Bill of Health

APRIL 13, 2022

When the PHE ultimately expires, this will also trigger the end of the Medicaid continuous enrollment requirement, under which states must provide continuous Medicaid coverage for enrollees through the end of the last month of the PHE in order to receive enhanced federal funding. What States Are Doing Now. Continuity of Coverage.

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Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). MFCUs reported 1,143 total convictions in FY 2023—a marked decrease from 1,327 convictions in FY 2022.

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Fraud Medicaid Medicaid Licensing 52

Healthcare IT News - Telehealth

JUNE 19, 2023

Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.

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Medicare Medicare Telemedicine Medicaid 147

HIPAA Journal

APRIL 27, 2023

The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.

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HIPAA Journal

DECEMBER 15, 2022

On November 14, 2022, Fairmont, WV-based Health Care Management Solutions (HMS) reported a data breach to the HHS’ Office for Civil Rights that affected up to 500,000 individuals. It has now been confirmed that HMS suffered a ransomware attack on October 8, 2022. At the time, few details about the breach were released.

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Fierce Healthcare

AUGUST 24, 2023

The Centers for Medicare & Medicaid Services (CMS) announced that the Medicare Shared Savings Program (MSSP) has saved a net $1.8 billion in 2022 for accountable care organizations, which is th | Accountable care organizations saved a net $1.8

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HIT Consultant

AUGUST 8, 2022

FAIR Health Monthly Telehealth Regional Tracker, May 2022, United States. The data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid. – FAIR Health reports national telehealth utilization increased 10.2 percent, from 4.9 percent in May.

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Healthcare IT News - Telehealth

DECEMBER 14, 2021

This is why, as the new year approaches, Healthcare IT News has sat down with an expert in value-based care to get his views on what 2022 will hold for the payment system. Caravan Health President and CEO Tim Gronniger previously was chief of staff and director of delivery system reform at the Centers for Medicare and Medicaid Services.

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The Health Law Firm Blog

JANUARY 12, 2024

Board Certified by The Florida Bar in Health Law The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. The deal was signed on July 11, 2022, but wasn’t publicly [.] Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

Innovaare Compliance

FEBRUARY 25, 2024

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. CMS proposes calibrating the RxHCC model for CY 2025 on 2021 diagnoses and 2022 expenditure data from PDE records.

Medicare 52

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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.

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Bill of Health

DECEMBER 27, 2022

2022 Nov;18(2):14-26. Frequency of Approval and Marketing of Biosimilars With a Skinny Label and Associated Medicare Savings. 2022 Nov 28. 2022 Nov 14. 2022 Nov 19. 2022 Nov 1;24(11):E1083-1090. 2022 Nov 7:e224131. Getting the Price Right: Lessons for Medicare Price Negotiation from Peer Countries.

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Medisys Compliance

DECEMBER 23, 2022

The internet is ringing with the news of the CMS Updates Final rule for the 2023 Medicare Physician Fee Schedule. The finalized 2023 Medicare Physician Fee Schedule was announced by the Centers for Medicare & Medicaid Services (CMS) on November 1 2022. Medicare reimbursement for telehealth services.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 98

Fierce Healthcare

NOVEMBER 2, 2023

The Centers for Medicare & Medicaid Services has dropped the final rule to remedy the invalidated 340B-acquired drug payment policy for calendar years 2018 to 2022. |

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Healthcare Law Blog

DECEMBER 1, 2023

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) recently released its “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2022 ” (the “Report”), highlighting continued enforcement and recovery actions under the Health Care Fraud and Abuse Control Program (HCFAC).

COVID-19 52

COVID-19 Fraud Telemedicine Medicaid 52

HIT Consultant

MAY 9, 2022

FAIR Health Monthly Telehealth Regional Tracker, February 2022, National. The FAIR Health data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid. percent nationally in February 2022, from 5.4 Telehealth Utilization Decline.

