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.

Medicare 112

Medicare Medicare Medicaid Medicaid 112

Healthcare Law Today

NOVEMBER 30, 2022

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released its final 2023 Medicare Physician Fee Schedule (PFS) rule. Telehealth and other digital health modalities continue to increase in importance for Medicare populations and corresponding health care providers.

Medicare 132

Medicare Medicare Telemedicine Nurses 132

Healthicity

NOVEMBER 4, 2022

2023 is fast approaching, and so are new changes from the Centers for Medicaid & Medicare (CMS)!

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Healthcare IT Today

DECEMBER 22, 2024

Access to home health for Medicare beneficiaries is decreasing , according to a recent report from Trella Health, with the number of home health visits per day down more than 17% between 2017 and 2023. That said, rejection rates hit a trough in 2018 and have increased 16% since then.

Medicare 84

Medicare Medicare FDA Telemedicine 84

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. 2023 Feb 25;S0012-3692(23)00301-X. 2023 Feb 7;329(5):386-392. 2023 Feb 13:e226444.

Medicare 147

Medicare Medicare Medicaid Medicaid 147

Healthcare It News

OCTOBER 27, 2023

In previous years, the USDA has funded food equity programs through Medicare and Medicaid. Vilsack talked about a number of initiatives and noted that the Gus Schumacher Nutrition Incentive Program , which ends in 2023, funds fruit and vegetable purchases by SNAP participants and has a produce prescription program.

Medicaid 319

Medicaid Medicaid World Health Health Outcomes 319

Fierce Healthcare

NOVEMBER 11, 2024

Accountable care organizations in the ACO Reach program can claim credit for saving the Centers for Medicare & Medicaid Services (CMS) hundreds of millions of dollars | CMS released favorable savings results for ACO REACH Model participants, as industry group NAACOS begins to push for the program's extension through 2030.

Medicaid 116

Medicaid Medicaid Medicare Medicare 116

HIT Consultant

APRIL 18, 2025

– Synthesizing findings from three in-depth evaluations of digital health tools by the Peterson Health Technology Institute (PHTI) and analyzing trends in Medicare and Medicaid billing, the report sounds a timely alarm. However, the report reveals a concerning surge in Medicare billing for these services. million in 2023.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

MARCH 6, 2023

The Department of Justice has announced one of its first prosecutions under the Medicare Access and CHIP Reauthorization Act of 2015 in a case involving the theft and sale of Medicare Beneficiary Identifiers. MACRA also made it illegal to buy, sell, or distribute Medicare Beneficiary Identifiers without proper authority.

Medicare 102

Medicare Medicare Fraud Medicaid 102

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.

Medicaid 98

Medicaid Medicaid Ransomware Health Insurance 98

Compliance Now

SEPTEMBER 27, 2022

The October 14, 2022 deadline by which plan sponsors that offer prescription drug coverage to provide notices of creditable or non-creditable coverage to Medicare-eligible individuals is fast approaching. Active employees who qualify for Medicare and their dependents. COBRA participants who qualify for Medicare and their dependents.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Compliance Now

SEPTEMBER 28, 2022

The October 14, 2022 deadline by which plan sponsors that offer prescription drug coverage to provide notices of creditable or non-creditable coverage to Medicare-eligible individuals is fast approaching. Active employees who qualify for Medicare and their dependents. COBRA participants who qualify for Medicare and their dependents.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

Medicaid 100

Medicaid Medicaid Compliance COVID-19 100

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

Medicaid 100

Medicaid Medicaid Compliance COVID-19 100

Center for Health Insurance Reform

MARCH 31, 2022

In the proposed Notice of Benefit and Payment Parameters for 2023, the Centers for Medicare & Medicaid Services asked for feedback on how to promote health equity through ACA marketplace operations and plan certification standards.

ACA 94

ACA Health Insurance Medicaid Medicaid 94

Healthcare IT News - Telehealth

AUGUST 29, 2024

The American Telemedicine Association and ATA Action in a letter to the Centers for Medicare and Medicaid Services seeks to preserve pandemic-era Medicare telehealth flexibilities that it says are responsible for improving access to healthcare across the U.S. Permit access virtual cardiac and pulmonary rehabilitation services.

Medicare 150

Medicare Medicare Medicaid Medicaid 150

Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

HIPAA Journal

JANUARY 31, 2024

Report: Security Breaches in Healthcare (Direct Download PDF, 1.9MB, 16 pages) An unwanted record was set in 2023 with 725 large security breaches in healthcare reported to the Department of Health and Human Services (HHS) Office for Civil Rights (OCR), beating the record of 720 healthcare security breaches set the previous year.

Ransomware 126

Ransomware HIPAA Hospitals Compliance 126

Health Populi

APRIL 3, 2023

public does not want politicians to “up-end” government-funded health programs, according to the Kaiser Family Foundation’s March 2023 Health Tracking Poll. adults between March 14-23, 2023. Most health citizens, cross party affiliation, are worried about the future of Medicare. A majority of the U.S.

