 pandemic, virtual care and digital health tools are more popular than ever.

Medicaid 133

Medicaid Medicaid COVID-19 133

Fierce Healthcare

JANUARY 18, 2024

2024 | This week, Humana announced workforce reductions, a study associated Medicaid expansion with reduced lung cancer mortality and Bright Health moved its corporate headquarters. Below is a round-up of payer-centric news for the week of Jan.

Medicaid 113

Medicaid Medicaid 113

Center for Health Insurance Reform

OCTOBER 19, 2023

A number of new and ongoing policy changes will impact the Marketplace in 2024, including special enrollment opportunities tied to the Medicaid “unwinding,” continuing enhanced financial assistance, and administrative flexibilities designed to reduce barriers to enrollment.

ACA 104

ACA Medicaid Medicaid Health Insurance 104

Healthcare It News

DECEMBER 29, 2023

This past week, New York Governor Kathy Hochul signed Senate Bill 1196a/Assembly Bill 1673a into law directing all state-regulated health plans, including Medicaid, to cover comprehensive biomarker testing, clearing the path for more patients to access precision medicine treatments.

Medicaid 242

Medicaid Medicaid Health Outcomes 242

Verisys

MARCH 12, 2024

Compliance Updates: March 2024 Overlook: Board Updates Georgia : The Georgia Medical Board has extended tele-prescribing flexibility until May 1, 2024. As of May 1, 2024, licensees should refer to the Medical Practice Act and Board Rules to ensure compliance with telemedicine practices. MD BOP Regulations 10.34.34.04

Regulatory Compliance 52

Regulatory Compliance Compliance Medicaid Medicaid 52

Healthcare Dive

DECEMBER 21, 2023

Enrollment in the Affordable Care Act exchanges could be boosted by extended subsidies and the effects of Medicaid redeterminations.

ACA 236

ACA Medicaid Medicaid 236

HealthIT Answers

AUGUST 29, 2023

By Chris Emper - On July 13, the Centers for Medicare & Medicaid Services released a 1,920-page proposed rule that would update payment policies and programs regarding Medicare payments to physicians and other providers under the Physician Fee Schedule on or after January 1, 2024.

Medicare 111

Medicare Medicare Medicaid Medicaid 111

Fierce Healthcare

SEPTEMBER 26, 2023

Expect premiums, benefits and plan choices for Medicare Advantage (MA) and the Medicare Part D prescription drug program to look similar in 2024, the Centers for Medicare & Medicaid Services (C | CMS announced that nearly three-quarters of MA plan beneficiaries will not see their premiums rise.

Medicare 117

Medicare Medicare Medicaid Medicaid 117

Healthcare Dive

NOVEMBER 14, 2023

in the 2024 fiscal year — the largest year-over-year drop since 1998, according to KFF. Enrollment in the safety-net insurance program could plummet 8.6%

Medicaid 164

Medicaid Medicaid 164

Healthcare Dive

APRIL 25, 2023

The payer beat Wall Street expectations in the first quarter on both earnings and revenue, which reached $39 billion.

Medicaid 192

Medicaid Medicaid 192

MedTrainer

JANUARY 10, 2024

It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024. It may seem a little early to do some spring cleaning, but not when it comes to compliance!

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

Medisys Compliance

APRIL 23, 2024

This comprehensive guide explores the key medical billing best practices for 2024, empowering healthcare providers to optimize their revenue cycle and minimize administrative burdens. Utilize resources from the Centers for Medicare & Medicaid Services (CMS) and your local healthcare associations.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medicare Medicare 59

Verisys

MARCH 8, 2024

February 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M The post February 2024 Bad Actors Roundup appeared first on Verisys.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Fierce Healthcare

APRIL 26, 2024

Below is a roundup of payer-centric news headlines for the week of April 22, 2024. This week, Molina Healthcare gave an update on the Florida and Virginia Medicaid awards process, UHG announced a $2 million grant for Native American behavioral health and new partnerships were unveiled by WellCare of Kentucky and Humana.

Medicaid 52

Medicaid Medicaid 52

Verisys

FEBRUARY 8, 2024

The updated rules are effective January 2, 2024. NLC Final Rules Effective 1/2/2024 A new rule included in the Nurse Licensure Compact update affects nurses moving residence from one compact state to another compact state. Effective January 2, 2024. If the license is not renewed, it will expire on 8/2/2024.

Regulatory Compliance 52

Regulatory Compliance Compliance Licensing Nurses 52

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

Medicaid 100

Medicaid Medicaid Compliance Health Insurance 100

Medisys Compliance

MARCH 7, 2024

In 2024, the AMA introduced 349 changes to the CPT code set, comprising 230 new codes, 49 deletions, and 70 revisions. Staying abreast of these 2024 CPT code updates is essential for healthcare professionals to ensure precise coding and proper financial reimbursement.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Regulatory Compliance Compliance 59

Innovaare Compliance

DECEMBER 25, 2023

Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS) issued a memorandum detailing several announcements relating to its 2024 CMS program audit. Prepare for both routine and focused audits to be conducted in 2024 by CMS.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Verisys

FEBRUARY 9, 2024

January 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 The post January 2024 Bad Actors Roundup appeared first on Verisys.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT Today

JANUARY 20, 2024

2024 Health IT Predictions : Cautionary Views of Healthcare AI. Our ongoing series of 2024 Health IT Predictions turned to some reasons to be wary of AI. Read more… 2024 Health IT Predictions: AI Use Cases in Healthcare. Read more… 2024 Health IT Predictions : AI’s Impact in Healthcare.