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HIT Consultant

NOVEMBER 30, 2022

Key Themes and Ideas Regarding Value-Based Care Reimbursement 2022. Significant Growth Anticipated for Medicaid and Capitation Contracts: Most respondents report strategic plans to expand their VBC contracts over the next three years.

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HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

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Medicaid Medicaid Ransomware Health Insurance 84

Fierce Healthcare

DECEMBER 13, 2023

trillion, or $13,493 per person, according to a new report from the Centers for Medicare & Medicaid Services published in Health Affairs. trillion in 2022, or $13,493. Healthcare spending has increased 4.1% Health care spending increased to $4.5 Here's how that breaks down.

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Fierce Healthcare

OCTOBER 24, 2023

The Center for Medicare and Medicaid Innovation (CMMI) unveiled 2022 calendar year results for the Direct Contracting Model on Monday. More than three-quarters of those who participated in the program reaped savings, data from CMMI revealed.

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Medicaid Medicaid Medicare Medicare 115

Healthcare Law Blog

MAY 22, 2023

With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9%

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

AUGUST 15, 2023

Tift Regional Medical Center in Georgia has started notifying 180,142 patients that their personal and protected health information was compromised in a cyberattack that was detected on or around August 16, 2022. The post Tift Regional Medical Center Patients Notified About August 2022 Cyberattack appeared first on HIPAA Journal.

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Health Care Law Brief

FEBRUARY 2, 2024

While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5 billion in Medicaid investments over the next three years. Services will be delivered via a two-tiered system.

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Medicaid Medicaid Medicare Medicare 52

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.

Medicare 52

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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The Health Law Firm Blog

JANUARY 13, 2024

Board Certified by The Florida Bar in Health Law On September 27, 2022, a Florida pharmacy owner pled guilty to conspiring to commit healthcare fraud in an $8.3 The scheme involved securing orders for medically unnecessary prescriptions billed to Medicare and paying bribes and kickbacks, [.] Indest III, J.D., million scheme.

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Fraud Medicare Medicare Medicaid 52

The Health Law Firm Blog

JULY 13, 2023

Board Certified by The Florida Bar in Health Law On March 13, 2022, a licensed professional counselor (LPC) was sentenced to nearly five years in prison for defrauding the Connecticut Medicaid Program of more than $1.3 By George F. Indest III, J.D., million, announced the U.S. Attorney for the U.S. District of Connecticut. [.]

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Licensing Medicaid Medicaid Fraud 52

Healthcare Law Blog

JANUARY 20, 2023

To add uniformity to this practice, CMS codified this flexibility in the 2016 Medicaid and Children’s Health Insurance Plan (CHIP) managed care final rule by authorizing coverage for “In Lieu of Service or Settings” (ILOS). [i] ILOSs must advance the objectives of the Medicaid program.

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Medicaid Medicaid Medicare Medicare 52

Medisys Compliance

MAY 19, 2022

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. 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. Eligible services.

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COVID-19 Medicare Medicare Medical Billing 52

HIT Consultant

DECEMBER 15, 2021

What You Should Know: – Ilumed , a Medicare transformation company focused on assisting patients to achieve their healthiest lives by driving lower cost, better quality and more equitable healthcare outcomes raises $16.5M in Series A funding led by Ascend Partners.

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Medicare Medicare Medicaid Medicaid 52

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 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.

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The Health Law Firm Blog

OCTOBER 18, 2022

Board Certified by The Florida Bar in Health Law The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. The deal was signed on July 11, 2022, but wasn’t publicly [.]. Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. 2022 Dec 1;182(12):1321-1323. JAMA Intern Med. Johnston JL, Ross JS, Ramachandran R.

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Medicare Medicare Medicaid Medicaid 144

MedTrainer

AUGUST 1, 2022

Medicare and Medicaid services are the backbone for supporting elderly and disabled Americans. However, there have been many cases of individuals and parties abusing Medicare regulations for their own financial gain — and medical professionals and organizations within the healthcare industry are among them. A Look at the OIG.

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Nurses Medicare Medicare Nursing Homes 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