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.

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Compliancy Group

MARCH 19, 2024

Also, all insurance and Medicare or Medicaid claims must only include charges for services and treatments ordered and deemed necessary. Department of Health and Human Services (HHS) enforces laws relevant to patient care, healthcare delivery and billing, and workplace safety in the U.S. name, phone number).

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

MedTrainer

JANUARY 12, 2024

The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance efforts expanded to encompass EHR security.

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Healthcare Law Blog

JANUARY 26, 2023

The PHS Act requires post-graduate physician training programs that do not perform induced abortions to be deemed accredited and protects governmental payments provided as reimbursement for carrying out health related activities. Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat.

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Compliancy Group

JANUARY 3, 2024

Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices. It pays to know the law and avoid temptations to cut corners.

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Medical Billing Compliance ACA Health Insurance 52

Health Populi

MARCH 11, 2021

health care, patient assistance programs, Medicare Advantage plans, and the bundling of proven high-value preventive services into the Affordable Care Act. These services are enumerated in Section 2713 in the ACA , prompting Dr. Kavita Patel to assert in the first panel of the day that, “2713 is my favorite number.”

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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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MedTrainer

JUNE 28, 2023

From sophisticated Medicare fraud to a rising prevalence of telehealth fraud , healthcare organizations need to be diligent in understanding these threats. The FCA prohibits submitting false or fraudulent claims for payment to government healthcare programs, such as Medicare and Medicaid. Anti-Kickback Statute (AKS).

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Medisys Compliance

NOVEMBER 6, 2023

Compliance with Regulatory Guidelines Ensure that all claims are submitted per all applicable laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and the Medicare Fraud, Waste, and Abuse (FWA) laws.

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Healthcare Law Blog

MARCH 20, 2023

1] In addition to the challenges presented by provider shortages, even when patients are able to locate an available mental health provider, many are hesitant to engage in treatment due to cost uncertainties, which often arise due to limited availability for in-network care and the subsequent need to seek out-of-network care. [2]

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MedTrainer

MARCH 28, 2024

Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations.

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Compliance Compliance Officers Licensing Regulatory Compliance 52

Medisys Compliance

APRIL 25, 2023

It is crucial to verify that the billing company is adhering to industry standards, such as HIPAA (Health Insurance Portability and Accountability Act) regulations, which protect patients’ medical information.

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Regulatory Compliance Compliance Medical Billing Outsourcing ACA 52

Healthcare IT Today

APRIL 10, 2023

The only way to actually change health behaviors—and therefore health outcomes—is by creating motivation on an individual basis. Behavioral Economics at the Core We partner with health insurers and providers to set up a monthly reward system that’s built on behavioral science, utilizing concepts such as loss aversion.

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Health Outcomes Hospitals ACA Doctors 95

Center for Health Insurance Reform

DECEMBER 12, 2022

As part of CHIR’s weekly installment of FAQs from our updated Navigator Resource Guide, we highlight questions about the marketplace and reproductive health care. Continue reading → The post Navigator Guide FAQs of the Week: Coverage of Reproductive Health Care appeared first on Center on Health Insurance Reforms.

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Health Populi

NOVEMBER 19, 2019

In research from HealthPocket , 2 in 5 Americans said they needed to reduce other household expenses to be able to afford their monthly insurance premiums. Four in ten consumers said their monthly health insurance premiums were increasing. Health insurance costs increased a whopping 20.1%

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Health Insurance Hospitals Nurses Doctors 68

Healthcare Law Blog

DECEMBER 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

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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. Once the new rules were published, Vista Health Plan, Inc., 2018 Final Rule, 83 Fed.

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ACA US Department of Health and Human Services Health Insurance 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”). This option is available for five years and ends on March 31, 2027.

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Medicaid Medicaid ACA Public Health 52

CMS.gov

MARCH 6, 2013

By: Christine Stahlecker, Director, Administrative Simplification Group, Office of E-Health Standards and Services, Centers for Medicare & Medicaid Services. These requirements are in place to lower costs, create uniform electronic standards, and streamline exchanges between health care providers and payers.

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Hall Render

SEPTEMBER 1, 2023

ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M

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Kaiser Health News

JULY 6, 2022

. “There are still some gaps that need to be filled,” said Katie Keith, a researcher at the Center on Health Insurance Reforms at Georgetown University. Medicare covers stool tests or flexible sigmoidoscopies, which screen for colon cancer, without cost sharing starting at age 50. The ACA does set parameters.