Medicaid 62

Medicaid Medicaid Medicare Medicare 62

HIT Consultant

JANUARY 18, 2023

Community pharmacists trusted to deliver care: In 2023, pharmacists will play an integral role as part of the team managing patient care for diseases like diabetes, hypertension, or multiple comorbidities. In 2022, 135 new bills that impacted PBM business practices were introduced in 36 states and many will continue to be in review in 2023.

Compliance 98

Compliance Medicaid Medicaid Medicare 98

HIPAA Journal

APRIL 17, 2025

In December 2023, the Department of Health and Human Services (HHS) published its strategy for Healthcare Sector Cybersecurity. If finalized, the proposals will not only become standards required for HIPAA compliance , but may also be adopted by CMS as conditions for participation in Medicare and Medicaid.

HIPAA 62

HIPAA Compliance Medicaid Medicaid 62

Compliance Now

SEPTEMBER 28, 2023

By Lee Spiegel , Compliance Director, MZQ Consulting By October 13, 2023, plan sponsors that offer prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-eligible individuals. Have a deductible that is no more than $250/year.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Compliance Now

SEPTEMBER 28, 2023

By Lee Spiegel , Compliance Director, MZQ Consulting By October 13, 2023, plan sponsors that offer prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-eligible individuals. Have a deductible that is no more than $250/year.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

HIPAA Journal

MAY 23, 2023

Largest Healthcare Data Breaches Reported in April 2023 As previously mentioned, April saw a major data breach reported that affected 3,037,303 individuals – The third largest breach to be reported by a single HIPAA-covered entity so far this year, and the 19 th largest breach to be reported by a single HIPAA-regulated entity to date.

Ransomware 106

Ransomware HIPAA Medicaid Medicaid 106

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

MRO Compliance

JULY 12, 2023

Why quality measures are a crucial on-ramp to VBC July 12, 2023 HealthData Management Technology is key to success as health systems and providers opt in to value-based contracts and away from fee-for-service reimbursement.

Medicaid 130

Medicaid Medicaid Medicare Medicare 130

Bill of Health

MARCH 27, 2024

Spravato is covered by Medicare Part B , which pays 80% of expenses. Luckily, many insurers do— Cigna , Aetna , Blue Cross Blue Shield , United Healthcare , Medicaid , and Medicare all provide coverage. As such, depending on coverage , Spravato can fall under either (or both) medical or pharmacy benefits.

FDA 203

FDA Medicare Medicare Health Insurance 203

AIHC

NOVEMBER 12, 2024

As of November 2023, twenty-five (25) states passed legislation banning unauthorized pelvic exams. [7] This article addresses how these privacy rights extend beyond rules designated under HIPAA and States passing rules banning unauthorized pelvic exams. OCR recently issued an FAQ focusing on this right. [6]

Informed Consent 98

Informed Consent HIPAA Compliance Hospitals 98

Healthcare IT News - Telehealth

FEBRUARY 3, 2023

An excepted benefit allows employers to finance additional medical care, like vision or dental coverage, according to the Centers for Medicare & Medicaid Services FAQs for insurance agents and brokers, requiring Congress to amend previous public health and funding laws. In an announcement about the bipartisan bill, Rep.

COVID-19 180

COVID-19 Public Health Medicare Medicare 180

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.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

Bill of Health

SEPTEMBER 25, 2024

District Court summary judgment decision for the defendants as affirmed in 2023 by the DC Circuit Court of Appeals. DSH payments are administered as part of the Medicare program. The Supreme Court will review a 2022 D.C.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Healthcare IT Today

MARCH 7, 2023

The company continues to be the largest network of independent primary care in the country, with more than two million patients covered by more than 150 value-based contracts across Medicare, Medicare Advantage, Medicaid and commercial payers. Originally announced February 21st, 2023

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Compliancy Group

JANUARY 31, 2025

Although the incident occurred in July 2023, Concerta could not confirm they were affected until January 2024. Centers for Medicare & Medicaid Services In May 2023, the Clop group exploited a zero-day vulnerability to gain unauthorized access to the networks of 2,500 companies. The damage?

Ransomware 52

Ransomware HIPAA Medicare Medicare 52

HealthIT Answers

JANUARY 31, 2024

The Centers for Medicare & Medicaid Services opened data submission for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the Quality Payment Program. The post Reminder: MIPS 2023 Data Submission is Open appeared first on Health IT Answers.

Payment Systems 59

Payment Systems Medicaid Medicaid Medicare 59

The Health Law Firm Blog

JUNE 14, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

MAY 28, 2024

I helped build the reference products like Blue Button and Data at the Point of Care at the Centers for Medicare and Medicaid Services that became part of these regulations. According to a 2023 study , some use cases could take years. For personal health records, this may be possible.

Electronic Medical Records 122

Electronic Medical Records Medicaid Medicaid Medicare 122

Healthcare It News

OCTOBER 12, 2023

" MEETING THE CHALLENGE UConn Health went live on the platform in early August 2023, and it is in active use by patients and more than 60 MSK surgeons, care team members and clinical practice leaders for spine, arthroplasty, sports and foot/ankle care. Another aspect of this approach is reimbursement.

COVID-19 294

COVID-19 Medicaid Medicaid Hospitals 294