Bill of Health

MAY 22, 2023

The selections feature topics ranging from an analysis of government and industry investments for recently approved drugs, to a discussion of court decisions on mifepristone, and an examination of the added therapeutic benefit associated with the top-selling brand-name drugs in Medicare. Cliff ERS, Kesselheim AS, Rome BN, Feldman WB.

Pharmaceutical Industry 157

Pharmaceutical Industry Medicare Medicare Medicaid 157

Medisys Compliance

JULY 13, 2023

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

Medicare 52

Medicare Medicare Medical Billing Outsourcing Health Outcomes 52

Medisys Compliance

MAY 19, 2022

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. Eligible services.

COVID-19 52

COVID-19 Medicare Medicare Medical Billing 52

Healthcare Law Today

DECEMBER 15, 2022

The case asks whether the government has authority to dismiss an FCA suit after initially declining to proceed with the action, and if so, what standard would apply. Petitioner-Relator Polansky is a doctor and former consultant for Executive Health Resources (EHR), a company that submits claims to Medicare on behalf of health care providers.

Governance 52

Governance Doctors Medicare Medicare 52

Hall Render

JUNE 8, 2023

On June 7, CMS issued a much-anticipated Final Rule addressing the placement of Medicare Advantage patient days within the Medicare DSH calculation. The Final Rule adopts a retroactive policy that will place Medicare Advantage days in the Medicare Fraction of the DSH calculation for discharges before October 1, 2013.

Medicare 40

Medicare Medicare Hospitals Governance 40

Hall Render

JUNE 16, 2023

The Court’s opinion settles two outstanding questions about the authority of the Government to dismiss FCA actions in which it first declines to intervene but that whistleblowers continue to pursue on the Government’s behalf. The Government and Defendants favored the broadest authority permitted in the D.C.

Governance 40

Governance Medicare Medicare Hospitals 40

Medisys Compliance

JUNE 10, 2022

Medicare covers limited chiropractic services when performed by a chiropractor who is licensed or legally authorized to furnish chiropractic services by the State or jurisdiction in which the services are furnished. In this article, we shared coding guidelines and Medicare coverage for Chiropractic Manipulative Treatment (CMT).

Medicare 59

Medicare Medicare Medical Billing Medical Billing Outsourcing 59

Bill of Health

JULY 15, 2022

The selections feature topics ranging from a discussion of potential pathways to enable government patent use before nonpatent exclusivities expire, to an examination of medical oncologists who receive more than $100,000 annually from pharmaceutical companies, to an analysis of the launch prices of new drugs from 2008-2021. JAMA Intern Med.

Public Health 205

Public Health Medicare Medicare Governance 205

Hall Render

DECEMBER 20, 2023

Finalized Revisions to Form CMS-855A For SNFs, the aforementioned data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). Hall Render blog posts and articles are intended for informational purposes only.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

AIHC

MARCH 12, 2024

Written by the AIHC Education Department This article provides an overview of how the media and government are reacting to the potential of artificial intelligence (AI) and potential threats associated with this advanced technology. A Government-Commissioned Report Released February 2024 The U.S.

Ransomware 59

Ransomware Governance Compliance HIPAA 59

Hall Render

FEBRUARY 23, 2024

Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, with qui tam actions accounting for over $2.3 Health Care Fraud Actions Medicare Advantage. As the largest component of Medicare, Medicare Advantage (Medicare Part C) was a target in 2023. billion of the $2.68

Compliance 71

Compliance Governance Medicare Medicare 71

AIHC

MARCH 12, 2024

Written by the AIHC Education Department This article provides an overview of how the media and government are reacting to the potential of artificial intelligence (AI) and potential threats associated with this advanced technology. A Government-Commissioned Report Released February 2024 The U.S.

Ransomware 52

Ransomware Governance Compliance HIPAA 52

Total Medical Compliance Resources

APRIL 14, 2023

FACT SHEET: Biden-Harris Administration Makes Progress in the Whole-of-Government Response to Long COVID U.S. Diagnosis code education: The Centers for Medicare and Medicaid developed educational materials for providers so they can use the new ICD-10 code for Long COVID. It also lays out a path for future inquiry.

