The Health Law Firm Blog

JANUARY 22, 2024

This agency investigates allegations of fraud, waste, and abuse against Medicare, Medicaid, and other federally funded healthcare programs. [.] Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG).

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The Health Law Firm Blog

JANUARY 8, 2024

This agency investigates allegations of fraud, waste, and abuse of Medicare, Medicaid, and other federally funded healthcare programs. [.] Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG).

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Fraud Medicaid Medicaid Medicare 52

The Health Law Firm Blog

JANUARY 1, 2024

This agency investigates allegations of fraud, waste, and abuse against Medicare, Medicaid, and other federally funded healthcare programs. [.] Department of Health and Human Services (HHS) issues investigative subpoenas through the Office of the Inspector General (OIG).

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Fraud Medicaid Medicaid Medicare 52

Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 With Medicaid, the challenges are equally formidable.

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HealthIT Answers

JANUARY 31, 2024

The Centers for Medicare & Medicaid Services opened data submission for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the Quality Payment Program. Data can be submitted and updated until 8:00 p.m. ET on April 1, 2024.

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Payment Systems Medicaid Medicaid Medicare 59

MedTrainer

JANUARY 30, 2024

Compliance is Mandatory for Federal Programs One constant is that organizations and facilities that participate in federal healthcare programs, such as Medicare and Medicaid, must have a compliance program. Laboratories: Clinical laboratories that perform tests covered by Medicare or Medicaid.

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Governance Compliance Nursing Homes Medicaid 52

HIT Consultant

JANUARY 15, 2024

Payers: Medicare Advantage on the Rise: Expect a surge in the Medicare Advantage population, particularly among duals eligible for both Medicare and Medicaid. This shift fuels a 5% CAGR for payer profit pools, reaching $78 billion by 2027.

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Medicare Medicare COVID-19 Nurses 104

Medisys Compliance

JANUARY 11, 2024

Audits: Increased scrutiny from Medicare and Medicaid for potential coding discrepancies. Regulatory Landscape Medicare and Medicaid regulations change frequently, demanding constant adaptation. Delays: Reimbursement postponed while errors are corrected. This includes: Wound assessments and progress notes.

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Medical Billing Outsourcing Medical Billing Medicaid Medicaid 59

The Health Law Firm

JANUARY 8, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule (PFS). Indest III, J.D.,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. This wastes taxpayer money and interferes with your medical care. trillion in 2015.

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Fraud Medicare Medicare Compliance 52

MedTrainer

JANUARY 22, 2024

She hints that changes you see within the Centers for Medicare and Medicaid (CMS) are likely to carry over to private payers and become industry standard. “If

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Compliance Medicare Medicare Medicaid 52

MedTrainer

JANUARY 12, 2024

Here are some of the key organizations involved in regulating healthcare compliance: Centers for Medicare & Medicaid Services (CMS): CMS is a federal agency within the U.S. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

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Compliance Fraud Medicaid Medicaid 52

Healthcare IT Today

JANUARY 5, 2024

The proceeds from the financing will support PursueCare’s ongoing collaborative care initiatives with health systems across 11 states, as well as expansion into value-based care with Medicaid managed care and other health plans. Patients can also seek treatment without a referral by downloading the app from Google Play or the Apple Store.

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FDA Medicaid Medicaid Hospitals 110

HIT Consultant

JANUARY 2, 2024

Her collaborative approach led to the development and implementation of successful programs for Medicare Advantage, Medicaid, commercial plans, Fortune 100 companies, and state health agencies across the country.

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Medicaid Medicaid Medicare Medicare 59

Verisys

JANUARY 8, 2024

This includes adherence to standards set by the Health Insurance Portability and Accountability Act (HIPAA) , the Centers for Medicare & Medicaid Services (CMS), and other regulatory bodies. Involves ensuring adherence to laws and regulations specific to the healthcare industry.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

Innovaare Compliance

JANUARY 19, 2024

Organizations offering Medicare Advantage (MA) plans and MA Prescription Drug Plans (MAPD) may be subject to a focused audit even if the organization completed a 2021 or 2022 routine program audit. CMS 4201-F emphasized that enrollees in MA plans have the same access to medically necessary care as those in traditional Medicare.

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Medicare Medicare Compliance Medicaid 52

HIPAA Journal

JANUARY 11, 2024

One of the first tasks undertaken by the newly created OIG in healthcare was to establish the OIG HHS Exclusions List as required by the Medicare-Medicaid Anti-Fraud and Abuse Amendments 1977. The post What is OIG in Healthcare? appeared first on HIPAA Journal.

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Fraud HIPAA Compliance Medicare 84

Hall Render

JANUARY 24, 2024

CMS introduced an updated Medicare Cost Report e-Filing system (“MCReF”) and related templates to allow Medicare Part A providers the ability to electronically file to their Medicare contractor supporting documentation in addition to their cost report for fiscal years ending on or after December 31, 2017.

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Medicare Medicare Medicaid Medicaid 40

Hall Render

JANUARY 23, 2024

Sarah Crosby is an experienced attorney who specializes in providing counsel to clients navigating Medicare reimbursement issues. Sarah began her law career as an Assistant Attorney General for the State of Washington where she prosecuted civil and criminal Medicaid fraud cases.

