Hall Render

FEBRUARY 22, 2024

In the FY 2024 IPPS Final Rule (the “Final Rule”), the Centers for Medicare & Medicaid Services (“CMS”) incorporated certain social risk factors into the Hospital Value-Based Purchasing (“VBP”) Program (“the Program”).

Hospitals 66

Hospitals Medicare Medicare Medicaid 66

Medval Compliance Blog

SEPTEMBER 29, 2021

by Frank Fairchok, Vice President of Medicare Reporting Services. The update reads as follows: “ September 27, 2021 – Section 111 Medicare Secondary Payer (MSP) Records Will Accept Future Effective Date. The most common way individuals become Medicare beneficiaries is through action taken by the Social Security Administration.

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Medicare Medicare 52

HIT Consultant

NOVEMBER 2, 2021

In 2010, the Affordable Care Act ushered in a new era for Medicaid Modularity, an approach anchored by breaking down large, monolith systems into smaller, more nimble and self-contained modules that can de-risk healthcare delivery and unlock innovation. Victor Sterling, Principal Industry Consultant at SAS.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Bill of Health

FEBRUARY 28, 2023

That approach successfully transformed public and private health care — albeit not without challenges for coordination and political resistance — through the Patient Protection and Affordable Care Act of 2010. This was accomplished by the U.S.

Public Health 176

Public Health COVID-19 Medicaid Medicaid 176

HIT Consultant

SEPTEMBER 8, 2022

From 2010-2012, he led the execution of natural language processing supplier CodeRyte’s rapid growth plan, culminating in its strategic acquisition by 3M in 2012. He served on the board of referral management leader, Boston-based Kyruus, as well as on the board of the Medicare Advantage solution provider for health systems, St.

Electronic Medical Records 98

Electronic Medical Records Medicare Medicare Governance 98

Natalia Mazina

APRIL 25, 2023

On another, Medicare Part B recently challenged payments to 340B providers. Medicare reimbursement cut In 2018, CMS implemented a 28.5% Manufacturers’ restricting use of contract pharmacies In 2010, the HHS’s issued guidance that covered entities could use unlimited number of contract pharmacies ( See 75 Fed. 10,272 (Mar.

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Payment Systems 52

Health Law Advisor

SEPTEMBER 1, 2023

On August 29, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the ten (10) Medicare Part D drugs selected for the first round of negotiations of the Medicare Drug Price Negotiation Program (Program)—a few days before the September 1, 2023, statutory deadline imposed by the Inflation Reduction Act (IRA).

Medicare 69

Medicare Medicare Licensing Medicaid 69

The Health Law Firm

NOVEMBER 25, 2019

According to federal prosecutors, the eye doctor billed patients and insurance companies for millions of dollars for surgeries that he never performed from 2010 to 2017. Indest III, J.D., Prosecutors also announced that they will sue his practice, The Eye Associates Group, in civil court under the False Claims Act (FCA). The Indictment.

Fraud 40

Fraud Doctors Medicare Medicare 40

Healthcare IT News - Telehealth

MAY 14, 2020

Since January 2010, 126 rural hospitals have shut down, with nearly 600 more on the brink of closing. "The Trump administration has built on this effort and temporarily expanded access to care by providing regulatory flexibility around the use of telehealth for all Medicare beneficiaries."

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Hospitals COVID-19 Medicare Medicare 192

Medisys Compliance

AUGUST 4, 2022

The Centers for Medicare & Medicaid Services (CMS) on June 21, 2022, issued a proposed rule that proposes to update payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023.

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Medical Billing Medical Billing Outsourcing Payment Systems Medicare 59

Kaiser Health News

JULY 6, 2022

Since late 2010, when this provision of the ACA took effect, many patients have paid nothing when they undergo routine mammograms, get one of more than a dozen vaccines, receive birth control, or are screened for other conditions, including diabetes, colon cancer, depression, and sexually transmitted diseases.

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ACA Medicare Medicare Medicaid 80

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Affordable Care Act (2010): The ACA introduced the concept of value-based care, emphasizing quality and patient outcomes over quantity of services.

