MedTrainer

JUNE 28, 2023

The primary goal of a Certified Fraud Examiner in healthcare is to safeguard the integrity of healthcare systems and protect patients, insurance providers, and government programs from financial losses due to fraudulent activities. Typically, that means looking at the five main Federal laws governing healthcare fraud : False Claims Act (FCA).

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Fraud Compliance Governance Compliance Officers 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. What is Healthcare Compliance?

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Compliance HIPAA Telemedicine ACA 52

MedTrainer

MAY 10, 2024

This process is vital for enhancing the accessibility and affordability of mental health services, aligning with the comprehensive healthcare coverage expansions under the Affordable Care Act ( ACA ). Credentialing confirms the providers’ eligibility to bill for services under government and accreditation regulations. Effective Jan.

Licensing 52

Licensing ACA Medicare Medicare 52

Healthcare Law Today

JANUARY 2, 2023

of a case where the hospital is diligently working on the claims and it's on the sixty-first day and they're still scrambling to go through their spreadsheets, you know, the government wouldn't be bringing that kind of a claim.” For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question.

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Overpayments Overpayment ACA Medicare 52

Healthcare Law Blog

MARCH 20, 2023

In light of the behavioral health shortage, and now that these crucial digital health resources have been established, the most looming priority for private and government payors is to address workforce limitations, which directly lead to accessibility limitations for mental health patients. 6] Increase provider reimbursement strategies.

Medicaid 52

Medicaid Medicaid Licensing ACA 52

Compliancy Group

JANUARY 3, 2024

When auditing claims, medical records, and financial documentation, it is essential to incorporate guidance based on the following questions: Are all codes for services and supplies correct?

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

Physician Credentialing Company

MAY 16, 2024

Regulatory Considerations When evaluating Management Services Organizations (MSOs) within healthcare, it is critical to understand the regulatory landscape that governs their operation. Compliance with Healthcare Laws MSOs must navigate a complex array of healthcare laws and regulations to ensure compliance.

Compliance 52

Compliance ACA Health Insurance Hospitals 52

MedTrainer

AUGUST 2, 2023

Federal Government Audits These audits are performed by government agencies such as the Centers for Medicare and Medicaid Services (CMS). They aim to ensure compliance with federal healthcare programs like Medicare and Medicaid, reviewing claims, billing practices, and overall adherence to program requirements.

Compliance 52

Compliance ACA Medicaid Medicaid 52

Medisys Compliance

APRIL 25, 2023

In addition, you should ensure that the billing company is knowledgeable about and compliant with other relevant regulations, such as the Affordable Care Act (ACA) and the Medicare Access and CHIP Reauthorization Act (MACRA).

Regulatory Compliance 52

Regulatory Compliance ACA Medical Billing Outsourcing Compliance 52

MedTrainer

MARCH 28, 2024

Establishes a governance structure, reviews compliance reports, and ensures the organization operates ethically and within legal boundaries. Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations. Cons: Limited focus on other aspects of compliance beyond their specific areas.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

Health Populi

MAY 6, 2018

government (which offers several flavors of plans through the VA, Tricare for active military, Medicare for aging people and Medicaid for people with low-incomes) or private sector employers, unions, and other insurance-conveners. .” At the time, this was one of the world’s biggest public-sector financed health plan.

Medicaid 54

Medicaid Medicaid Medicare Medicare 54

Kaiser Health News

JANUARY 6, 2022

South Dakota voters will decide in November whether the state should become the 39th to expand Medicaid under the Affordable Care Act, a move that would provide coverage to 42,000 low-income residents. Kristi Noem, a Republican, strongly opposes Medicaid expansion, even though the federal government picks up most of the cost.

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Medicaid Medicaid ACA Governance 124

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

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Compliance Framework Governance Compliance Medicaid 52

Kaiser Health News

MAY 31, 2022

The former generally incurs no cost to patients under the ACA; the latter can generate bills. Remind your provider that the government’s interpretation of the ACA requires that colonoscopies be regarded as a screening even if a polyp is removed.