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Fraud Medicaid Medicaid Medicare 40

MedTrainer

JANUARY 10, 2024

Centers for Medicare and Medicaid Services (CMS) requires nursing homes and ambulatory surgery centers (ASCs) to have an individual who is qualified by experience and training to serve as an infection control preventionist. Evaluate your current infection control and prevention plan.

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Compliance Fraud HIPAA Compliance Officers 94

Verisys

JANUARY 8, 2024

The OIG is responsible for combating fraud, waste, and abuse in health and human services programs, including Medicare and Medicaid. OIG compliance refers to adherence to the guidelines and regulations set forth by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services.

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Compliance Fraud Medicaid Medicaid 52

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

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US Department of Health and Human Services Medicare Medicare Medicaid 52

HIT Consultant

JANUARY 31, 2024

Expanding Access and Improving Quality Through this collaboration, both organizations aim to deliver high-quality care through value-based arrangements to patients with diverse insurance coverage, including Medicare, Medicaid, ACA Marketplace, and commercial plans.

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ACA Medicaid Medicaid Medicare 52

HIT Consultant

JANUARY 4, 2024

” “The need for Glytec’s solution is massive,” noted Cua, “and with new and increasing hospital and Center for Medicare and Medicaid Services (CMS) focus on electronic clinical quality measures (eCQMs) to lower costs and reduce adverse events, the time to act is now.”

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Hospitals Medicaid Medicaid Medicare 52

Compliancy Group

JANUARY 3, 2024

The regulations surrounding medical billing compliance policy come from: Federal laws, such as the Health Insurance Portability and Accountability Act (HIPAA) and Affordable Care Act (ACA) State laws Medicare and Medicaid guidelines Health insurance policies Failure to comply with medical billing compliance regulations can result in: Fines, penalties, (..)

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Medical Billing Compliance ACA Health Insurance 52

Healthcare Law Blog

JANUARY 9, 2024

The Somatus model is an interesting one, as it takes a whole person approach to kidney care, that reduced the medical loss ratio (MLR, the comparison of medical costs to total revenue, and ideally below 85% for Medicare patients) for kidney care patients by 21.9%, which is a remarkable number. More on the Cleveland Clinic tomorrow.

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Medicare Medicare Hospitals Doctors 59

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. MACRA (2015): The Medicare Access and CHIP Reauthorization Act (MACRA) introduced the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

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Compliance HIPAA Telemedicine ACA 52

Total Medical ComplianceHIPAA

JANUARY 11, 2024

These screenings search through various databases containing records of individuals or organizations barred from participating in Medicaid, Medicare, or other federal/state healthcare programs due to fraud, abuse, or other offenses. Why is Sanction Screening Vital Under HIPAA?

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HIPAA Regulatory Compliance Malpractice Compliance 52

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.

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Medicaid Medicaid FDA Medicare 115

HIT Consultant

JANUARY 8, 2024

– The strategic joint effort focuses on connecting vulnerable Medicaid, Medicare Advantage, and commercially insured beneficiaries with critical supplemental benefits like transportation, food delivery, and medication delivery.

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Health Outcomes Medicaid Medicaid Medicare 52

MedTrainer

JANUARY 30, 2024

The professionals who manage compliance are the front lines of preventing medical errors, deterring fraud, and staying in good standing with federal payers like the Centers for Medicare and Medicaid Services (CMS).

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Compliance Compliance Officers Fraud Medicaid 52

MedTrainer

JANUARY 12, 2024

Health plans: Insurance companies, HMOs, Medicare, Medicaid, and other health insurance providers. HIPAA primarily affects two types of organizations: Covered Entities Healthcare providers: Hospitals, physicians, nurses, dentists, and other healthcare professionals.

HIPAA 52

HIPAA Compliance Health Insurance Hospitals 52

MedTrainer

JANUARY 26, 2024

Significant fines also can be levied by the Office of Inspector General (OIG) for overbilling Medicare and Medicaid. These actions can lead to financial losses for patients and payers. Non-compliance includes improper hand hygiene, inadequate sterilization of medical equipment, and poor sanitation practices.

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Compliance Informed Consent HIPAA Medical Billing 52

Compliancy Group

JANUARY 17, 2024

Department of Health and Human Services (HHS), is tasked with combating fraud, waste, and abuse in health programs, ensuring efficiency, and promoting the integrity of HHS programs, including Medicare and Medicaid.

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US Department of Health and Human Services Compliance Regulatory Compliance Regulations Compliance 52

Healthcare IT Today

JANUARY 2, 2024

To a hacker or bad actor, one person’s medical file holds the information necessary to commit many crimes, including identity theft, the misuse of Medicare or Medicaid benefits, and even filling existing prescriptions for controlled substances. Healthcare’s most valuable data is their patient or policyholder data.

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Compliance US Department of Health and Human Services HIPAA Health Insurance 69

NY Health Law

JANUARY 4, 2024

This means that these changes cannot just occur in the self-pay or commercial markets – Medicare and Medicaid need to be a part of that change.

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Health Outcomes Licensing Medicaid Medicaid 59

HIPAA Journal

JANUARY 31, 2024

CA Healthcare Provider 2,364,359 Hackers hack access to its network between August 30, 2023, and September 1, 2023 Centers for Medicare & Medicaid Services MD Health Plan 2,342,357 MOVEit Transfer vulnerability exploited at Maximus Inc.

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Ransomware HIPAA Hospitals Compliance 121