Kaiser Health News

MARCH 15, 2022

But the new benefit for people enrolled in Medi-Cal, the state’s Medicaid health insurance program, has been delayed twice as the state and doulas — nonmedical workers who help parents before, during, and after birth — haggle over how much they should get paid. “It feels limiting,” Runnels said.

Medicaid 80

Medicaid Medicaid Health Insurance Public Health 80

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Tue, 10/02/2018 - 15:36. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Jeremy.Booth@c…. Seema Verma.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

Healthcare Compliance Blog

MAY 11, 2022

The South Carolina Attorney General announced that his office’s Medicaid Fraud Control Unit (SCMFCU) had arrested a 57-year-old woman on two counts of Exploitation of a Vulnerable Adult and two counts of Breach of Trust with Fraudulent Intent, value of $10,000 or more. Update as needed.

Fraud 59

Fraud Nursing Homes Medicaid Medicaid 59

HIT Consultant

APRIL 3, 2023

Progress toward VBC adoption hasn’t achieved its potential yet, hovering around 60% of all payment models from 2018 to 2021, with the remaining 40% comprised of traditional fee for service (FFS). These risk-based care models are designed to encourage proactive care, better population health and reduced spending across the healthcare spectrum.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Provider Trust

JULY 26, 2023

The data included in provider directories is comprised of information about individual providers, groups of providers, or institutions, including what services they provide, the health plans and networks they participate in, and contact information and location details. However, Medicaid Advantage plans aren’t alone in this problem.

Medicaid 52

Medicaid Medicaid Compliance Medicare 52

Healthcare IT Today

JANUARY 11, 2024

Another study in 2018 suggested something more personal. Then there’s the worry about privacy. They’re concerned about who might see their data and how it could be used. It’s not just about making a tool available; it’s about understanding the needs and concerns of the people who are supposed to use it.

Doctors 105

Doctors Hospitals Medicaid Medicaid 105

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Administrator, Centers for Medicare & Medicaid Services. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2018. percent in 2018. percent in 2018. percent in 2018.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Healthcare Law Blog

DECEMBER 27, 2022

The Centers for Medicare and Medicaid Services (“CMS”) has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the “Proposed Rule”). CMS appealed but did not challenge the court’s findings about the negligence standard. 2018), rev’d in part on other grounds sub nom.

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. Under the Wage Parity Law, which is funded by Medicaid, aides are to be paid a minimum amount in total compensation. Update as needed.

Medicaid 59

Medicaid Medicaid Governance Fraud 59

HIT Consultant

MARCH 15, 2023

A June 2022 report from Medicaid and CHIP Payment and Access Commission (MACPAC) further illuminated the issue, explicitly citing an extension of the financing through state Medicaid programs to drive health IT adoption as a decisive step to addressing gaps in access, outcomes data, and oversight.

Medicaid 98

Medicaid Medicaid Doctors 98

Healthcare IT News - Telehealth

MAY 13, 2020

"Psychiatrists were pleasantly surprised about how well it was going and about patient response." About a third of the interviewed psychiatrists were mostly using the telephone for sessions, Uscher-Pines said. The shift to telemedicine was made simpler, researchers note, by regulatory and reimbursement changes.

Telemedicine 215

Telemedicine COVID-19 HIPAA Medicare 215

HIT Consultant

MARCH 7, 2023

According to the AMA , studies conducted in 2018 showed that “most patients only take their medicine as prescribed about half the time and are often reluctant to tell their doctor, while a quarter of new prescriptions are never filled.” While that report raised alarms, we haven’t made much progress in solving the challenge.

Doctors 98

Doctors Medicaid Medicaid Governance 98

Kaiser Health News

JULY 11, 2023

The public school system here had to scramble in 2018 when the local hospital, newly purchased, was converted to a tax-exempt nonprofit entity. The district, about an hour’s drive from Philadelphia, had no choice but to trim expenses. POTTSTOWN, Pa. —

Hospitals 66

Hospitals Medicaid Medicaid Medical Billing 66

Health Populi

DECEMBER 19, 2018

mid-terms elections in the first week of November, 2018. Underneath this statistic, it’s important to compare the payor mix of patients delaying care: nearly one-third of people with private, commercial insurance delayed care by 2018; 22% of people enrolled in Medicaid or Medicare put off care. And, 19% of U.S.

Medicaid 84

Medicaid Medicaid Medicare Medicare 84

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 Errors identified in already completed audits will be extrapolated more aggressively for audits going back to 2018, and then going forward for new audits. million (net) and $4.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of LTSS spending. [5]

Nursing Homes 52

Nursing Homes Medicaid Medicaid Medicare 52

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.

ACA 105

ACA Medicaid Medicaid Compliance 105

Healthcare IT News - Telehealth

JUNE 26, 2020

Throughout 2018 and 2019, Northwell Health piloted small-scale programs in partnership with the Gary and Mary West Health Institute Collaboration to bring medical services virtually to the homes of their patients. Providers were able to see about six such patients per day, panelists noted, often with multiple hours of driving time.

COVID-19 185

COVID-19 Telemedicine Medicaid Medicaid 185

Healthcare IT News - Telehealth

MARCH 18, 2022

Healthcare IT News sat down with this digital health investor to talk about digital health investment trends during the pandemic and where he sees funding trending in 2022 and beyond. Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area.

Medicaid 198

Medicaid Medicaid COVID-19 Telemedicine 198

HIPAA Journal

JANUARY 23, 2024

Theranos and Homes denied the allegations and threatened to sue Carreyrou; however, in 2018, Homes stepped down from her position as CEO, and following an FBI investigation the company was shut down.