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ACA Doctors Medical Billing Hospitals 106

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). In states that have not expanded Medicaid, however, many postpartum women lose coverage.

Medicaid 52

Medicaid Medicaid ACA Public Health 52

Kaiser Health News

FEBRUARY 8, 2022

The federal government has penalized 764 hospitals — including more than three dozen it simultaneously rates as among the best in the country — for having the highest numbers of patient infections and potentially avoidable complications. Other hospitals declined to comment or did not respond to emails.

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Medicare Medicare Hospitals COVID-19 125

Center for Health Insurance Reform

JANUARY 20, 2022

The federal government has taken a series of actions to strengthen the Affordable Care Act (ACA) and Medicaid, and the Biden administration has announced its intent to do more in this arena.

ACA 98

ACA Federal Policy Health Insurance Medicaid 98

Hall Render

FEBRUARY 21, 2023

For NFs, the data would be reported via means prescribed by the particular state Medicaid agency. The post Proposed Ownership Disclosure Requirements for Medicare Skilled Nursing Facilities and Medicaid Nursing Facilities appeared first on Law Firm | Health Care Law Firm in the USA | Hall Render.

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Nurses Medicaid Medicaid Medicare 40

Verisys

MARCH 24, 2022

Healthcare facilities receive billions of dollars in federal and state funding through the Affordable Care Act (ACA), Medicare, Medicaid, CHIP, and other programs. government can still impose fines for doing business with these companies, even if an organization’s non-compliance was not intentional. However, the U.S.

ACA 52

ACA Compliance Governance Medicaid 52

Health Populi

SEPTEMBER 17, 2020

In addition, people living in states that failed to expand Medicaid as part of the Affordable Care Act provisions were also at greater risk of inadequate coverage. Early in the pandemic, a team of physicians estimated that 18 million U.S. This at-risk population was more likely to be Black, earning low-incomes, or living in rural areas.

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COVID-19 Health Insurance Public Health Health Care Access 62

Kaiser Health News

JULY 6, 2022

Since late 2010, when this provision of the ACA took effect, many patients have paid nothing when they undergo routine mammograms, get one of more than a dozen vaccines, receive birth control, or are screened for other conditions, including diabetes, colon cancer, depression, and sexually transmitted diseases. The ACA does set parameters.

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ACA Medicare Medicare Medicaid 86

Bill of Health

FEBRUARY 10, 2023

Failing to anticipate litigation that challenges our efforts, such as with the ACA or the upcoming attempt to “codify Roe v. This replacement, “neoliberalism,” has as its central tenet that markets are, in all ways and at all times, superior to government in allocating societal resources.

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Public Health Health Care Reform ACA COVID-19 264

Healthcare Law Blog

JANUARY 26, 2023

BACKGROUND The Proposed Rule is the latest in a long line of federal legislation and rulemakings governing the conscience rights of healthcare providers and entities. The Church Amendments In the 1970s, the federal government enacted the Church Amendments, 42 U.S.C.

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ACA Medicaid Medicaid Compliance 105

Health Populi

MARCH 15, 2021

voters support efforts to expand government subsidies for people to buy health insurance as well as for U.S. State Governors to expand Medicaid. See in this last bar chart that one-half of Republicans supports both financial help for people buying into health plans as well as Medicaid expansion to cover more low-income adults.

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COVID-19 Health Insurance ACA Medicaid 117

AIHC

AUGUST 13, 2024

Written by Corliss Collins , BSHIM, RHIT, CRCR, CSM, CCA, CBCS, CPDC and Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS The 2024 Final Rule for Section 1557 of the Affordable Care Act (ACA) was issued by the Department of Health and Human Services (HHS) on April 26, 2024.

Compliance 52

Compliance ACA Health Insurance Medicaid 52

Hall Render

MAY 2, 2023

Importantly, when the NE ends, the HHS projects that an estimated 15 million individuals will lose Medicaid or CHIP coverage and will be entitled to a special enrollment period to enroll in an employer-sponsored group health plan. With the expiration of the PHE, these requirements will also end.