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Bill of Health

FEBRUARY 27, 2023

This pervasive structure for public health and health care laws caused problems before the New Roberts Court, but COVID-19 politics highlighted the degree to which state officials are turning away from partnering and toward what I call the “state veto.” It would also offer some defense against clear statement rules on steroids.

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Health Populi

MAY 6, 2018

Over time, America’s approach to health care provision fragmented by plan sponsor, whether U.S. 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.

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Medicaid Medicaid Medicare Medicare 54

MedTrainer

NOVEMBER 15, 2023

Department of Health and Human Services The United States Department of Health and Human Services (HHS) is the primary federal agency responsible for protecting the health of all Americans and providing essential human services. Office for Civil Rights The Office for Civil Rights (OCR) is another branch of HHS.

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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.

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Health Populi

OCTOBER 8, 2019

More savings would accrue through the quicker adoption of value-based payment models, the authors assert, where clinicians take on financial risk for managing population health. The Centers for Medicare and Medicaid Services (CMS) forecasts that prescription drug spending will be the fastest-growing cause of rising health spending by 2027.

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Hall Render

AUGUST 19, 2022

Connecticut ditches $20M health information exchange software. Two Health Insurers Grilled for Proposing Rate Increases of 20 and 25 Percent. Kaiser mental health worker strike to expand to Hawaii. Hawaii Health Department reports 2 more monkeypox cases, bringing total to 18. Novant Health patients.

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

Hall Render

OCTOBER 27, 2023

Here’s why Grady Health System recognized as health care I.T. Million Health Care Fraud Conspiracy in Idaho Orthopedic activity in the 5 most underserved states St.

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

Compliance Now

JANUARY 13, 2022

The Biden Administration recently announced the new out-of-pocket (OOP) limits that will apply to group and individual health plans during the 2023 plan year, as well as the Patient-Centered Outcomes Research Institute (PCORI) Fee for plan or policy years ending on or after October 1, 2021, and before October 1, 2022. This is a $.13

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CMS.gov

OCTOBER 22, 2018

New State Relief and Empowerment Waiver Guidance Gives States Tools to Help Fix Broken Health Insurance Markets. Administrator, Centers for Medicare & Medicaid Services. million Americans remain without health insurance. As the ACA regulations took effect, choice plummeted and premiums soared.

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Health Insurance ACA Medicaid Medicaid 55

Bill of Health

MAY 12, 2023

Frequently, in these low-wage positions, workers earn just enough to pay for their health insurance premiums and sometimes the associated cost-sharing requirements. And if a person’s employer offers insurance benefits which exclude IVF, she does not qualify for premium subsidies on the exchanges.

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Healthcare Law Blog

AUGUST 25, 2022

The expansive legislation includes key health care provisions, including drug pricing reforms, inflationary rebates, Medicare Part D benefit redesign, as well as myriad other updates. Medicare Drug Price Negotiation Program. The Inflation Reduction Act (“IRA”) was signed into law by President Biden on August 16, 2022.

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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). The 2023 NBPP final rule makes regulatory changes in the individual and small group health insurance markets and establishes requirements for the 2023 benefit year.

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ACA Health Insurance Medicaid Medicaid 52

Health Populi

MAY 14, 2018

The 50 ways to reform prescription drug pricing include: Increasing competition via promoting innovation and competition and developing proposals to drop Medicaid and ACA programs from raising drug prices in the private market. health consumers/voters want to see, shown in the second graph.

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Prescription Drug Pricing Governance ACA Medicare 48

Hall Render

APRIL 7, 2023

Judge denies challenge to measure that would cap LA hospital exec pay COLORADO Builders show little interest in city, hospital employee housing project Capitol Pain Institute acquires 3 Colorado practices, ASC Colorado lawmakers seek financial information from hospitals in larger debate over health care costs Colorado to advance $1.4

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

Hall Render

JUNE 16, 2023

24 spot in national ranking of life science talent What changes did CT make to its Medicaid program in 2023? Health director New tool tracks gun injuries at D.C. Council approves bill requiring health insurance companies to cover fertility treatment Hospital Must Bargain With Nurses Union, DC Circ. emergency rooms D.C.

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

Health Populi

MARCH 27, 2019

Health insurance was on the collective minds of American voters in the 2018 midterm elections. Health care, broadly defined, drove many people to the polls voting with feet and ballots to protect their access to a health plan covering a pre-existing condition or to protest the cost of expensive prescription drugs.

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