MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the Bureau of Facility Standards , provide oversight with certain standards, adding a layer of complexity to successfully managing healthcare compliance in Idaho. Continue reading this overview for key aspects of healthcare compliance specific to the state of Idaho.

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MedTrainer

JANUARY 12, 2024

At its core, healthcare compliance ensures the quality of care, patient safety, and integrity of healthcare systems. Over the years, healthcare compliance has evolved significantly, driven by changing regulations, advances in technology, and a growing emphasis on patient-centric care. What is Healthcare Compliance?

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MedTrainer

NOVEMBER 27, 2023

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

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MedTrainer

DECEMBER 7, 2023

To sail smoothly through the complex rules and requirements, you need a deep knowledge of the most essential aspects of healthcare compliance in Maine. A successful compliance program involves adaptability, comprehensive planning, and insight into key compliance factors, including credentialing requirements.

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MedTrainer

MAY 3, 2024

Non-compliance with these regulations can result in jail time, large fines, and even loss of license. Keeping compliance and fraud prevention top of mind can help to protect both your organization and its staff. For those who are not, there are five main federal laws they are likely violating related to healthcare fraud.

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MedTrainer

NOVEMBER 20, 2023

Managing healthcare compliance in Texas is nuanced and challenging. For successful compliance management in Texas, healthcare organizations need to develop a strong system for tracking and interpreting regulatory changes, and promptly adapt to these modifications.

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Verisys

NOVEMBER 3, 2023

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Healthcare Fraud Crackdown! to Pay $32.5

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MedTrainer

DECEMBER 7, 2023

Healthcare compliance in New Mexico mirrors the state’s diverse culture, with unique regulations that differ from other states, such as credentialing documentation requirements for managed care organizations. To participate in the Medical Cannabis Program, providers must complete a Medical Provider application.

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MedTrainer

NOVEMBER 17, 2023

This model involves specific regulations and agreements with Medicare and Medicaid, impacting how healthcare providers in the state bill for services and receive payments. Both the Maryland Department of Health – Behavioral Health Administration and the Board of Physicians license medical and mental/behavioral health providers.

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Innovaare Compliance

JANUARY 15, 2024

The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. This blog delves into the details of these changes and their implications for plan sponsors and beneficiaries. The transformational changes in 2025 are highlighted below.

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Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”).

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Healthcare Compliance Blog

APRIL 19, 2022

A Mississippi man conspired with other individuals to provide fraudulent statements to Medicare for reimbursements of claims for patient treatment and prescriptions. The events took place between January 2016 through March 11, 2019, during which time the man claimed to be a licensed physician in the state of Mississippi.

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MedTrainer

SEPTEMBER 8, 2023

Maintaining compliance with healthcare regulations and standards isn’t just a legal requirement; it’s a crucial element in upholding patient safety, data security, and the overall integrity of healthcare practices. Hear more on compliance essentials from a panel of expert healthcare surveyors. Why Is Healthcare Compliance Important?

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MedTrainer

OCTOBER 16, 2023

This is the essence of corporate compliance in healthcare. Just as every piece of the puzzle must fit perfectly, every compliance element in healthcare needs precise integration to ensure seamless, ethical, and effective operations. Dive with us as we explore the complexities and necessities of compliance in the healthcare sector.

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Provider Trust

SEPTEMBER 29, 2022

Mendez, who was a physician assistant at CCI Therapy Counseling Centers International, was working with a suspended medical license. However, despite his suspended medical license, Mendez continued to treat patients at various mental health clinics in Brownsville, Harlingen, and Pharr, TX. How Often Should You Verify Employee Licenses?

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MedTrainer

OCTOBER 4, 2023

To ensure organizations meet these standards, federal healthcare compliance requirements have been put in place. Let’s look at some of the key federal healthcare compliance requirements, state-specific variations, and accreditation standards healthcare organizations must adhere to. What Are Federal Healthcare Compliance Requirements?

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Verisys

MAY 9, 2023

Data Compliance: 3 Focus Areas for Mitigating Organizational Risk A three-part compliance series that focuses on using technology to help you achieve your compliance goals. There is no question that healthcare organizations should have an effective healthcare compliance program.