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Public Health COVID-19 COVID-19 Vaccine ACA 40

Health Populi

MARCH 27, 2019

Because the United States is not urging that any portion of the district court’s judgment be reversed, the government intends to file a brief on the appellees’ schedule.” Twelve million people would lose Medicaid coverage. Even with the continued paring back of aspects of the ACA, 8.5 ” Texas v.

Health Insurance 94

Health Insurance ACA Governance Medicare 94

CMS.gov

NOVEMBER 2, 2018

Just another name for a government-run, single payer system. Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Just another name for a government-run, single payer system. Imagine funding the rest of government, from defense to education, at a level 30 percent less than today, or imagine a $2.5

Governance 55

Governance Medicare Medicare ACA 55

Health Populi

JANUARY 24, 2019

Most Americans believe in building onto existing programs — that is, making incremental changes to what they know-they-know — like expanding Medicaid or Medicare buy-in for people who don’t have health coverage. percent in 2016 at the moment when President Trump promised to “repeal and replace” the ACA.

ACA 67

ACA Medicare Medicare Health Insurance 67

Kaiser Health News

OCTOBER 13, 2022

For the first time, Medicare Advantage plans are poised to enroll more than half of the Medicare population despite allegations that many of the largest insurers are getting billions of dollars in overpayments from the federal government. Democrats were aware of this problem even as they passed the ACA.

ACA 74

ACA Medicare Medicare Governance 74

Health Populi

NOVEMBER 7, 2018

While we have a divided government via split legislature, one winner in the 2018 midterm outcome is Medicaid. In these midterms, governors flipped from Republican to Democrat in Kansas, Maine and Wisconsin, all of whom promised to expand Medicaid through the Affordable Care Act. pharma costs on reference pricing].

Prescription Drug Pricing 40

Prescription Drug Pricing Medicaid Medicaid Medicare 40

Jane Sarashon

DECEMBER 12, 2024

trust the CDC, NIH, and FDA, and most people also want the 47th incoming President Donald Trump to strengthen health/care institutions — from the VA and FDA to Medicare, Medicaid, as well as the CDC and Affordable Care Act. That) American government makes the health and well-being of citizens a priority.” public health.

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FDA Public Health Medicaid Medicaid 52

Healthcare Law Blog

APRIL 27, 2022

The five barriers are: Nondiscrimination in HHS: Civil Rights Protections and Language Access —This area focuses on increasing meaningful access to Medicare, Medicaid, and other federally assisted programs for Limited English proficiency. HHS is working to expand postpartum care via CHIP and Medicaid and identifying ways to improve such care.

Governance 52

Governance ACA Hospitals Medicaid 52

Healthcare Law Blog

MAY 17, 2022

On January 5, 2022, we discussed the Notice of Benefit and Payment Parameters for 2023 proposed rule released by the Centers for Medicare & Medicaid Services (CMS). On April 28, 2022, CMS issued the NBPP 2023 Final Rule. CMS published a Fact Sheet and other resources on April 28, 2022.

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ACA Health Insurance Medicaid Medicaid 52

Hall Render

MARCH 31, 2023

in 2022, survey finds Senate votes to end COVID-19 national emergency Why are 600+ rural hospitals at risk of closing?

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US Department of Health and Human Services Nursing Homes COVID-19 Nurses 40

Kaiser Health News

APRIL 22, 2025

Now, though, the broad federal reduction in force set in motion by the Trump administration has cut the ranks of those caseworkers, slashing two out of six divisions of caseworkers, according to one affected worker and a former Centers for Medicare & Medicaid Services official familiar with the situation, Jeffrey Grant. billion a year.

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ACA Governance Fraud Health Insurance 95

Health Populi

MAY 3, 2019

This was equally true for people whether enrolled in Medicare, Medicaid, or covered by private insurance. Most Americans favored the government ensuring healthcare for all , shown in the chart… but not necessarily running that system. By late 2018, seven in ten Americans had a negative view of the U.S.

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ACA Doctors Health Care Reform Health Insurance 75