Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

Medicare 52

Medicare Medicare Overpayments Overpayment 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.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. The ophthalmologist was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

Fraud 95

Fraud Medicaid Medicaid Doctors 95

Healthcare Compliance Blog

FEBRUARY 8, 2022

The complaint alleges that an Alabama psychiatrist caused the submission to Medicare and Medicaid of false and fraudulent claims for the prescription drug Nuedexta. From 2015 through 2019, the pharmaceutical company that manufactures Nuedexta paid the Alabama psychiatrist more than $400,000 to make speeches about Nuedexta.

Nursing Homes 52

Nursing Homes Nurses Compliance Medicare 52

HIT Consultant

DECEMBER 26, 2022

Prior to COVID-19 , the volume of diagnostic imaging examinations had been growing annually by >3% and hit 5.0bn in 2019. Arun joined Signify Research in 2019 as part of the Digital Health team focusing on EHR/EMR, integrated care technology, and telehealth.

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

Hall Render

JUNE 15, 2022

Becerra , the Supreme Court ruled the payment cuts made by the Department of Health and Human Services’ (“HHS”) Centers for Medicare & Medicaid Services (“CMS”) for 340B eligible outpatient drugs were not permissible under the governing statute. Background. for 340B eligible hospitals.

Medicare 45

Medicare Medicare Hospitals Governance 45

HIT Consultant

APRIL 4, 2023

Q1 Funding Soars, But 2023 May Struggle to Catch Up to 2019 Q1 2023 U.S. If funding for the next three quarters matches the average funding across the prior three quarters, 2023 is on pace for the lowest level of annual funding since 2019. digital health funding closed with $3.4B across 132 deals, with an average deal size of $25.9M.

FDA 52

FDA Medicaid Medicaid COVID-19 52

HIT Consultant

AUGUST 15, 2022

Approximately 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans—a segment projected to reach 46% by 2025. Due to rapid growth of the 65-and-older portion of the population, Medicare expenditures are forecast to reach $1,559.4 – Continued increase in overall Medicare costs. Case in Point.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Today

DECEMBER 16, 2022

To seek a higher sentencing guidelines range, the government often relies on a defendant’s “intended” loss,” rather than the “actual” loss. 2400 (2019) narrowing Auer deference applied to the Sentencing Commission’s commentary. Sentencing in federal fraud cases is driven by loss amounts.

Fraud 52

Fraud Governance Medicaid Medicaid 52

HIT Consultant

JANUARY 9, 2023

The Star Rating system, which measures the quality of care and member satisfaction in privately managed Medicare plans, helps consumers compare the benefits and costs of different plans. It also impacts government payment rates. The eGFR test assesses kidney function, while the ACR checks kidney damage levels. .

Medicare 52

Medicare Medicare FDA COVID-19 52

Healthcare IT Today

SEPTEMBER 21, 2022

For example telehealth utilization increased 63x (in Medicare alone!) between the beginning of 2019 and the end of 2020. Additionally, an Assistant Secretary for Planning and Evaluation report found that Medicare visits conducted through telehealth skyrocketed from approximately 840,000 in 2019 to 52.7

Fraud 69

Fraud COVID-19 Medicare Medicare 69

AIHC

SEPTEMBER 5, 2023

Higher rates of use of telehealth are now standard in many practices since the coronavirus disease 2019 (COVID-19) pandemic. Medicare covers many telebehavioral and telemental health services including audio-only services. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Health Populi

JULY 16, 2020

2019-nCoV acute respiratory disease; and, B97.29, other coronavirus as the cause of disease classified elsewhere which was the original code used until March 18, 2020, when the specific coronavirus code was implemented. They used two ICD-10-CM diagnostic codes for this research: U07.1,

COVID-19 145

COVID-19 Hospitals Health Insurance Medicare 145

Healthcare IT News - Telehealth

FEBRUARY 5, 2024

When telepsychiatry was first in higher demand due to COVID, it is estimated in February 2019, 4% of survey respondents indicated using telehealth services. You say payers and patients will more greatly embrace telepsychiatry as a form of healthcare delivery. What does this mean for mental healthcare this year?

COVID-19 144

COVID-19 Public Health Licensing FDA 144

Healthcare IT Today

SEPTEMBER 12, 2022

Founded in 2017, PurpleLab has a strong pedigree in proprietary methodologies for data organization, cleansing, management, and governance to solve key challenges across the healthcare industry. Following its Series A financing in July of 2019, the company raised a Series B financing of $40M on September 12, 2022. About PurpleLab.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment. Physical Therapy 3.30

Medicare 52

Medicare Medicare Payment Systems Governance 52

Health Law Advisor

NOVEMBER 23, 2021

On November 12, 2021, the Centers for Medicare and Medicaid Services (“CMS”) released final guidance confirming that hospitals can be co-located with other hospitals or healthcare providers. Omits much of the language that was in the proposed guidance instructing surveyors on what deficiencies should be cited in particular situations.

Hospitals 40

Hospitals Compliance Medicare Medicare 40

Healthcare IT News - Telehealth

MARCH 18, 2022

Norden is particularly passionate about funding companies focused on the Medicaid population – a traditionally tricky and often ignored area. Before COVID-19, a few companies, such as Livongo, made a splash in the digital health community by going public – Livongo in July 2019. Hospitals are faced with impossible decisions.

Medicaid 202

Medicaid Medicaid COVID-19 Telemedicine 202

Med Law Blog

MAY 1, 2023

Christopher’s Hospital, to American Academic Health System, which then closed Hahnemann Hospital in June of 2019. Howell, Constantine Yannelis and Abhinav Gupta positing that their research shows that “PE ownership increases short term mortality of Medicare patients by 10%, in nursing homes”. in United States ex rel. Cho and Baker v.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

CMS.gov

MARCH 14, 2019

Thu, 03/14/2019 - 17:33. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. I’ve heard the derisive comments from those in the health policy stratosphere that prefer centralized government command and control of health care in America. Good Ideas Must Be Evaluated. Jeremy.Booth@c….

