MedTrainer

NOVEMBER 17, 2023

This model involves specific regulations and agreements with Medicare and Medicaid, impacting how healthcare providers in the state bill for services and receive payments. Regulations Unique to Maryland To meet the standards of healthcare compliance in Maryland, there are a few additional regulations.

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Compliance Licensing Hospitals Health Insurance 52

Medisys Compliance

JUNE 27, 2022

The Centers for Medicare and Medicaid Services (CMS) has announced a shift in its eligibility criteria for coverage of lung cancer screening using low-dose CT (LDCT), with implementation date of October 3 rd , 2022. CMS Announcement for Revised Coverage. Preventive Services Task Force recommendation. Beneficiary Eligibility Criteria.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 97

Healthcare IT News - Telehealth

JUNE 8, 2022

based attorney in the health law practice of Baker, Donelson, Bearman, Caldwell & Berkowitz about what providers should be doing to ensure compliance when the PHE finally sunsets. What do you see as the primary compliance issues providers will have to contend with? If Medicare coverage requirements for telehealth services (e.g.,

US Department of Health and Human Services 187

US Department of Health and Human Services Compliance Overpayments Overpayment 187

Compliancy Group

NOVEMBER 16, 2022

In 2015, legislation known as the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted. Under MACRA, the Centers for Medicare and Medicaid Services created regulations for healthcare providers’ use of health information technology. MACRA MIPS 2022 is discussed in greater detail below. Find Out More!

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Medicare Medicare HIPAA Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

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Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

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Medicare Medicare Medicaid Medicaid 52

Med-Net Compliance

OCTOBER 21, 2022

The Office of Inspector General (OIG) has recently posted the False Claims Act (FCA) settlements for FY 2022 Q1–Q4 on the risk spectrum. OIG cases against these parties are closed without evaluating the effectiveness of any efforts the parties have made to ensure future compliance with Federal healthcare program requirements.

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Fraud Compliance Medicare Medicare 59

Innovaare Compliance

APRIL 29, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. Multiple Medicare Advantage Prescription Drug Plans (MAPDs) have already received notification of their selection. Medicare Beneficiary Identifier (MBI) has been replaced with Enrollee ID.

Regulatory Compliance 52

Regulatory Compliance Compliance Medicare Medicare 52

YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. The CCR is determined by a hospital’s cost report that is reconciled with the local Medicare contractor.

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Compliance US Department of Health and Human Services Overpayments Overpayment 52

YouCompli

JANUARY 4, 2023

The healthcare enterprise risk approach takes compliance in new directions . Featured speakers: James Bryant , Vice President and Chief Compliance Officer, Brigham and Women’s Hospital; Timothy C. Bryant, Hogan, and Wroth addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance forum in December 2022.

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Verisys

NOVEMBER 13, 2022

September 23, 2022 – Governor Ron DeSantis declared a state of emergency for 24 counties. September 29, 2022 – Governor Brian Kemp declared a state of emergency for the state of Georgia, which will remain valid for 29 days, expiring October 28th, 2022, unless renewed by the governor. North Carolina: . Virginia: .

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Compliance Licensing Nurses COVID-19 52

Healthcare IT Today

JANUARY 2, 2024

In healthcare, unauthorized access translates to compliance failures, potential lawsuits, additional financial losses, and even weakened brand reputation and loss of customer trust. In 2022, DigiCert found that 47% of consumers stopped doing business with an organization once trust was lost in the organization’s digital security.

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Compliance US Department of Health and Human Services HIPAA Health Insurance 69

Healthcare Blog

AUGUST 23, 2023

It is critical for an organization to have strategies for promoting ethical behavior in healthcare compliance. Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization.

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Compliance Nurses Regulatory Compliance Medicaid 56

Healthcare Compliance Blog

MARCH 2, 2022

An indictment was filed on February 25, 2022, against ten persons in Florida for their alleged roles in a $67 million healthcare fraud, wire fraud kickback, and money laundering scheme. The ten Florida defendants began their initial appearances in federal court during the last week of February 2022.

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Medicare Medicare Fraud Compliance 45

Med Law Blog

APRIL 4, 2022

The Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA), was passed as part of the consolidated Budget Act for 2022, which also included the telehealth provisions I posted about last week. The definition of “covered entity” in the Act is far greater than covered entity as defined by HIPAA.

HIPAA 52

HIPAA Medicare Medicare Compliance 52

Innovaare Compliance

JUNE 21, 2023

The Inflation Reduction Act of 2022 has wide-ranging impact on payments for drugs used by Medicare beneficiaries, whether they are administered in the provider’s office (Part B) or used in the ambulatory setting (Part D). Part B drugs have had the fastest spending growth for drugs for Medicare. percent annually.

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US Department of Health and Human Services Medicare Medicare Medicaid 52

Medisys Compliance

MAY 19, 2022

During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. In this article, we shared revised Medicare billing and coding guidelines which will help in billing Medicare telehealth during COVID-19 PHE.

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COVID-19 Medicare Medicare Medical Billing 52

Innovaare Compliance

JUNE 28, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of CMS program audits in February 2022. Even though we’re six weeks from the end of the 2022 cycle, there’s still time to review the new and changed features of the CMS audit protocol (CMS 10717) for CY 2022. What to look for during an audit .