Licensing 100

Licensing Medicaid Medicaid Hospitals 100

Modern Healthcare

JULY 31, 2023

Skilled nursing faciltiies will receive a higher Medicare pay bump in fiscal 2024 than proposed by the Centers for Medicare and Medicaid Services in April.

Nursing Homes 80

Nursing Homes Medicare Medicare Nurses 80

Fierce Healthcare

JULY 13, 2023

The Centers for Medicare & Medicaid Services has released its proposed Medicare payment rates and policy updates under the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory S | The CY 2024 OPPS and ASC Payment System Proposed Rule includes a 2.8%

Payment Systems 97

Payment Systems Medicare Medicare Medicaid 97

Fierce Healthcare

APRIL 11, 2024

Payer Roundup—UHG exec stock sell-off after DOJ probe; Michigan awards Medicaid contracts; Cigna announce innovation hub home ntong Thu, 04/11/2024 - 15:39

Medicaid 52

Medicaid Medicaid 52

Healthcare IT Today

JANUARY 2, 2024

As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. All of this year’s 2024 health IT predictions (updated as they’re shared): John and Colin’s 2024 Healthcare IT Predictions And now, check out our community’s Health Equity predictions.

Telemedicine 98

Telemedicine Health Outcomes Medicaid Medicaid 98

Center for Health Insurance Reform

JUNE 3, 2022

Beginning in 2023, CMS will require QHP provider networks for plans sold on the federal marketplace to meet minimum time-and-distance standards and, beginning in 2024, minimum standards for appointment wait times.

Medicaid 98

Medicaid Medicaid Health Insurance 98

Center for Health Insurance Reform

MARCH 31, 2023

With the twin goals of building on the enrollment gains and improving the consumer experience, the Centers for Medicare & Medicaid Services (CMS) has proposed an annual set of requirements. Stakeholder Perspectives on CMS’s 2024 Notice of Benefit and Payment Parameters: Health Insurers

Health Insurance 97

Health Insurance ACA Medicaid Medicaid 97

Innovaare Compliance

MARCH 11, 2024

The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data Processing System (DDPS) since inception of Part D in 2006. Due to multiple changes to the Part D program pursuant to the Inflation Reduction Act (IRA) of 2022, some DDPS edit changes will take effect on January 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Medisys Compliance

APRIL 11, 2024

A New Era for Mental Health Access The landscape of mental healthcare in the United States underwent a significant change on January 1, 2024. The Centers for Medicare & Medicaid Services (CMS) website offers a comprehensive guide, including FAQs, enrollment instructions, and billing manuals specifically tailored for MFTs and MHCs.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Modern Healthcare

AUGUST 18, 2022

States would have to track Medicaid and Children's Health Insurance Program quality metrics starting in fiscal 2024.

Medicaid 79

Medicaid Medicaid Health Insurance 79

Healthcare IT Today

JANUARY 14, 2024

The American Telehealth Association announced its policy priorities for 2024 ; they include making Medicare telehealth flexibilities permanent before the end of the year and removing the in-person requirement for the remote prescribing of controlled substances. Wellness app Vivoo launched an at-home digital UTI test.

Medicaid 106

Medicaid Medicaid FDA Medicare 106

Compliancy Group

APRIL 17, 2024

Focus Areas for 2024 The OIG’s General Compliance Program Guidance (GCPG) establishes industry-specific compliance program guidance (ICPG) for 2024 that focuses on forms of fraud, waste, and abuse specific to certain types of suppliers, providers, and entities like nursing homes, clinical laboratories, and hospitals.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

Provider Trust

JANUARY 25, 2024

Though HHS has made efforts to address the challenges outlined in this year’s report, there are still many opportunities for improvement in 2024. We’ve broken down the report’s primary themes and how they affect healthcare organizations moving forward in 2024. With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Medisys Compliance

APRIL 15, 2024

This article explores some of the key changes in urology CPT codes for 2024, empowering you to navigate the billing landscape with confidence. The 2024 CPT manual introduces new codes (0811T and 0812T) specifically for complex uroflowmetry performed remotely.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medical Billing Services Medicaid 64

Healthcare IT Today

MARCH 9, 2024

Read more… Bonus Features for March 3, 2024: 75% of healthcare leaders expect widespread implementation of AI in 3 years, yet 78% of orgs lack knowledge on how to train employees to use AI. Dina raised $7 million in Series B funding ; the company supports network management for Medicare Advantage and Managed Medicaid.

Medicaid 93

Medicaid Medicaid Medicare Medicare 93

Medisys Compliance

MARCH 10, 2024

Introduction Wound care billing in 2024 continues to be a dynamic and intricate aspect of healthcare administration, offering both challenges and opportunities for providers and coders. Prior Authorization Challenges and Strategies Another challenge in wound care billing in 2024 is navigating prior authorization requirements.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing COVID-19 Nurses 59

Innovaare Compliance

JANUARY 19, 2024

2] Through a combination of routine and focused audits in 2024, CMS aims to evaluate the UM-related performance of plans serving approximately 88% of people in MA plans. Audit notification will begin in January 2024. The post 2024 CMS Program and Focus Audits: Are You Prepared? What is the intent of a focus audit?

Medicare 52

Medicare Medicare Compliance Medicaid 52

Medisys Compliance

DECEMBER 12, 2023

As we move into 2024, several key updates will impact how behavioral health providers bill for their services. In this article, we will explore the most important behavioral health billing updates planned for 2024, focusing on both Medicare and commercial payers. This shift is expected to continue in 2024 and beyond.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medicare Medicare 59