Governance 59

Governance COVID-19 Department of Veterans Affairs COVID-19 Vaccine 59

Healthcare IT Today

NOVEMBER 15, 2023

The previous article in this series explained some of the ways payers, providers, and digital health companies demonstrate that they have made a positive difference in their patients’ lives. ” This article looks at the measurements and reporting strategies used by some specific companies. offering in-home treatment.

Medicare 113

Medicare Medicare Hospitals Compliance 113

Medisys Compliance

MAY 20, 2024

This article dives into the world of mental health services reimbursement rates, empowering providers with knowledge to navigate this complex system. Payer type: Private insurance companies, Medicare, and Medicaid have their own reimbursement structures. What are Reimbursement Rates?

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Medicare 59

Hall Render

FEBRUARY 21, 2023

For SNFs, the data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). Hall Render blog posts and articles are intended for informational purposes only. For NFs, the data would be reported via means prescribed by the particular state Medicaid agency.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

Medisys Compliance

MARCH 5, 2024

This article explores into the details of cardiology billing, offering insights into payer audits and reimbursement challenges in cardiology billing. This complexity is reflected in the coding and billing requirements set forth by government payers such as Medicare, as well as private insurance companies.

Medical Billing Outsourcing 105

Medical Billing Outsourcing Medical Billing Compliance Governance 105

YouCompli

MARCH 22, 2023

According to the OIG, prior error rate testing has suggested an improper payment rate of almost 30% for Medicare. Urine Drug Testing Enforcement Specifics The enforcement and settlement amounts highlighted at the beginning of this article share some common alleged non-compliant behaviors. Some were never tested at all.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

HIT Consultant

AUGUST 6, 2023

Often, insurance or the government covers part of the healthcare costs, but if a patient doesn’t have healthcare coverage, they will be responsible to reimburse their providers for the entire cost of the care. They are no longer simply a place for aging Medicare and Medicaid patients to live out their final years. percent of U.S.

Nursing Homes 98

Nursing Homes Nurses Medicare Medicare 98

Bill of Health

JANUARY 3, 2023

A potential constitutional basis for federal licensure could hinge on the Commerce Clause in Article I, which grants Congress the power “To regulate commerce with foreign nations, and among the several states, and with the Indian tribes.”. Invoking the landmark 1824 case Gibbons v. Tenth Amendment and “Police Power”. Marino et al.,

Licensing 130

Licensing Telemedicine Governance Federal Policy 130

Healthcare IT Today

JANUARY 17, 2024

The following is a guest article by Ritesh Ramesh, CEO at MDaudit Safeguarding revenues in the coming year requires healthcare systems to proactively navigate an evolving landscape with cross-functional collaboration, technological innovation, and increased AI investments. healthcare organizations.

Compliance 115

Compliance Overpayments Overpayment Medicare 115

Medisys Compliance

FEBRUARY 27, 2024

In this article, we will explore the complex landscape of radiology billing compliance, exploring key regulations, audit processes, and strategies for ensuring adherence to guidelines. Understanding Regulatory Framework Radiology billing is governed by a multitude of regulations at the federal, state, and local levels.

Compliance 59

Compliance Medical Billing Outsourcing Medicare Medicare 59

Healthcare IT Today

FEBRUARY 17, 2023

Amid swirling accusations that Medicare Advantage Organizations (MAOs) are overbilling the U.S. government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. They expect to recoup 4.7 But the needles pile up fast.

Overpayments 106

Overpayments Overpayment COVID-19 Medicare 106

Healthcare IT News - Telehealth

JANUARY 11, 2023

This article was updated with additional comments. Guth also said that Medicaid program respondents also indicated that they are awaiting federal guidance to inform their long-term telehealth policy decisions, such as Medicare policies. WHY IT MATTERS. " THE LARGER TREND.

Medicaid 142

Medicaid Medicaid Medicare Medicare 142

Healthcare IT Today

JULY 23, 2023

This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Welcome to the weekly edition of Healthcare IT Today Bonus Features. The American Telemedicine Association will host its third annual Telemedicine Awareness Week from Sept. 17 to 23.

