Medisys Compliance

JUNE 24, 2022

What’s a Medicare Administrative Contractor (MAC)? Its quite common for any provider to get confused while billing to Medicare for healthcare services, as they not billing to Medicare but to a MAC. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 52

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. According to the FBI, more than $43 billion was lost to these scams between June 2016 and December 2021, and in 2021 alone, the FBI Internet Crime Complaint Center received reports of losses of $2,395,953,296 to BEC scams. million, and $6.4

Medicaid 75

Medicaid Medicaid Medicare Medicare 75

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Nursing Homes 59

Kaiser Health News

FEBRUARY 8, 2022

The federal government has penalized 764 hospitals — including more than three dozen it simultaneously rates as among the best in the country — for having the highest numbers of patient infections and potentially avoidable complications. The total amount of the penalties is determined by how much each hospital bills Medicare.

Medicare 115

Medicare Medicare Hospitals COVID-19 115

Healthcare IT News - Telehealth

JUNE 3, 2021

HIMSS this week has unveiled the list of the first recipients of its 2021 HIMSS Changemaker Awards. Before that she served as director of the State Innovation Models Initiative at the Centers for Medicare and Medicaid Services. They are: Aysha Al Mahri. President, Emirates Nursing Association. Abu Dhabi, UAE. Isaiah Nathaniel.

Department of Veterans Affairs 94

Department of Veterans Affairs COVID-19 COVID-19 Vaccine Nurses 94

Healthcare It News

NOVEMBER 23, 2023

Victoria to complete Altera EMR rollout across Gippsland The state government of Victoria has committed to finishing the deployment of an integrated EMR system across the rural region of Gippsland. It recently announced A$12 million in funding over four years to support health services in the region to upgrade their systems.

Public Health 276

Public Health Governance Hospitals Medicare 276

Bill of Health

JULY 15, 2022

The selections feature topics ranging from a discussion of potential pathways to enable government patent use before nonpatent exclusivities expire, to an examination of medical oncologists who receive more than $100,000 annually from pharmaceutical companies, to an analysis of the launch prices of new drugs from 2008-2021. 2022 Jun 6.

Public Health 205

Public Health Medicare Medicare Governance 205

Hall Render

FEBRUARY 4, 2022

billion from False Claims Act (“FCA”) cases in the federal fiscal year 2021, “the second largest annual total in False Claims Act history” and more than doubling the FCA recoveries for the DOJ from fiscal year 2020. Whistleblowers themselves received $237 million in 2021. ” Medicare Part C.

Fraud 40

Fraud Governance Medicare Medicare 40

Medisys Compliance

MAY 5, 2022

On 22 nd April 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. These proposals implement important provisions of the Consolidated Appropriations Act, 2021 (CAA).

Medicare 52

Medicare Medicare Medical Billing Outsourcing Medical Billing 52

Health Law Advisor

FEBRUARY 3, 2022

Department of Justice (DOJ) released its annual False Claims Act (FCA) enforcement statistics for fiscal year (FY) 2021. [1]. billion, FY 2021 marks DOJ’s largest annual total FCA recovery since FY 2014, and more than twice the $2.3 Marking another record, DOJ’s health care recoveries in FY 2021 in non- qui tam actions ($3.6

Fraud 52

Fraud COVID-19 Governance Medicare 52

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Healthcare IT News - Telehealth

JUNE 20, 2023

A bipartisan group of legislators has reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act – first introduced in 2016 – to expand opportunities and coverage for telehealth through Medicare. THE LARGER TREND In 2021, a bipartisan group of 50 U.S. Mike Thompson (D-Calif.)

Medicare 133

Medicare Medicare COVID-19 Doctors 133

Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 in 2021 to $170.00 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] annually on average between 2021 and 2029 compared to 4.4% in Social Security benefits.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Health Populi

JUNE 5, 2022

In 2006 the Medicare Part D program was implemented, covering older Americans for prescription drugs for the first time. Medicare further drove expansion of generic drug utilization, with co-pays for generics lower for Medicare enrollees than branded drugs. While these four actions to lower drug costs garner over 80% of U.S.

Overpayments 153

Overpayments Overpayment Medicare Medicare 153

Bill of Health

DECEMBER 6, 2023

To tackle this issue, federal and state governments should strengthen the regulation of insurance networks and insurers should address underlying causes of inadequate networks. For instance, a psychiatrist could make two to three times more by charging a patient out-of-pocket compared to taking Medicare or Medicaid.

