Medisys Compliance

APRIL 11, 2024

A New Era for Mental Health Access The landscape of mental healthcare in the United States underwent a significant change on January 1, 2024. Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can now directly bill Medicare for services they furnish and diagnose.

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Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Modern Healthcare

JULY 3, 2023

Nursing homes, rehab providers and psychiatric hospitals urged the Centers for Medicare and Medicaid Services to account for economic conditions in fiscal 2024 rates

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Medicare Medicare Nursing Homes Medicaid 93

Fierce Healthcare

JULY 13, 2023

The Centers for Medicare & Medicaid Services has released its proposed Medicare payment rates and policy updates under the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory S | The CY 2024 OPPS and ASC Payment System Proposed Rule includes a 2.8%

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Payment Systems Medicare Medicare Medicaid 98

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. Prepare for both routine and focused audits to be conducted in 2024 by CMS.

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MedTrainer

JANUARY 10, 2024

It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024. It may seem a little early to do some spring cleaning, but not when it comes to compliance!

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Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

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Compliance Officers Compliance Medicare Medicare 52

Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”).

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Medicare Medicare Licensing Malpractice 40

Verisys

FEBRUARY 9, 2024

January 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 The post January 2024 Bad Actors Roundup appeared first on Verisys.

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Healthcare Law Blog

AUGUST 11, 2023

On July 13, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its proposed rule (the “Proposed Rule”) for the 2024 Medicare Physician Fee Schedule (“PFS”). CMS projects that the Proposed Rule will lead to growth in the Medicare Shared Savings Program (“MSSP”).

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Modern Healthcare

MARCH 31, 2023

The Centers for Medicare and Medicaid Services estimates health insurance companies will see a 3.32% increase in Medicare Advantage revenue next year.

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Medicare Medicare Health Insurance Medicaid 80

Medisys Compliance

MARCH 7, 2024

In 2024, the AMA introduced 349 changes to the CPT code set, comprising 230 new codes, 49 deletions, and 70 revisions. Staying abreast of these 2024 CPT code updates is essential for healthcare professionals to ensure precise coding and proper financial reimbursement.

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Medical Billing Medical Billing Outsourcing Regulatory Compliance Compliance 59

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. These changes become effective on January 1, 2024.

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The Health Law Firm

JANUARY 8, 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 (PFS). percent in 2024. Indest III, J.D.,

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Medicare Medicare Medicaid Medicaid 52

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.”

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Medicaid Medicaid Compliance Health Insurance 100

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. June 3, 2024, is the deadline for submitting bids for Parts C and D. PDT on June 3, 2024.

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Hall Render

MARCH 8, 2024

On January 30, 2024, the Centers for Medicare and Medicaid Services (“CMS”) issued a Request For Information (“RFI”) seeking input from interested parties regarding Medicare Advantage (“MA”) data. Comments are due on or before May 29, 2024 to be assured consideration.

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Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS.

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Medicare Medicare Overpayments Overpayment 52

Provider Trust

JANUARY 25, 2024

Though HHS has made efforts to address the challenges outlined in this year’s report, there are still many opportunities for improvement in 2024. We’ve broken down the report’s primary themes and how they affect healthcare organizations moving forward in 2024. With Medicaid, the challenges are equally formidable.

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Fraud Medicaid Medicaid Medicare 52

Compliancy Group

FEBRUARY 12, 2024

In one incident, a New Jersey pharmacy admitted to conspiracies to defraud benefits providers, including Medicare and Medicaid, of $65 million for medications never provided to patients. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Wyatt Law Blog

FEBRUARY 22, 2024

On February 8, 2024, the Centers for Medicare and Medicaid Services (CMS) issued a memorandum entitled Texting of Patient Information and Orders for Hospitals and CAHs (the 2024 Memo), which provides updated guidance to State Survey Agency Directors.

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Medicaid Medicaid Medicare Medicare 98

Innovaare Compliance

JANUARY 19, 2024

Organizations offering Medicare Advantage (MA) plans and MA Prescription Drug Plans (MAPD) may be subject to a focused audit even if the organization completed a 2021 or 2022 routine program audit. Audit notification will begin in January 2024. What is the intent of a focus audit?

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Medicare Medicare Compliance Medicaid 52

Innovaare Compliance

MARCH 11, 2024

The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data Processing System (DDPS) since inception of Part D in 2006. Due to multiple changes to the Part D program pursuant to the Inflation Reduction Act (IRA) of 2022, some DDPS edit changes will take effect on January 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Fierce Healthcare

JANUARY 29, 2024

In 2024, 50 accountable care organizations are new to the Medicare Shared Savings Program and 71 ACOs renewed participation, according to new numbers released by Centers for Medicare & Medicaid | CMS released new data Monday showing ACO participation in the Medicare Shared Savings Program, with 19 ACOs set to participate in a new payment option, (..)

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Medicare Medicare Medicaid Medicaid 109

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

Hall Render

DECEMBER 20, 2023

As summarized below, the Final Rule finalizes these proposed revisions to take effect on January 16, 2024. Finalized Revisions to Form CMS-855A For SNFs, the aforementioned data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”).

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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

Medisys Compliance

DECEMBER 12, 2023

As we move into 2024, several key updates will impact how behavioral health providers bill for their services. In this article, we will explore the most important behavioral health billing updates planned for 2024, focusing on both Medicare and commercial payers. Behavioral Health Billing Updates: For Medicare 1.

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Medical Billing Medical Billing Outsourcing Medicare Medicare 59

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

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Medicare Medicare Licensing Compliance 52

Center for Health Insurance Reform

MARCH 31, 2023

With the twin goals of building on the enrollment gains and improving the consumer experience, the Centers for Medicare & Medicaid Services (CMS) has proposed an annual set of requirements. Stakeholder Perspectives on CMS’s 2024 Notice of Benefit and Payment Parameters: Health Insurers

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Health Insurance ACA Medicaid Medicaid 72

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

Health Care Law Brief

FEBRUARY 2, 2024

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). 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

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Fierce Healthcare

NOVEMBER 1, 2023

Centers for Medicare & Medicaid Services (CMS) released a rule Wednesday that increases the 2024 home health payments by 0.8%, or $140 million. | CMS' new proposed rule will increase home health payments by 0.8%, or $140M, among other changes.

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Medicaid Medicaid Medicare Medicare 117

Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025. Phase 1 of the application submission process opens on May 20, 2024, and closes on June 17, 2024.

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Healthcare IT Today

JANUARY 14, 2024

The American Telehealth Association announced its policy priorities for 2024 ; they include making Medicare telehealth flexibilities permanent before the end of the year and removing the in-person requirement for the remote prescribing of controlled substances. Wellness app Vivoo launched an at-home digital UTI test.

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Medicaid Medicaid FDA Medicare 99

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year. CERT Testing is planned to begin on July 1, 2024.

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Healthcare IT Today

MARCH 9, 2024

Read more… Bonus Features for March 3, 2024: 75% of healthcare leaders expect widespread implementation of AI in 3 years, yet 78% of orgs lack knowledge on how to train employees to use AI. Dina raised $7 million in Series B funding ; the company supports network management for Medicare Advantage and Managed Medicaid.

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