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Compliance HIPAA Telemedicine ACA 52

Bill of Health

MAY 19, 2022

Incremental benefits of novel pharmaceuticals in the UK: a cross-sectional analysis of NICE technology appraisals from 2010 to 2020. Epub ahead of print. Polak TB, Cucchi DGJ, Darrow JJ, Versteegh MM. 2022 Apr 8;12(4):e058279. Rome BN, Sarpatwari A, Kesselheim AS. State Laws and Generic Substitution in the Year After New Generic Competition.

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Health Insurance Hospitals FDA Medicaid 205

Healthcare IT Today

NOVEMBER 22, 2023

A payer such as Medicare could just put a card on its web site for each patient to download. Once you have a card, uploading a URL or QR code to a web site should take no more effort than typing in your Medicare number. is a greatly expanded version of the classic Blue Button created by the Department of Veteran Affairs in 2010.

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Department of Veterans Affairs Medicare Medicare COVID-19 111

The Health Law Firm

JULY 26, 2012

On July 2, 2012 the Officer of Inspector General (OIG) released its Medicare compliance review of West Florida Hospital in Pensacola. According to the audit, the hospital complied with Medicare billing requirements for the documentation majority of inpatient and outpatient claims. Official Break Down of the Audit.

Medicare 40

Medicare Medicare Compliance Overpayments 40

Health Law Advisor

FEBRUARY 3, 2022

Whistleblowers (known as “relators” under the FCA) filed 598 new actions under the qui tam provisions of the FCA in FY 2021, a decrease from the 675 actions filed in FY 2020, and the lowest number of filings since FY 2010. WHISTLEBLOWER ACTIONS AND AWARDS REACH DECADE LOW.

Fraud 52

Fraud COVID-19 Governance Medicare 52

Jane Sarashon

FEBRUARY 27, 2024

In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.

ACA 113

ACA Prescription Drug Pricing Health Insurance Hospitals 113

The Health Law Firm

OCTOBER 9, 2013

Board Certified by The Florida Bar in Health Law The University of Miami Hospital allegedly owes Medicare $3.7 This is according to an audit report of the hospital’s billing practices that found the hospital allegedly overbilled the health care program in 2009 and 2010. Indest III, J.D.,

US Department of Health and Human Services 40

US Department of Health and Human Services Medicare Medicare Overpayments 40

Healthcare IT Today

FEBRUARY 7, 2024

According to Dr. Colin Banas, chief medical officer at DrFirst , they initiated EPCS in 2010, partnering with the Massachusetts Department of Health. Kelly says that a federal bill in 2021 required EPCS for Medicare prescriptions. How do you transmit the prescription to the pharmacy and record it in the PDMP?

Telemedicine 114

Telemedicine Doctors COVID-19 Medicare 114

Hall Render

AUGUST 10, 2023

On August 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its Final Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) PPS rule for fiscal year (“FY”) 2024 (“Final Rule”). The Final Rule increases the rate for IPPS payments by 3.3% in FY 2024 but applies a 0.2%

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

The Health Law Firm

SEPTEMBER 12, 2012

The report focuses on the nation’s mental health clinics that overbilled Medicare in 2010, some by tens of millions of dollars. Big Busts in Two South Florida Mental Health Clinics for Medicare Fraud. The majority of these clinics were located in South Florida, Texas and Louisiana.

Fraud 40

Fraud Medicare Medicare 40

Healthcare IT News - Telehealth

OCTOBER 26, 2020

From 2006 to 2010, they explained, an integrated delivery system staggered implementation of an integrated EHR across 17 hospitals. WHY IT MATTERS. The research team studied nearly 250,000 hospital discharges in patients with diabetes from 2005 to 2011.

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Telemedicine Hospitals Health Outcomes Medicaid 155

HIPAA Journal

JUNE 14, 2023

The ransomware attack prevented the hospital from submitting claims to insurers, Medicare, and Medicaid for months, piling even more financial pressure on the already struggling St. The ransomware attack itself did not trigger the closure, but it did play a key part in the decision to close. Margaret’s Health.

