Medisys Compliance

JANUARY 30, 2023

Let us discuss the top compliance issues in the medical billing industry, shall we? Medicare and Medicaid: Medicare and Medicaid are government-funded healthcare programs that provide coverage to millions of Americans. Data Security: Data security is an increasingly important compliance issue for the medical billing industry.

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Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

American Medical Compliance

JUNE 19, 2023

Several states have recently approved the extension of postpartum Medicaid coverage beyond the usual two-month period. By providing extended Medicaid coverage, states are taking a proactive approach to safeguarding the well-being of mothers during this vulnerable period. Reference US News and World Report (1 June 2023).

Medicaid 52

Medicaid Medicaid Compliance 52

MedTrainer

FEBRUARY 12, 2024

Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. How are healthcare organizations ensuring compliance and minimizing exposure risks to false claims?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

MedTrainer

NOVEMBER 27, 2023

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Compliancy Group

OCTOBER 5, 2023

Under MACRA, the Centers for Medicare and Medicaid Services (CMS) created regulations to encourage healthcare providers to use secure health information technology. The MIPS rules for 2023 are discussed below. The MIPS rules for 2023 are discussed below. What Are the MIPS Rules for 2023? It has no numeric value.

HIPAA 52

HIPAA Medicare Medicare Compliance 52

MedTrainer

MARCH 28, 2024

Healthcare compliance. Just as perplexing is who is responsible for compliance in healthcare organizations. The answer has as many layers as the definition of compliance itself. The answer has as many layers as the definition of compliance itself. Who in the Organization Is Responsible for Healthcare Compliance?

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Compliance Compliance Officers Licensing Regulatory Compliance 52

MedTrainer

NOVEMBER 20, 2023

Similar to other states, maintaining healthcare compliance in Florida State involves meeting state-specific regulations and requirements. This post offers an overview of must-know compliance requirements for Florida. While many states have rules that prohibit the storage of Medicaid data outside the U.S.,

Compliance 52

Compliance Licensing Regulatory Compliance Medicaid 52

MedTrainer

NOVEMBER 27, 2023

As is the case with every state, there are distinctive challenges in the management of healthcare compliance in North Carolina, shaped by its own unique regulations. Keep scrolling for a summary of the crucial elements of healthcare compliance relevant to North Carolina.

Compliance 52

Compliance Licensing Telemedicine Medicaid 52

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. New York Social Services Law § 363-d.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

HIPAA Journal

MAY 29, 2023

It has been 27 years since President Clinton signed the Health Insurance Portability and Accountability Act (HIPAA) into law, but compliance is still proving a challenge for many HIPAA-regulated entities. The 2016-2017 HIPAA audit program identified many areas of noncompliance.

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HIPAA Compliance Due Diligence COVID-19 95

MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the Bureau of Facility Standards , provide oversight with certain standards, adding a layer of complexity to successfully managing healthcare compliance in Idaho. Continue reading this overview for key aspects of healthcare compliance specific to the state of Idaho.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

Hall Render

JULY 28, 2023

Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”). UB claim).

Medicare 40

Medicare Medicare Compliance COVID-19 40

Innovaare Compliance

OCTOBER 6, 2022

According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. And, in 2023, there will be more enrollees in MAPD than in original Medicare. Another highly anticipated change to begin on January 1, 2023 pursuant to the IRA is the $35 cap per month on out-of-pocket costs to Medicare beneficiaries.

Medicare 52

Medicare Medicare Compliance Public Health 52

MedTrainer

DECEMBER 7, 2023

Ensuring healthcare compliance in New Hampshire involves maintaining both federal and state guidelines, while providing quality patient care. New Hampshire healthcare organizations must develop dynamic compliance programs to keep up with evolving regulations. Two significant changes were made in 2023.

Compliance 52

Compliance Licensing Public Health Medicaid 52

Innovaare Compliance

DECEMBER 11, 2023

The Contract Year (CY) 2024 Readiness Compliance Checklist for Medicare Advantage Organizations, Prescription Drug Plan Sponsors, 1876 Cost Plans, and Medicare-Medicaid Plans released by the Centers for Medicare & Medicaid Services (CMS) on October 13, 2023, is an excellent place to start. the disabled.

Medicare 52

Medicare Medicare Compliance Medicaid 52

The Health Law Firm

JUNE 6, 2023

Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders easily accessible to the public. Indest III, J.D.,

Medicaid 52

Medicaid Medicaid Compliance 52

MedTrainer

SEPTEMBER 8, 2023

Maintaining compliance with healthcare regulations and standards isn’t just a legal requirement; it’s a crucial element in upholding patient safety, data security, and the overall integrity of healthcare practices. Hear more on compliance essentials from a panel of expert healthcare surveyors. Why Is Healthcare Compliance Important?

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Compliance HIPAA Medicaid Medicaid 52

MedTrainer

NOVEMBER 14, 2023

Healthcare compliance regulations can vary significantly from one state to another, so managing healthcare compliance in Virginia may be different compared to other states. Regulations Unique to Virginia To meet the standards of healthcare compliance in Virginia, there are a few additional regulations.

