Compliance Now

MARCH 8, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. Under the ACA, non-grandfathered group health plans must provide benefits for “preventive care” on a first-dollar basis. This means such coverage must be provided at no cost to participants (i.e., no co-payments, co-insurance, or deductibles may be applied).

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MRO Compliance

MAY 15, 2025

Health Insurance Marketplace: Established under the Affordable Care Act (ACA), the Marketplace provides competitive, commercial insurance plans for individuals and small groups. This collaborative approach supports both payers and providers in achieving their goals while maintaining high standards of data security and compliance.

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Healthcare IT Today

DECEMBER 4, 2024

The following is a guest article by Karie Bostwick, VP of People and Compliance at Revenue Enterprises The Consumer Financial Protection Bureau (CFPB) has announced that it wants to ban the inclusion of medical debt data in credit reports to lessen the negative impact of medical debt on credit scores and improve financial outcomes for consumers.

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Compliance Now

APRIL 6, 2022

On April 5, 2022, the Administration issued new proposed regulations changing certain aspects of the affordability and minimum value rules under the Affordable Care Act (“ACA”). Jennifer Berman, CEO, MZQ Consulting. However, since its inception, concerns have been raised about the “family glitch.”

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Compliance Now

DECEMBER 20, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. The good faith transition relief that formerly shielded employers from penalties for incorrect and/or incomplete ACA filings is no longer available. Below is an overview of several items that plan sponsors should be mindful of this season.

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Compliance Now

DECEMBER 20, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. The good faith transition relief that formerly shielded employers from penalties for incorrect and/or incomplete ACA filings is no longer available. Below is an overview of several items that plan sponsors should be mindful of this season.

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Healthcare Blog

NOVEMBER 9, 2023

An effective healthcare compliance program is a crucial aspect of any healthcare organization. Healthcare organizations should clearly define their expectations and the consequences for non-compliance. Healthcare organizations should clearly define their expectations and the consequences for non-compliance.

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HIT Consultant

JANUARY 2, 2025

Karie Bostwick, VP of People and Compliance, Revenue Enterprises The Consumer Financial Protection Bureau (CFPB) has announced that it wants to ban the inclusion of medical debt data in credit reports to lessen the negative impact of medical debt on credit scores and improve financial outcomes for consumers.

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Compliance Now

DECEMBER 22, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. To comply with the ACA, non-grandfathered health plans cannot require a participant to pay more out-of-pocket during the plan year than the amounts listed below. Under the ACA, the OOP limitation requirement directly applies to essential health benefits.

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Compliance Now

DECEMBER 22, 2022

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting. To comply with the ACA, non-grandfathered health plans cannot require a participant to pay more out-of-pocket during the plan year than the amounts listed below. Under the ACA, the OOP limitation requirement directly applies to essential health benefits.

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Innovaare Compliance

APRIL 27, 2023

A perspective on recent industry shifts influencing ACA plan operations in states, which are yet to adopt ACA Medicaid expansion Health Exchange plans covered under ACA (Accountable Care Act) witnessed 36% enrollment growth between 2021 and 2023. This is the sharpest rise in ACA enrollment since inception. ACA plans).

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Compliance Now

OCTOBER 10, 2023

By Megan Diehl, director of compliance consulting, MZQ Consulting The Internal Revenue Service (IRS) recently released draft instructions for preparing, distributing, and filing 2023 Forms 1094-B/C and 1095-B/C. This year, employers could mail their Forms 1094 and 1095 to the IRS if their submission included fewer than 250 forms.

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Compliance Now

OCTOBER 10, 2023

By Megan Diehl, director of compliance consulting, MZQ Consulting The Internal Revenue Service (IRS) recently released draft instructions for preparing, distributing, and filing 2023 Forms 1094-B/C and 1095-B/C. This year, employers could mail their Forms 1094 and 1095 to the IRS if their submission included fewer than 250 forms.

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YouCompli

JANUARY 28, 2025

If you think about it, healthcare compliance can be comparable to juggling chainsaws in the sense that both require a high level of skill, focus, and precision. Think about your organization as the big top, and all of the responsibilities you have as the compliance officer are your chainsaws!

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Healthcare Law Blog

MARCH 25, 2022

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger insurers. United States Dep’t of Health & Hum. 20-50963, 2022 WL 807554, at *1 (5th Cir. The Risk-Adjustment Program.

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Medisys Compliance

NOVEMBER 6, 2023

Introduction Orthopedic billing compliance is essential for healthcare providers to avoid costly audits and penalties. By following a comprehensive orthopedic billing compliance checklist, providers can ensure that their claims are accurate, complete, and supported by proper documentation.

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Compliancy Group

MARCH 19, 2024

Hospitals and private practices aren’t the only enterprises with compliance obligations within this sector. Regulatory compliance in healthcare ensures quality care for patients. In this blog, we’ll outline the fundamentals and importance of regulatory compliance in healthcare in the U.S.

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

MedTrainer

JANUARY 12, 2024

At its core, healthcare compliance ensures the quality of care, patient safety, and integrity of healthcare systems. Over the years, healthcare compliance has evolved significantly, driven by changing regulations, advances in technology, and a growing emphasis on patient-centric care. What is Healthcare Compliance?