Fraud 70

Fraud FDA Medicaid Medicaid 70

Pharmacy Law Blog

MAY 14, 2018

The Following is a list of little known facts about state investigations (including DOH investigations) that could save your license: 1. This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment. About the Author: George F.

Licensing 40

Licensing Nurses Medicaid Medicaid 40

Pharmacy Law Blog

MAY 7, 2018

The Following is a list of little known facts about state investigations (including DOH investigations) that could save your license: 1. This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment. About the Author: George F.

Licensing 40

Licensing Nurses Medicaid Medicaid 40

HIT Consultant

AUGUST 17, 2021

In 2018, 36% of spending was via alternative payment models and by 2025, CMS has targeted 100% of Medicare and 50% of Commercial and Medicaid spending.4 ClosedLoop is on a mission to make every decision about the ‘best next action’ for a patient be data-driven and AI-enabled. “We Empowering The Data Science Team.

COVID-19 98

COVID-19 Health Outcomes Medicaid Medicaid 98

HIT Consultant

APRIL 20, 2022

Hospitals report the data to the Centers for Medicare & Medicaid Services (CMS), which uses that data to create the Overall Hospital Quality Star rating for each hospital. In 2018, Milliman issued an updated report with more recent data. This accounts for about 34 percent of total health care spending. About Tom Zaubler, MD.

Medicare 98

Medicare Medicare Telemedicine Medicaid 98

Health Populi

SEPTEMBER 5, 2018

health politics, many more women are concerned about losing health insurance coverage and paying more for that coverage. The second chart presents these data, published in this week’s Kaiser Family Foundation Health Tracking Poll, dated late Summer 2018. At this moment in U.S.

Health Insurance 63

Health Insurance Medical Billing Medicaid Medicaid 63

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. I talked to Nikki Henck, Senior Director of Utilization Management at Sagility , about the implementation and potential impact of this proposed requirement, which, if finalized, will be enacted in January 2026.

Electronic Medical Records 93

Electronic Medical Records Doctors Governance Medicaid 93

Health Populi

AUGUST 24, 2020

Eight percent of doctors have closed their practices as a result of COVID-19, tallying about 16,000 closed practices. Two-thirds of doctors are also concerned about closure of practices due to COVID-19 causing great harm to patients. One-half of physicians in the U.S. On the payor front, large U.S.

COVID-19 154

COVID-19 Telemedicine Doctors Medicare 154

Healthcare Law Today

DECEMBER 8, 2022

On November 28, 2022, the Centers for Medicare & Medicaid Services (CMS) Center for Clinical Standards and Quality issued a memorandum to State Survey Agency Directors stating that hospitals risk Condition of Participation (CoP) violations for failure to adequately respond to and prevent incidents of workplace violence.

Hospitals 111

Hospitals Nurses Nursing Homes Medicaid 111

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts.

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Health Populi

JANUARY 16, 2020

Most people dealing with chronic conditions, and those who care for them, believe that “home is where the health is,” according to a survey about the “21st century house call” from CareMore Health. adults 23 years of age and over in September and October 2019.

Doctors 159

Doctors Hospitals Nurses Medicaid 159

Healthcare IT News - Telehealth

APRIL 24, 2020

The Alliance for Integrated Care of New York (AICNY) oversees the healthcare needs of roughly 6,200 dually eligible Medicare and Medicaid beneficiaries with intellectual and developmental disabilities (IDD). Over three quarters of 2018, AICNY inpatient expenditures saw a 6% reduction. THE PROBLEM. ” PROPOSAL. MARKETPLACE.

Telemedicine 155

Telemedicine COVID-19 Medicaid Medicaid 155

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% 9] Step Therapy for Part B guidance published by CMS on August 7, 2018, shows one of the ways to manage utilization compliantly.

Medicare 59

Medicare Medicare COVID-19 Hospitals 59

HIT Consultant

NOVEMBER 2, 2021

Today, patients are the third-largest payer – behind Medicaid and Medicare. – Financial process clarity: Often, the patient financial experience is convoluted, leaving patients confused about their financial responsibility. . In 2018, 14.2% About Randall Shafer. Let’s begin by looking at what providers can do.

Hospitals 52

Hospitals Patient Advocacy Medicaid Medicaid 52

HIT Consultant

OCTOBER 21, 2022

It is important for company executives and hospital system leadership teams to talk about what is working. The Centers for Medicare & Medicaid Services (CMS) is evaluating hospitals’ antibiotic stewardship and more recently, in the area of sepsis, hospitals’ compliance with CMS’ 1-h and 3-h sepsis resuscitation guidelines.

Hospitals 98

Hospitals FDA Compliance COVID-19 98

Healthcare Law Blog

JANUARY 13, 2022

Let’s talk about fixing the huge American diabetes problem, providing better healthcare for Medicaid and dual eligible beneficiaries, and helping people beat cancer. Making Medicaid Better and Physicians More Accessible: Cityblock Health and ZocDoc. Did you know that on average one of every two babies today is born on Medicaid?

COVID-19 52

COVID-19 Medicaid Medicaid Doctors 52

Health Populi

MAY 17, 2018

One-third of Americans are following a specific eating pattern, including intermittent fasting, paleo gluten-free, low-carb, Mediterranean diet, and Whole 30, among dozens of other food-styles in vogue in 2018. But underneath these healthy eating intentions are concerns about the cost of nutritious foods, IFIC reports.

Doctors 74

Doctors Medicaid Medicaid Nurses 74

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% 9] Step Therapy for Part B guidance published by CMS on August 7, 2018, shows one of the ways to manage utilization compliantly.

Medicare 52

Medicare Medicare COVID-19 Hospitals 52