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).

Regulatory Compliance 52

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

Center for Health Insurance Reform

FEBRUARY 10, 2022

Continue reading → The post January Research Roundup: What We’re Reading appeared first on Center on Health Insurance Reforms.

Health Insurance 74

Health Insurance Medicare Medicare ACA 74

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.

Compliance 52

Compliance HIPAA Telemedicine ACA 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.”

Health Insurance 98

Health Insurance ACA Medicare Medicare 98

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.

ACA 72

ACA Health Insurance Licensing Governance 72

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.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

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.

ACA 105

ACA Medicaid Medicaid Compliance 105

MedTrainer

APRIL 8, 2024

These requirements include but are not limited to: Health Insurance Portability and Accountability Act (HIPAA): Protects the privacy and security of patients’ health information. Medicare Access and CHIP Reauthorization Act (MACRA): Promotes value-based care and rewards healthcare providers for quality and performance.

Compliance 52

Compliance Governance ACA HIPAA 52

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.

Compliance 59

Compliance Medical Billing Outsourcing Medical Billing ACA 59

Bill of Health

APRIL 13, 2022

After the PHE, states can facilitate smooth transitions for those no longer eligible for Medicaid by taking advantage of the full 12- to 14- month period that the Centers for Medicare & Medicaid Services (CMS) has established for redetermining eligibility. What States Are Doing Now.

Medicaid 144

Medicaid Medicaid COVID-19 Public Health 144

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).

Fraud 52

Fraud Compliance Governance Compliance Officers 52

MedTrainer

JANUARY 31, 2024

The introduction of laws like the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and the Medicare Modernization Act have added layers of complexity to healthcare compliance.

Compliance 52

Compliance Fraud Governance ACA 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.

Regulatory Compliance 52

Regulatory Compliance Compliance Medical Billing Outsourcing ACA 52

MedTrainer

MARCH 28, 2024

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

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

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.

Health Insurance 50

Health Insurance ACA Medicaid Medicaid 50

Health Populi

MAY 15, 2018

The social determinants of health — income and good jobs, using tobacco, and having health insurance — bolster good health. Light blue to blue is a good thing; the grey area is negative for level of uninsured population and greater self-rationing health care services due to costs.

Health Insurance 74

Health Insurance Health Outcomes ACA Public Health 74

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.

Health Outcomes 87

Health Outcomes Hospitals ACA Doctors 87

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%

Health Insurance 68

Health Insurance Hospitals Nurses Doctors 68

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.

ACA 52

ACA US Department of Health and Human Services Health Insurance Medicaid 52

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]

Medicaid 52

Medicaid Medicaid Licensing ACA 52

Health Populi

MARCH 7, 2018

There’s an old saw that the US government is an insurance company with an army” quips @PaulKrugman @HIMSS #HIMSS18 #HX360 #Healthinsurance #Medicare #Healthcare #Healthcosts. The post Tweets at Lunch with Paul Krugman – Health IT Meets Economics appeared first on HealthPopuli.com. More #nurses than #miners #healthcosts.

ACA 48

ACA Governance Nurses Medicare 48

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.

ACA 80

ACA Medicare Medicare Medicaid 80

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.

ACA 30

ACA HIPAA Medicaid Medicaid 30

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.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Hall Render

SEPTEMBER 1, 2023

ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M Elizabeth Medical Center to receive nearly $400k in federal funds to combat substance abuse UofL lands nearly $12 million grant from National Institute of Health Winchester physician Michael Kuduk, M.D.,

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

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.”

Public Health 246

Public Health COVID-19 Medicaid Medicaid 246

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.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

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.

Medicaid 54

Medicaid Medicaid Medicare Medicare 54

Health Populi

JUNE 2, 2021

The team also calculated annual health care costs per individual, which are expected to be $6,516 in 2021, about 7.6% Each year, I figure out what the average PPO cost could buy someone in exchange for that health insurance. adults living in 17 States and DC who had one of five types of health care coverage, public and private.

COVID-19 174

COVID-19 Health Insurance Health Outcomes Public Health 174

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.

Prescription Drug Pricing 104

Prescription Drug Pricing Medicare Medicare ACA 104

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

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

AUGUST 19, 2022

Connecticut ditches $20M health information exchange software. Two Health Insurers Grilled for Proposing Rate Increases of 20 and 25 Percent. Henry Ford Health reports negative operating margin. Michigan health insurance companies ordered to lower costs. UnitedHealth Group buys Medicare insurer in Texas.

COVID-19 40

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. with historic building purchase MICHIGAN Bronson raises capital campaign goal to $4.5M

US Department of Health and Human Services 40

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

Health Populi

AUGUST 16, 2019

Co-pay accumulators are being discussed across health plan types, including government-sponsored plans like Medicare along with commercial health insurance programs. The margins between voters’ demands for single payer versus Medicare4All versus public option/ACA update may become increasingly thin.

Governance 74

Governance Health Care Reform FDA ACA 74

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

ACA 113

ACA Health Insurance Medicaid Medicaid 113

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. Seema Verma.

Health Insurance 55

Health Insurance ACA Medicaid Medicaid 55