Governance 144

Governance Medicaid Medicaid Medicare 144

Healthcare IT News - Telehealth

JANUARY 30, 2023

FINDINGS Based on the state audit , the department fell short in governance, risk management, and evaluation of the telehealth expansion. While it made "significant" changes to the Medicare Benefits Schedule (MBS), the expanded telehealth services were "only partly supported by sound implementation arrangements.

COVID-19 143

COVID-19 Governance Medicare Medicare 143

Healthcare Blog

APRIL 13, 2023

As hospitals have become increasingly complex organizations, effective governance, risk, and compliance (GRC) strategies have become essential for ensuring patient safety and regulatory compliance. What are the Key Components of a Successful Governance, Risk, and Compliance (GRC) Strategy? Nurs Forum , 56(1):89-94. doi: 10.1111/nuf.12514.

Governance 40

Governance Compliance Hospitals Regulatory Compliance 40

HIT Consultant

MARCH 18, 2022

What You Should Know: – The 32BJ Health Fund, a self-insured fund that provides care for 32BJ SEIU members and their dependents, today released a report that lays bare the stark price disparities between Medicare and private hospitals, and outlines solutions to both reins in prices and holds hospital systems accountable for these practices.

Governance 52

Governance Hospitals Medicare Medicare 52

Healthcare IT News - Telehealth

APRIL 30, 2021

senators has reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021. The act would expand coverage of Medicare telehealth services and make some COVID-19 telehealth flexibilities permanent, among other provisions. Access for Medicare beneficiaries.

COVID-19 216

COVID-19 Medicare Medicare Public Health 216

Bill of Health

FEBRUARY 23, 2023

Over the course of the COVID-19 pandemic, now entering its fourth year in 2023, legislators, executives, and judges at every level of government have sought measures to derail efficacious public health interventions. After Florida Governor Ron DeSantis banned school-based mask mandates via executive order in July 2021, affected parents sued.

COVID-19 176

COVID-19 Public Health COVID-19 Vaccine Governance 176

Healthcare Compliance Blog

MARCH 2, 2022

The money laundering scheme involved the submission of false and fraudulent claims to Medicare for medically unnecessary genetic tests and durable medical equipment. Allegedly, between January 2020 and July 2021, the ten Florida defendants referred Medicare beneficiaries for medically unnecessary genetic tests and durable medical equipment.

Medicare 45

Medicare Medicare Fraud Compliance 45

Healthcare IT News - Telehealth

DECEMBER 12, 2021

The Australian government has set aside A$106 million ($76 million) over four years to support what it calls "permanent" telehealth, which will ensure flexibility in healthcare delivery and continuous health consultations via phone or online. WHY IT MATTERS. Around 89,000 providers are now using telehealth services. million ($22.8

COVID-19 182

COVID-19 COVID-19 Vaccine Governance Telemedicine 182

Healthcare It News

MARCH 2, 2023

Adelaide-based consultant Chamonix IT Management Consulting was tapped for the mobile app development in 2021 via a competitive tender process. It wished to see the platform be used by both healthcare providers and patients at the point of care "to improve clinical decision-making.

Medicare 254

Medicare Medicare Governance Hospitals 254

Health Law Advisor

AUGUST 30, 2023

TMA III challenged certain portions of the July 2021 No Surprises Act (“NSA”) interim final rules proposed by the U.S. In a decision that significantly levels the field for providers, the District Court ruled in part for the provider plaintiffs and in part for the Government in the TMA III ruling. Earlier this month, the U.S.

Governance 105

Governance Medicaid Medicaid Medicare 105

Health Law Advisor

AUGUST 14, 2023

2] This means, in most cases, that Medicare beneficiaries must now come to a physician practice’s office location to pick up their DME – including IUCs – when the DME items are furnished and billed by physicians or their practices. The IOAS exception does NOT apply.

COVID-19 52

COVID-19 Medicare Medicare Public Health 52

Healthcare Law Blog

APRIL 13, 2022

However, in all states, the NSA governs disputes relating to air ambulance services, not state law. 36,925 (July 13, 2021). Federal law governs disputes relating to out-of-network services provided by air ambulance providers. Background of the NSA. See 86 Fed. The DMHC’s APL Confirms the Application of the NSA in California.