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Overpayments Overpayment Compliance Medicare 52

Verisys

DECEMBER 22, 2021

However, based on discussions with Verisys clients and prospects, most health plans are unprepared to meet the requirements due by January 1, 2022. Should a group health plan, insurer, or state agency find that time is running out on achieving regulatory compliance with H.R. The post Ensuring Provider Directory Compliance With H.R.

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Compliance Regulatory Compliance Healthcare information Technology Health Insurance 52

Florida Health Care Law Firm

DECEMBER 10, 2021

Many DME providers have had tremendous hurdles to overcome this year, from the implementation of a new round of Medicare’s Competitive Bidding Program through continued impacts of COVID-19. Mergers and acquisitions are through the roof as a result, as are continued compliance concerns that plague the industry. Marketing Concerns.

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Medicare Medicare Telemedicine COVID-19 40

Medval Compliance Blog

FEBRUARY 8, 2022

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that it will be hosting a Workers’ Compensation Medicare Set-Aside (WCMSA) webinar next Thursday, February 17, 2022 at 1:00 pm ET. The post CMS to Host Workers’ Compensation Medicare Set-Aside Webinar appeared first on Medval.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

JANUARY 17, 2024

Patient volumes and surgical procedures showed signs of recovery from pandemic-era declines, increasing by 23% and 27% respectively over 2022. This underscores industry trends toward increased productivity and strategic implementation of technology, automation, and analytics in billing compliance and revenue cycle management operations.

Compliance 106

Compliance Overpayments Overpayment Medicare 106

Innovaare Compliance

JANUARY 3, 2022

January and February are usually busy months for Medicare Advantage Organizations (MAO). The Centers for Medicare & Medicaid Services (CMS) began call-center monitoring for timeliness and accessibility in 2015 and has continued since. This is an increase from two for 2022. The average rating in 2022 is 4.37

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Compliance Medicare Medicare Medicaid 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. Sections 120 and 402 of the CAA made two key changes to Medicare enrollment rules.

Medicare 52

Medicare Medicare Medical Billing Outsourcing Medical Billing 52

MRO Compliance

JUNE 1, 2022

Each year HEDIS rating criteria is updated, meaning your organization needs to stay up-to-date on the latest news and trends for HEDIS compliance audits. HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. Compliance with HEDIS specifications.

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Medicare Medicare Compliance Medicaid 130

Innovaare Compliance

DECEMBER 25, 2023

Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS) issued a memorandum detailing several announcements relating to its 2024 CMS program audit. Make use of resources available on the ( [link] ) to prepare for 2024 program audits.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

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Medicare Medicare Licensing Health Insurance 52

AIHC

JANUARY 5, 2022

Written by: Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, COCAS, CORCM, OHCC, ICDCT-CM/PCS As a result of the 2021 Consolidated Appropriations Act, several No Surprises Billing Act regulations went into effect on January 1, 2022, for providers, facilities and air ambulance services.

Medical Billing 52

Medical Billing Health Insurance Hospitals Medicare 52

YouCompli

NOVEMBER 30, 2022

The same tool nurses use to communicate about health emergencies – can help you secure investment in your compliance department. . Healthcare compliance professionals who want to make a case for investing in a healthcare regulatory change management solution like YouCompli are using the SBAR framework: Concisely explain the situation.

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Regulatory Compliance US Department of Health and Human Services Compliance Compliance Officers 52

Medisys Compliance

FEBRUARY 7, 2022

Medicare pays a physician for an Annual Wellness Visit (AWV) service. This visit is planned to develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA) which is covered once every 12 months by Medicare. Medicare also waives the AWV coinsurance or co-payment and the Medicare Part B deductible.

Medicare 52

Medicare Medicare Medical Billing Outsourcing Medical Billing 52

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

Fraud 52

Fraud Medicare Medicare Medicaid 52

Medisys Compliance

JUNE 10, 2022

Medicare covers limited chiropractic services when performed by a chiropractor who is licensed or legally authorized to furnish chiropractic services by the State or jurisdiction in which the services are furnished. In this article, we shared coding guidelines and Medicare coverage for Chiropractic Manipulative Treatment (CMT).

Medicare 59

Medicare Medicare Medical Billing Medical Billing Outsourcing 59

Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 in 2022, which is partly offset by a cost-of-living increase of 5.9% 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] in 2021 to $170.00 in Social Security benefits.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Health Law Advisor

FEBRUARY 10, 2023

Department of Justice (DOJ) released its annual False Claims Act (FCA) enforcement statistics for fiscal year (FY) 2022, which ended on September 30, 2022. [1] 2] DOJ’s press release touts the FY 2022 as having the second highest number of settlements in history. 1] While total recoveries exceeded $2.2 1] [link]. [2]

Fraud 52

Fraud COVID-19 Governance Medicaid 52

Innovaare Compliance

JANUARY 19, 2021

It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the past several years—and especially with changes implemented for the 2021 Plan Year—that member experience and medication adherence is of utmost importance to the CMS. Medicare Star Ratings 2021 Changes.

Medicare 52

Medicare Medicare COVID-19 Compliance 52

Medisys Compliance

JUNE 20, 2022

Under Fee-for-service (FFS) Medicare, home infusion therapy (HIT) involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. Medicare Coverage. CPT codes, descriptions and other data only are copyright 2022. Basics of Home Infusion Therapy (HIT). American Medical Association.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Healthcare Law Blog

OCTOBER 27, 2022

On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursing home facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program.

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