Medicaid 31

Medicaid Medicaid Governance Medicare 31

Healthcare IT Today

JANUARY 4, 2023

A 2021 report by the Department of Health and Human Services estimates that the number of medical visits via telehealth grew from 840,000 in 2019 to 52.7 Healthcare providers maintain different systems than payers, as do government entities like Medicare and Medicaid. million in 2020.

US Department of Health and Human Services 64

US Department of Health and Human Services Doctors Health Outcomes COVID-19 64

Healthcare Law Blog

MARCH 8, 2023

Medical Coding ChatGPT can potentially be trained to comprehend Medicare and Medicaid codes, prepare billing reports, and process claims, which would significantly reduce the workload for coders and also provide a potential backup confirmation to reduce potential billing and coding errors. 9] Minimum Necessary Requirement | HHS.gov

HIPAA 52

HIPAA Licensing Compliance Health Insurance 52

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). This option is available for five years and ends on March 31, 2027.

Medicaid 52

Medicaid Medicaid ACA Public Health 52

HIT Consultant

NOVEMBER 22, 2021

July 1, 2021 was the enforcement date for the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule. John Kelly, Principal Business Advisor, Edifecs. The healthcare industry is now closer than ever to its quest for true interoperable data exchange.

Compliance 52

Compliance Medicaid Medicaid Medicare 52

Healthcare IT Today

OCTOBER 19, 2022

Beyond the fact that DotCom Therapy has been successfully delivering services since 2015, a review of two dozen studies in 2019 found that phone and video therapies were equally effective at treating conditions like anxiety, depression, and post-traumatic stress disorder as in-person therapy.

Medicaid 89

Medicaid Medicaid Telemedicine COVID-19 89

Health Populi

MARCH 28, 2021

It’s timely, then, to re-visit a research paper on subsidizing fruits and vegetables from a March 2019 issue of PLOS as an introduction to a new initiative growing out of The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) on produce prescriptions. Springtime is finally emerging on the east coast of the U.S.

Medicaid 165

Medicaid Medicaid COVID-19 Medicare 165

HIT Consultant

NOVEMBER 29, 2022

Beyond the fact that DotCom Therapy has been successfully delivering services since 2015, a review of two dozen studies in 2019 found that phone and video therapies were equally effective at treating conditions like anxiety, depression, and post-traumatic stress disorder as in-person therapy.

Medicaid 98

Medicaid Medicaid Telemedicine Governance 98

AIHC

NOVEMBER 15, 2022

Noncompliance with the Hospital Price Transparency Rule The Hospital Price Transparency Final Rule (“the final rule”) was published in November 2019 and went into effect on January 2021. The government expects hospitals to be compliant as there has been ample time to prepare for its implementation and to comply with the requirements.

Hospitals 52

Hospitals US Department of Health and Human Services Compliance Governance 52

AIHC

MARCH 28, 2022

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?

Medicare 52

Medicare Medicare Compliance Governance 52

Healthcare IT Today

APRIL 20, 2023

million in 2019 to 28.5 Setting a Higher Bar While the industry has historically been protected by government oversight, Health Gorilla and several other organizations are looking to deepen public-private collaboration by applying to be QHINs. million in 2021 – and 35 percent more patients were impacted in the second half of 2022.

Governance 59

Governance Medicaid Medicaid Medicare 59

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. The CMS star ratings challenge. Why are CMS star ratings important?

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Bill of Health

SEPTEMBER 2, 2022

billion dollars of health system funds were invested into SDOH efforts from 2017 to 2019. Per the study, SDOH represent nearly half of the cost structure of Medicare and Medicaid. million in 2019 to $75.7 A study of 917 hospitals found that a total of $2.5 million in 2021. Learning Bias.

Informed Consent 246

Informed Consent Medicaid Medicaid Public Health 246

Healthcare Law Blog

JANUARY 11, 2022

Morgan Conference – COVID-19, the jittery stock market, the future of Medicare Advantage and recent industry changes. Centene noted that for Centene Medicare members, the inpatient utilization trend was higher than 60%, but lower than 60% for Medicaid and Marketplace members. There are a LOT of shadows over this year’s J.P.

COVID-19 52

COVID-19 Medicare Medicare COVID-19 Vaccine 52

HIPAA Journal

MAY 12, 2023

However, when continuity of care involves multiple providers in a linear process, some transfers of information can be incomplete due to the complicated language of the Privacy Rule and seemingly conflicting guidance issued by HHS’ Office for Civil Rights in 2019 with regard to HIPAA care coordination and HIPAA continuity of care.

HIPAA 62

HIPAA Compliance Health Services Administration Medicare 62

Health Populi

OCTOBER 2, 2023

could save at least $13 billion a year through deploying medically-tailored meals for people enrolled in Medicare, Medicaid, and private insurance programs, according to the True Cost of Food , research published by the Tufts School of Nutrition Science and Policy collaborating with The Rockefeller Foundation. .

Governance 73

Governance Public Health Health Outcomes Medicaid 73

Hall Render

AUGUST 19, 2022

Health Affairs report shows Alaskans spent more out-of-pocket dollars on health care than residents in any other state in 2019. PruittHealth CEO: Nursing Home Operators Can’t Break Into Small Markets Without Government Support. ‘The unwinding’: Idaho Medicaid must recheck eligibility for 131K people when U.S.

COVID-19 40

COVID-19 Nursing Homes US Department of Health and Human Services Nurses 40