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Compliancy Group

JANUARY 3, 2024

This article discusses the issues related to medical billing compliance policy and the steps for providers to maintain financial integrity and adherence to all requirements. Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices.

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MedTrainer

JANUARY 31, 2024

Healthcare compliance isn’t a new concept. Who started the first healthcare compliance program? It was passed to combat fraud by government contractors during the conflict and set the stage for future compliance regulations. However, it wasn’t until the mid-20th century that healthcare compliance regulations and programs began.

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MedTrainer

APRIL 8, 2024

As a healthcare professional, it is vital to maintain compliance with the 629 legal and regulatory requirements that govern the delivery of quality care. One effective tool to achieve this is through internal healthcare compliance audits. What Is an Internal Healthcare Compliance Audit?

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Compliance Now

JANUARY 20, 2022

The ACA requires non-grandfathered health plans to pay for “preventive care” on a first-dollar basis, meaning that no copays, coinsurance, or deductibles can be charged for certain services defined as “preventive” under these rules. By: Jessica Waltman, Principal, Forward Health Consulting.

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MedTrainer

AUGUST 31, 2023

Yet, navigating the intricacies of healthcare compliance can be daunting. It’s why we’ve compiled a series of the most common healthcare compliance FAQs and their answers. Any healthcare professional curious about compliance practices will find these answers helpful, insightful, and empowering. What Is Healthcare Compliance?

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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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Healthcare Blog

NOVEMBER 9, 2023

An effective healthcare compliance program is a crucial aspect of any healthcare organization. Healthcare organizations should clearly define their expectations and the consequences for non-compliance. Healthcare organizations should clearly define their expectations and the consequences for non-compliance.

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Compliance Compliance Officers ACA Patient Satisfaction 52

Compliance Now

JULY 14, 2023

By Jessica Waltman Late last week, the Departments of Health and Human Services, Labor, and Treasury (the Departments) published a set of FAQs that clarify how certain surprise billing protections interact with the Affordable Care Act’s (ACA) maximum out-of-pocket limit (OOP) requirements.

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Compliance Now

JULY 14, 2023

By Jessica Waltman Late last week, the Departments of Health and Human Services, Labor, and Treasury (the Departments) published a set of FAQs that clarify how certain surprise billing protections interact with the Affordable Care Act’s (ACA) maximum out-of-pocket limit (OOP) requirements.

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Healthcare IT Today

JANUARY 16, 2025

Levin explains, In this environment, it is more important than ever to have an unbiased third party who can credibly provide transparency tools and pricing analysis in support of ERISA-based fiduciary duty responsibilities and ACA compliance regulations.

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MedTrainer

JANUARY 26, 2024

What compliance regulation most directly affects the operations of a healthcare provider? HIPAA compliance is a fundamental aspect of healthcare operations in the United States, playing a pivotal role in safeguarding patient privacy and data security. Impacts every employee. Impacts technology used.

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HIPAA Compliance ACA Health Insurance 52

Medisys Compliance

APRIL 25, 2023

Need of Choosing Oncology Billing Company As an oncology practice, selecting the right billing company is a crucial decision that can significantly impact your financial success and regulatory compliance. On the other hand, a wrong choice can lead to delayed payments, billing mistakes, and even regulatory non-compliance issues.

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Regulatory Compliance ACA Medical Billing Outsourcing Compliance 52

Healthcare IT Today

OCTOBER 19, 2023

Compliance: Are service delivery systems and interpreters HIPAA compliant? Languages: Do you have reliable access to interpreters with rare language combinations and specialized skill sets? Reporting: Can you access and monitor usage of your language services?

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Health Outcomes ACA Nurses HIPAA 61

Hall Render

JANUARY 10, 2025

Background CMSs 60-Day Rule is a regulation under the Affordable Care Act (“ACA”) that requires health care providers and suppliers to report and return identified Medicare and Medicaid overpayments within 60 days of identifying them. Failure to comply can result in liability under the FCA.

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Compliancy Group

FEBRUARY 12, 2024

Meeting Medical Billing Compliance Standards Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices. Compliancy Group’s healthcare compliance tracking software enables organizations to implement policies, procedures, and training to prevent fraud.

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YouCompli

AUGUST 9, 2023

An opportunity to reframe, regroup, and refocus  Now that the COVID-19 Public Health Emergency (PHE) is well behind us, we have an opportunity to reframe patient expectations – and regroup and refocus on compliance-related patient care needs. You can use commercially available tools or create your own.

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MedTrainer

AUGUST 2, 2023

Auditing helps healthcare organizations maintain accurate and appropriate documentation, optimize revenue, minimize compliance risks, and improve overall operational efficiency. The Importance of Medical Auditing From a compliance standpoint, medical auditing serves several important purposes within healthcare organizations.

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Compliance ACA Medicaid Medicaid 52

Bill of Health

APRIL 13, 2022

In addition to ensuring compliance with the timeline requirements for the unwinding period, this may empower policymakers to quantify the effects of continuous enrollment, as well as different approaches to renewals, to make long-term strategies for improving coverage.

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Physician Credentialing Company

MAY 16, 2024

These organizations are tailored to support healthcare operations through services such as billing and collections, human resources, vendor management, and compliance with regulations. Operational Support: Compliance with healthcare regulations, risk management, and facility management.

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