Medicare 96

Medicare Medicare Telemedicine Public Health 96

MedTrainer

MAY 21, 2024

The Centers for Medicare and Medicaid Services (CMS) defines behavioral health as the emotions and behaviors that affect your overall well-being. This article will explore the requirements for behavioral health training, the entities that govern required and recommended courses, and ways to simplify training delivery.

Compliance 52

Compliance Medicaid Medicaid HIPAA 52

Health Populi

JUNE 28, 2019

Sanders, noting his call for big new government benefits like universal health care through Medicare for All and free college tuition. Senator Harris, too, mentioned government benefits like free college and Medicare for All as her health plan preference. Lester Holt began with Sen. ” Sen.

Medicare 70

Medicare Medicare Health Insurance Governance 70

Healthcare Law Blog

JUNE 21, 2023

(“Merck”), as well as four chambers of commerce , have filed suits against the federal government, arguing that the Medicare Drug Price Negotiation Program introduced by the Inflation Reduction Act of 2022 stands in violation of multiple constitutional provisions. What is the Medicare Drug Price Negotiation Program?

Medicare 52

Medicare Medicare Public Health Governance 52

Healthcare IT Today

MAY 13, 2024

The following is a guest article by Nitin Kunte, Sr. Providers not using certified EHR may face downward payment adjustments to their Medicare reimbursements in the affected payment year. Governance and Monitoring: Set up a governance model to monitor compliance.

Compliance 110

Compliance Governance Medicare Medicare 110

Healthcare IT Today

FEBRUARY 7, 2024

This article explains the complexities that makes it so hard to implement electronic prescribing for controlled substances (EPCS), summarizes the intended impacts of the bills, and introduces Imprivata digital identity technology, which has been used in health care for such purposes for many years. Two bills in U.S.

Telemedicine 119

Telemedicine Doctors COVID-19 Medicare 119

AIHC

NOVEMBER 29, 2023

We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article. Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. Why this Trend of Value-Based Care?

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Medisys Compliance

MARCH 14, 2023

In this article, we shared wound care reimbursements in certain healthcare facilities. DRGs are a payment classification system used by Medicare and other insurance providers to categorize patients into groups based on their diagnosis, severity of illness, and the resources required for their care.

Payment Systems 52

Payment Systems Medical Billing Medicare Medicare 52

Healthcare IT Today

OCTOBER 18, 2023

Previous articles in this series showed why social determinants of health (SDoH) are the hottest recent addition to data used by the medical industry. This article shows how organizations are collecting it. We’ve explored how SDoH data is defined and shared. The percentage is much higher in some areas.

Doctors 123

Doctors Public Health Medicare Medicare 123

Bill of Health

JANUARY 10, 2022

This is because the questioning , directly and by implication, calls into doubt what past Courts have identified the framework of federalism — a nickname for the Constitution’s balancing of a strong federal government against the rights of individual states. Exceeding the Authority of the Federal Government.

Governance 236

Governance Federal Policy Public Health Medicaid 236

Healthcare IT Today

JUNE 29, 2023

The following is a guest article by Isaac Smith, Billing, Coding, and Reimbursement Specialist at Medcare MSO ASCs are types of medical facilities that are subject to stringent regulations. Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

YouCompli

APRIL 13, 2022

This month’s article looks at beneficiary inducement actions. But tactics common in other industries might be considered illegal beneficiary inducements in healthcare, especially for beneficiaries of federal programs like Medicare or Medicaid. Deflated Medicare copayment and ‘courtesy adjustments’ for injections.

Medicare 40

Medicare Medicare Governance Compliance 40

MedTrainer

APRIL 8, 2024

As a healthcare professional, it is vital to maintain compliance with the 629 legal and regulatory requirements that govern the delivery of quality care. Legal And Regulatory Requirements In Healthcare More than 620 legal and regulatory requirements govern how the healthcare industry ensures patient safety, privacy, and quality of care.

Compliance 52

Compliance Governance ACA HIPAA 52