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

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. Under the ACA, sliding-scale subsidies are available to help low- and moderate-income people buy coverage.

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ACA Health Insurance Licensing Governance 72

Health Populi

FEBRUARY 18, 2020

Chartis found nine of these to be most important in predicting closure: average age of the plant, case mix index, government control status, percentage capital efficiency, percentage change total revenue, percentage occupancy, percentage outpatient revenue, system affiliation, and state-level Medicaid expansion status.

Hospitals 103

Hospitals Medicaid Medicaid Health Care Reform 103

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

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

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.

Overpayments 52

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

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.

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Compliance Compliance Officers Licensing Regulatory Compliance 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-19 123

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

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 Compliance ACA Medical Billing Outsourcing 52

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.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

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

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 80

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.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

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

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.

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ACA Federal Policy Health Insurance Medicaid 98

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.

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Medicaid Medicaid Medicare Medicare 54

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

Hall Render

NOVEMBER 27, 2023

11 Plan To Slash $1.5B face growing challenges to stay open KENTUCKY BehaVR merges with New York City-based Fern Health For years, a powerful Louisville hospital sued people for unpaid bills.

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US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

Hall Render

AUGUST 19, 2022

PruittHealth CEO: Nursing Home Operators Can’t Break Into Small Markets Without Government Support. ‘The unwinding’: Idaho Medicaid must recheck eligibility for 131K people when U.S. Failed Medicaid expansion negotiations reveal N.C. ACA health plan costs to drop sharply in Virginia. emergency ends.

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

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.

Public Health 40

Public Health COVID-19 COVID-19 Vaccine ACA 40

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?

US Department of Health and Human Services 40

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

Hall Render

OCTOBER 27, 2023

Ransomware attacks against hospitals put patients’ lives at risk, researchers say States, FTC continue to target noncompetes: 3 updates The best hospital in each state, per Newsweek What to know about Stark law’s $9.2M Here’s why Grady Health System recognized as health care I.T.

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

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 Health Outcomes 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

JANUARY 27, 2023

California’s healthcare worker retention payments to start in February Julie Miller-Phipps to retire after 45-year career with Kaiser Permanente COLORADO By the numbers: How pandemic-induced staffing issues are leaving Colorado seniors out in the cold Colorado’s rural hospitals could get $3 million a year to end inpatient care.

US Department of Health and Human Services 40

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

Health Populi

MAY 14, 2018

Seniors and government programs over-paying for drugs. Foreign governments’ “free-riding” Americans’ investment in innovation. The blueprint for restructuring the prescription drug industry, is called “American Patients First,” addressing four challenges: High list prices for drugs.

Prescription Drug Pricing 48

Prescription Drug Pricing Governance ACA Medicare 48

Healthcare Law Blog

MAY 25, 2022

She filed suit under Section 504 of the Rehabilitation Act (“Rehab Act”) and Section 1557 of the Affordable Care Act (“ACA”), two federal statutes that prohibit recipients of federal funding from discriminating in the delivery of services based on disability. As explained below, the Supreme Court affirmed the Fifth Circuit ruling.

ACA 52

ACA Governance Medicaid Medicaid 52

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 112

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

Hall Render

FEBRUARY 4, 2022

Florida’s ACA enrollment is tops nationally, but Medicaid expansion questions remain. Governor Hochul Announces Additional Support from Federal Government to Provide Military Medical Teams to Upstate Hospitals. Up to 80,000 Ohioans could end up on different health plan in reformed Medicaid system. SOUTH DAKOTA.

COVID-19 40

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

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. This last chart makes the point that if you have a connection to Medicaid, you tend to see it as “health insurance” versus a “welfare program.”

Medicaid 62

Medicaid Medicaid Medicare Medicare 62

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 93

Health Insurance ACA Governance Medicare 93

Health Populi

OCTOBER 19, 2020

Having the Federal government paying for testing, tracking, and treatment for COVID-19. Women, being Chief Health Officers of their Families, influencing 80% of health care decisions, well know how to connect the dots between health care costs and their household financial wellness.

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COVID-19 Health Insurance Prescription Drug Pricing ACA 105

HIT Consultant

OCTOBER 10, 2023

Section 1557, known as the “Health Care Rights Law,” is the main nondiscrimination provision of the Affordable Care Act (ACA). Carla Fogaren R.N., It prohibits discrimination in healthcare based on factors like race, ethnicity, language, age, disability, and sex.

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Compliance ADA Informed Consent ACA 111

Hall Render

MAY 12, 2023

Connecticut is weighing several changes to Medicaid. Here’s what it means. Cloud Hospital names Chief Quality Officer Tampa’s Lions Eye Institute adopts new name Troubled Cano Health records $60.6M Cloud Hospital names Chief Quality Officer Tampa’s Lions Eye Institute adopts new name Troubled Cano Health records $60.6M

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