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Ransomware Hospitals COVID-19 HIPAA 98

Healthcare IT Today

AUGUST 26, 2022

When VBC programs were expanded as part of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, there was hope that the existing fee-for-service model would begin to decline.

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Health Outcomes Medicare Medicare 86

Healthcare Compliance Blog

MAY 17, 2022

The National Background Check Program, enacted by legislation in 2010, provides grants to states and territories to assist them in developing and improving systems to conduct federal and state background checks of prospective LTC employees.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

HIT Consultant

NOVEMBER 16, 2022

People over 85 are the most rapidly expanding demographic and the elderly segment of the American population is expected to double in 2030 from 2010. These potentially avoidable hospitalizations roughly cost Medicare over $1 billion annually, not to mention the personal toll on a frail population and their loved ones.

Nurses 52

Nurses Telemedicine Patient Satisfaction Medicare 52

Bill of Health

MARCH 25, 2022

Medicaid Expenditures and Estimated Rebates on Line Extension Drugs, 2010-2018. New EU regulation on health technology assessment of cancer medicines. Lancet Oncol. 2022 Feb;23(2):e58. PMID: 35114127. Hwang TJ, Feng J, Maini L, Kesselheim AS. J Gen Intern Med. 2022 Feb 22. Epub ahead of print. PMID: 35194743. Mitchell AP, Trivedi NU, Bach PB.

FDA 205

FDA COVID-19 Medicaid Medicaid 205

Healthcare Compliance Blog

FEBRUARY 15, 2022

In 2009 and 2010, further improvements were made to the False Claims Act and its whistleblower provisions. Other leading sources include: Combatting the Opioid Epidemic Medicare Advantage Program (Medicare Part C) Unlawful Kickbacks Unnecessary Medical Services Procurement Fraud COVID-Related Fraud Other Fraud Recoveries.

Fraud 59

Fraud Governance Compliance Medicare 59

Compliancy Group

NOVEMBER 16, 2022

In 2015, legislation known as the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted. healthcare system since 2010’s Affordable Care Act. Under MACRA, the Centers for Medicare and Medicaid Services created regulations for healthcare providers’ use of health information technology.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

Innovaare Compliance

FEBRUARY 7, 2022

Health plans (collectively, “plan sponsors”) that contract with the Centers for Medicare & Medicaid Services (CMS) to provide health services to eligible Medicare beneficiaries are responsible for legal, contractual, and fiduciary obligations whether performed by the plan or those to whom the company delegates those obligations.

Compliance 52

Compliance Medicare Medicare Medicaid 52

Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. The release of FHIR in the mid-2010 decade changed everything. The Dilemma of Prior Authorization Prior authorization, also known as a pre-approval, strikes fear into both patients and providers.

Electronic Medical Records 99

Electronic Medical Records Doctors Governance Medicaid 99

HIPAA Journal

OCTOBER 21, 2022

However, in 2015, Congress partially relented its stance by passing the Medicare Access and CHIP Reauthorization Act which requires the Centers for Medicare and Medicaid to remove Social Security Numbers from Medicare cards and replace them with Medicare Beneficiary Numbers.

HIPAA 95

HIPAA Compliance Medicare Medicare 95

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Medicare Advantage and Part D) for a comprehensive assessment of a health plan’s performance. Read More – Medicare Star Ratings Changes 2021 . Industry trends.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

CMS.gov

SEPTEMBER 22, 2020

On December 19, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule implementing the Physician Payments Sunshine Act, which was included as section 6002 of the Affordable Care Act of 2010.

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Medicaid Medicaid Medicare Medicare 20

MedTrainer

MARCH 28, 2024

Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

Hall Render

JUNE 29, 2022

On June 9, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a notice seeking public comment on its plan to revise the way information is collected under its voluntary Self-Referral Disclosure Protocol (“SRDP”). CMS will accept comments on the proposed rule through August 8, 2022.

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Medicaid Medicaid Medicare Medicare 72

Healthcare Law Blog

JANUARY 26, 2023

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

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ACA Medicaid Medicaid Compliance 105