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Compliance Licensing Governance Hospitals 52

MedTrainer

NOVEMBER 29, 2023

A unique set of rules and standards can pose a unique set of challenges for overseeing healthcare compliance in Indiana. Just as in other states, Indiana health professionals and groups must have a firm grasp of state-specific regulations in order to effectively manage their healthcare compliance.

Compliance 52

Compliance Licensing Governance Public Health 52

MedTrainer

NOVEMBER 20, 2023

Managing healthcare compliance in Texas is nuanced and challenging. For successful compliance management in Texas, healthcare organizations need to develop a strong system for tracking and interpreting regulatory changes, and promptly adapt to these modifications.

Compliance 52

Compliance Licensing Public Health Governance 52

MedTrainer

NOVEMBER 30, 2023

Healthcare compliance in Missouri is uniquely challenging due to state-specific regulations, such as the surgical smoke plume evacuation system requirement. This article provides a concise overview of Missouri’s healthcare compliance, highlighting the state-specific requirements to be aware of.

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Compliance Compliance Officers Hospitals Public Health 52

MedTrainer

NOVEMBER 5, 2023

Colorado, like other states in the United States, has its own set of regulations and requirements that make managing healthcare compliance in Colorado tricky. To effectively manage compliance, healthcare organizations must establish a robust system for monitoring and interpreting these changes and swiftly implement necessary adjustments.

Compliance 52

Compliance Licensing Informed Consent Public Health 52

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

Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes, which went into effect on January 1, 2023, are designed to ensure health plans are accurately reporting their costs and that they are not overcharging the government.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Bill of Health

MAY 22, 2023

2023 Apr 7;4(4):e230511. 2023 Apr 26. 2023 Apr 3;6(4):e238835. 2023 Apr 3;6(4):e237467. 2023 Apr 18;329(15):1283-1289. Trends in Spending and Claims for P2Y12 Inhibitors by Medicare and Medicaid From 2015 to 2020. Trends in Spending and Claims for P2Y12 Inhibitors by Medicare and Medicaid From 2015 to 2020.

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Pharmaceutical Industry Medicare Medicare Medicaid 157

Provider Trust

AUGUST 9, 2023

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its latest 2023 Spring Semiannual Report to Congress, providing a comprehensive overview of its activities from October 2022 to March 2023. Led by acting Inspector General Christi A.

Nursing Homes 52

Nursing Homes COVID-19 Fraud Medicaid 52

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. Effects of the PFS in 2023 on providers. Principles of PFS.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 98

The Health Law Firm Blog

JANUARY 4, 2024

On November 6, 2023, the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG), released 91 pages of "General Compliance Program Guidance" (GCPG) on its website. This is the first compliance program guidance the OIG has released since 2008. The GCPG provides general compliance guidance, [.]

Compliance 52

Compliance Fraud Medicaid Medicaid 52

AIHC

AUGUST 30, 2023

What compliance issues need to be considered when drafting a marketing strategy? Let’s take a closer look at potential compliance risks. As with all marketing strategies, remember Compliance, Compliance, Compliance! So, what is telemarketing in healthcare ? Great idea, right? I can’t say it enough.

Compliance 52

Compliance Fraud Medicare Medicare 52

Healthcare IT Today

NOVEMBER 4, 2023

Answers include infrastructure management, resource utilization, data management, data protection, and security and compliance monitoring. Bonus Features for October 29, 2023: 66% of patients prefer email or text for reminders about medical bills, plus 94% of clinicians said lack of timely access to insights within EHR impacts patient care.

Medical Billing 92

Medical Billing Medicaid Medicaid Compliance 92

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Priorities for Massachusetts’s Medicaid Fraud Division.

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Fraud COVID-19 Compliance Medicaid 52

Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. What is an effective healthcare compliance program?

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Compliance Compliance Officers ADA Governance 52

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

C&M Health Law

DECEMBER 18, 2023

Department of Health and Human Services (HHS) published the General Compliance Program Guidance (GCPG) on November 6, 2023. The GCPG provides updated descriptions of the seven elements of an effective compliance program that health care entities have long relied upon. The Office of the Inspector General (OIG) of the U.S.

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

MedTrainer

MAY 4, 2023

That includes many compliance professionals. There are plenty of compliance implications for the end of the Public Health Emergency on May 11, 2023 , and an assessment is a great place to start. But, anyone who started in the field within the past three years has only worked under the leniencies granted through the PHE.

Public Health 52

Public Health Compliance COVID-19 COVID-19 Vaccine 52

HIT Consultant

APRIL 4, 2023

What You Should Know: 2023 started off with the hallmarks of a rebound year. 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.

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FDA Medicaid Medicaid COVID-19 52

Compliancy Group

FEBRUARY 16, 2024

We also covered two Medicaid fraud schemes , one resulting in billions of dollars in billing for medical supplies that were never received. for Medicaid Fraud In March 2014, the Maryland Board of Dental Examiners received complaints against Seyed Hamid Tofigh, DDS, claiming the dentist posed a risk of harm, and suspended his license.

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Fraud Licensing Medicaid Medicaid 52