Kaiser Health News

APRIL 16, 2024

In turn, sales agents used the information to either enroll them in ACA plans or switch their existing policies without their consent. Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov.

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Fierce Healthcare

SEPTEMBER 19, 2023

Troubled insurtech Bright Health must shell out about $380 million to the Centers for Medicare & Medicaid Services (CMS) over the next 18 months, according to a recent

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Center for Health Insurance Reform

MARCH 31, 2023

The Affordable Care Act (ACA) recently celebrated its 13th anniversary with historic enrollment growth in the health insurance Marketplaces and the lowest-ever recorded uninsured rate.

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Health Insurance ACA Medicaid Medicaid 72

Kaiser Health News

FEBRUARY 8, 2022

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest. Paradoxically, all those hospitals have five stars, the best rating, on Medicare’s Care Compare website.

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Healthcare IT Today

DECEMBER 22, 2020

CMS has released a proposed rule that will require Medicaid managed care plans and other insurers offering products on the ACA Exchanges to support the sharing of patient data amongst themselves.

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Health Populi

JUNE 18, 2021

workers with private insurance more likely report poor access to health care, greater costs of care, and lower satisfaction with care versus people covered by public health insurance plans — whether Medicaid, Medicare, VHA or military coverage. Health Populi’s Hot Points: U.S. households. households.

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HIT Consultant

FEBRUARY 6, 2024

Expanding Payer Reach and Expertise Based in Chicago with 160 experienced professionals, HealthScape offers comprehensive consulting services to payers across all segments, including commercial, Medicare, Medicaid, ACA, and federal.

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Jane Sarashon

FEBRUARY 27, 2024

In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.

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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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Healthcare IT News - Telehealth

AUGUST 29, 2022

Galileo first launched with in-home care for Medicare and Medicaid patients, creating a framework to include social determinants of health in clinical analysis and to bridge gaps in healthcare education. We currently power UnitedHealthcare's Virtual-First ACA Exchange plan in multiple states with more coming in 2023.

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Healthcare IT Today

FEBRUARY 21, 2024

Based in Chicago with 160 professionals, HealthScape helps payers across all segments, including commercial, Medicare, Medicaid, ACA, and federal, navigate the evolving healthcare landscape.

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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. That is why the ACA’s Medicaid expansion doesn’t exist in 11 states , why the penalties for failing to have insurance under the “individual mandate” has been set to $0.00.

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HIT Consultant

JANUARY 31, 2024

Expanding Access and Improving Quality Through this collaboration, both organizations aim to deliver high-quality care through value-based arrangements to patients with diverse insurance coverage, including Medicare, Medicaid, ACA Marketplace, and commercial plans.

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Healthcare Law Blog

JANUARY 26, 2023

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

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HIT Consultant

NOVEMBER 22, 2021

Health Fidelity’s technology uncovers insights that enable better care planning and more complete revenue capture; giving health plans and providers the ability to succeed in risk-sharing arrangements across Medicare Advantage, Affordable Care Act (ACA), Medicaid, and Accountable Care Organization programs.

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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. Coding and billing : All physicians and healthcare providers must maintain accuracy and avoid misconduct in all billing activities. name, phone number).

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

The Health Law Firm

JANUARY 29, 2015

This hypothetical situation begs the question: Why would physicians agree to treat Medicaid patients? Treating Medicaid patients has never been a money maker for physicians. However, for the past two years, Medicaid programs have been required to reimburse primary care providers at Medicare levels, which is typically higher.

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Medicaid Medicaid ACA Medicare 40

Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. In addition, the ACA amended Section 1833(b)(1) of the Act to waive the Part B deductible for screening colonoscopies, which includes moderate sedation services as an inherent part of the screening colonoscopy procedural service.

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MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Affordable Care Act (2010): The ACA introduced the concept of value-based care, emphasizing quality and patient outcomes over quantity of services.

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Compliancy Group

JANUARY 3, 2024

The regulations surrounding medical billing compliance policy come from: Federal laws, such as the Health Insurance Portability and Accountability Act (HIPAA) and Affordable Care Act (ACA) State laws Medicare and Medicaid guidelines Health insurance policies Failure to comply with medical billing compliance regulations can result in: Fines, penalties, (..)

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The Health Law Firm

MAY 9, 2014

Board Certified by The Florida Bar in Health Law The Centers for Medicare and Medicaid Services (CMS) is enforcing fingerprint-based background checks for Medicare suppliers and providers designated as "high risk." Indest III, J.D.,

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HIT Consultant

SEPTEMBER 15, 2021

By integrating Talix’s technology with Edifecs’ signature Encounter Management solution, Edifecs will provide the opportunity for customers to operate risk adjustment processes more efficiently for Medicare Advantage, Managed Medicaid, and Affordable Care Act (ACA) products.

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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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Healthcare IT Today

JULY 18, 2023

The Centers for Medicare & Medicaid Services has expanded Medicare Advantage through 2023 to make the shift, and digital health tools are crucial for support. Additionally, rural patients often receive coverage from Medicare and Medicaid, limiting the providers they can access from an affordability standpoint.

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Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). The public has until 5 p.m.

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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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Healthcare IT Today

JULY 14, 2022

Is the algorithm in question used for Medicare, Medicaid, or ACA populations? Similar situations could arise around specific medical conditions where clustering around common environments for physically distant regions could provide higher volumes of data. Health coverage program.

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Healthcare Law Blog

MARCH 20, 2023

The Kaiser Family Foundation surveyed forty-four state Medicaid officials about strategies to address behavioral health workforce shortages and found the following four categories to be most critical. [6] 8] State Delivery System and Payment Strategies Aimed at Improving Outcomes and Lowering Costs in Medicaid , Kaiser Family Foundation (Jan.

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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

A spokesperson for the Centers for Medicare & Medicaid Services said in an email that the agency is not seeing a pervasive problem, but he declined to provide data on how often such cases occur or how the agents or brokers get the personal information needed to enroll unsuspecting people.

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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. Stay up-to-date on all changes to regulatory requirements.

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Compliance Medical Billing Outsourcing Medical Billing ACA 59

Med-Net Compliance

NOVEMBER 8, 2022

The inspection objective was to determine whether the direct care licensed nursing hours recorded at the nursing home supported the hours submitted to the US Centers for Medicare & Medicaid Services (CMS) in compliance with federal requirements.

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Nursing Homes Nurses US Department of Health and Human Services Licensing 59

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

Healthcare IT Today

APRIL 10, 2023

Notably, our payer clients have measured drastic savings to medical costs by preventing hospitalizations and ED visits, and we’ve helped Medicare Advantage plans achieve higher Star ratings. Medicare Advantage, Medicaid, ACA/Exchange) that share in our mission.

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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).

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Regulatory Compliance Compliance Medical Billing Outsourcing ACA 52

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. When it comes to healthcare, knowing who you’re doing business with matters.

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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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