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Compliance Risks Associated with Outlier Payments 

YouCompli

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Price increases can sometimes result in inappropriate outlier payments. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS).

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ACOs prepare for eCQM quality reporting

MRO Compliance

This transformation aims to enhance patient care quality and better align ACO reporting with the Quality Payment Program (QPP) Merit-Based Incentive Payment System (MIPS). These organizations received concessions from CMS to serve as early adopters and test the system.

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Uncompensated Care and DSH (Medicare disproportionate share hospitals)

AIHC

For more information on filing compliance cost reports, attend the Medicare Cost Report Camp in March 2022 presented by KraftCPAs and sponsored by the American Institute of Healthcare Compliance. billion in uncompensated care payments for FY 2021, a decrease of approximately $60 million from FY 2020.

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2023 Deadline for Physicians, Advanced Practice Providers and Teaching Hospitals to Review Sunshine Act Data Approaching

Hall Render

During the Dispute Period, Covered Recipients may use CMS’ Open Payments system to formally dispute any information they believe is incorrect. If a Covered Recipient fails to dispute data reported in the system during the Dispute Period, the information will be published on June 30 th as originally reported.

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Investigation of Hospitals Hiding Prices from Patients

AIHC

Compliance is mandatory. However, a low compliance level among hospitals would compromise the operational effectiveness of this regulation. Understanding hospitals’ compliance status to the regulation has important implications for its enforcement effort and effectiveness assessment. So, exactly what is this all about?

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CMS Issues a New “Advancing Interoperability and Improving Prior Authorization Processes” Proposed Rule

C&M Health Law

The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). For these reasons, CMS withdrew the December 2020 CMS Interoperability proposed rule.

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June Regulatory Update

Verisys

A big thanks to our compliance team, who monitors state, federal, and international updates. If online applications and payments were submitted during this time period, please do not resubmit without checking the status of the license or registration. June Regulatory Update – The best resource for monthly updates.