Governance 52

Governance Medical Billing Licensing Medicare 52

HIT Consultant

AUGUST 8, 2022

It also offers in-home health evaluations for Medicare Advantage and other government-run managed-care plans. Signify went public in February 2021. In July, the company said it planned to wind down one of its units after changes to a government-payment model and focus on more-profitable businesses. for about $3.2

Governance 97

Governance Medicare Medicare Health Insurance 97

Health Law Attorney

DECEMBER 18, 2020

The Centers for Medicaid & Medicare Services ( CMS ) recently released the 2021 Outpatient Prospective Payment System ( OPPS ) and Ambulatory Surgical Center ( ASC ) Final Rule, which may be accessed here. CMS Administrator Seema Verma indicated there would be less micromanagement from the government regarding such decisions.

Medicare 40

Medicare Medicare COVID-19 Payment Systems 40

Healthcare IT News - Telehealth

JULY 23, 2020

Wolf also pointed out that the recent bloom in telehealth is rooted, in part, in the government's electronic health record incentive program and meaningful use. She also pointed out that many state governments have also been in limbo waiting for the federal government to take action. " she said.

COVID-19 183

COVID-19 Electronic Medical Records Medicare Medicare 183

Healthcare IT News - Telehealth

JANUARY 5, 2022

Some changes to the Medicare Benefits Schedule for telehealth items in Australia – including the termination of 128 items, amendment of 17 items, and the addition of two more items – have taken effect this week. WHAT IT'S ABOUT. The changes come following the recommendations by the MBS Review Taskforce. THE LARGER CONTEXT.

COVID-19 172

COVID-19 Nurses Governance Telemedicine 172

Verisys

MARCH 23, 2023

3 Healthcare Fraud and Abuse Laws Providers Should Know About In 2021, the Department of Justice reported recovering over $5.5 Over $5 billion of the total amount recovered in 2021 was related to the healthcare industry. Abuse of government healthcare programs is a federal offense with severe penalties.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare Law Blog

JANUARY 31, 2023

Venture capital funding for digital mental health services for children and teens was close to $1 billion in 2021, more than double from 2020. Part 2, which governs the medical records of federally assisted substance use treatment programs. The reimbursement landscape has changed since the start of the pandemic.

COVID-19 105

COVID-19 Medicare Medicare Medicaid 105

Health Populi

JUNE 18, 2021

Even in 2021, we still see so-called “job-lock” with workers staying in jobs that offer health insurance benefits. adults aged 18 and over in March 2021 for this study. Supreme Court’s ruling on the Affordable Care Act (i.e., California v. One-half of U.S. Gallup-West Health surveyed 3,870 U.S.

ACA 138

ACA Health Insurance Medicaid Medicaid 138

HIT Consultant

APRIL 21, 2022

What You Should Know: – Centers for Medicare & Medicaid Services’ (CMS) payment adjustments did not adequately address hospitals increased costs for FY 2021, according to new data from Premier. For the FY 2021 and FY 2022 rules, CMS applied upward payment adjustments of 2.4 percent rate increase, compared to a 6.5

Hospitals 52

Hospitals COVID-19 Payment Systems Medicaid 52

Healthcare It News

FEBRUARY 28, 2023

UPMC Central Pennsylvania, a hospital that in 2021 achieved Stage 7, the top of the HIMSS Electronic Medical Record Adoption Model, has been a leader in telemedicine, with more than two dozen robust virtual care programs. The virtual-first primary care was launched in January of 2021 to a ten-county geography in central Pennsylvania.

Electronic Medical Records 254

Electronic Medical Records Telemedicine Health Insurance Health Outcomes 254

Health Law Advisor

FEBRUARY 10, 2023

billion recovered in FY 2021, marking the lowest annual reported recovery in 14 years. billion resolution with one opioid manufacturer in FY 2021), health care and life sciences entities continue to be the primary focus of the enforcement effort by DOJ and relators. 1] While total recoveries exceeded $2.2 Indeed, of the more than $2.2

Fraud 52

Fraud COVID-19 Governance Medicaid 52

HIT Consultant

AUGUST 5, 2022

– Healthcare & Life Science M&A activity plummeted to 338 deals in Q2 2022 versus 535 in Q2 2021 and a record 565 deals in Q4 2021. The weak first half of 2022 was to be expected given the bolus of transactions that were consummated at the end 2021, but the second quarter dip was far greater than anticipated.

Telemedicine 98

Telemedicine Medicaid Medicaid Malpractice 98