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MedTrainer

MARCH 30, 2024

Enrollment delays cost nearly a third of organizations polled in a 2023 MedTrainer survey money, and 26% believe credentialing delays increase compliance risks that can significantly drain coffers. Any delay in the provider enrollment process means less revenue for the organization – and the longer the holdup, the harder the hit.

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MedTrainer

MAY 10, 2024

It can also be a prerequisite for enrolling with an insurance network or Medicare for the first time. Here’s what a typical credentialer’s workflow looks like: Like other providers, mental health professionals must be licensed in states where they offer services and enrolled with payers doing business in those areas. Effective Jan.

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Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. Watch the Webinar During the Keynote Speech at the HCCA Compliance Institute this year, Office of Inspector General (OIG) Christi A.

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MedTrainer

MAY 4, 2023

That includes many compliance professionals. There are plenty of compliance implications for the end of the Public Health Emergency on May 11, 2023 , and an assessment is a great place to start. This article will focus on the federal changes, but make sure to check with all states where your providers are licensed to stay up-to-date.

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Verisys

MAY 13, 2024

April 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network.

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Verisys

JUNE 8, 2023

Data Compliance: How to Identify and Close Data Risk Gaps Using Technology A three-part compliance series that focuses on using technology to help you achieve your compliance goals. Hiring a provider with red flags, even if in the past, can put your organization at risk for non-compliance.

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MedTrainer

FEBRUARY 5, 2024

In this blog, we’ll discuss the two processes and key differences between provider enrollment and credentialing. Provider enrollment is when a healthcare provider is registered with insurance networks or government payers , like Medicaid or Medicare. So, what is the difference between provider enrollment and credentialing?

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Hall Render

JUNE 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) recently imposed financial penalties for the first time against two hospitals for failure to comply with the Hospital Price Transparency Rule requirements. CMS began auditing compliance with the Hospital Price Transparency Rule in early 2021. First Reported Penalties.

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MRO Compliance

JUNE 1, 2022

Each year HEDIS rating criteria is updated, meaning your organization needs to stay up-to-date on the latest news and trends for HEDIS compliance audits. HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. Compliance with HEDIS specifications.

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Verisys

MARCH 8, 2024

February 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M Peters Physician Pleads Guilty to False Statements, Resulting in $1.4

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MedTrainer

JULY 28, 2023

That mean, maintaining compliance standards, efficient reporting, and conducting thorough internal audits are vital. OIG Inspections in Healthcare The OIG focuses its resources on oversight of Medicare and Medicaid — programs that represent a large portion of the federal budget. Medicare/Medicaid Compliance Reviews.

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YouCompli

APRIL 27, 2022

As more healthcare professionals obtain licensure under compacts, compliance officers need to be aware of interstate licensure requirements – and their effects on patient care. The Nurse Licensure Compact (NLC) is an interstate agreement allowing nurses to practice in multiple states with one multistate license issued from their home state.

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Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

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YouCompli

JANUARY 4, 2022

Hughes and Cosgrove addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance Forum in December 2021. This recap of their remarks looks at how they worked with providers to stay in compliance as demand for telehealth surged with the Pandemic. Interstate licensing for telehealth.

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Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. Case Study: S.

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YouCompli

JUNE 29, 2022

With it, compliance officers have guided their healthcare organizations in complying with changing documentation, coding, and confidentiality requirements. As virtual care requirements for telehealth evolve, we explore how compliance officers can support patient care and help their organizations stay up to date. the end of COVID-19.

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Verisys

FEBRUARY 9, 2024

January 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network.

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MedTrainer

FEBRUARY 20, 2024

In this blog, we’ll review what is insurance credentialing, the process, and who’s required to complete insurance credentialing. While these professions do require credentialing, many other licensed healthcare providers require insurance credentialing as well. There are many steps to this time-consuming process.

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Verisys

APRIL 2, 2024

March 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare Fraud Scheme ( Full Story ) New York-Presbyterian/Brooklyn Methodist Hospital Settles Health Care Fraud Claims for $17.3 Secure your success by choosing Verisys.

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YouCompli

AUGUST 29, 2023

Health and Human Services Office of Inspector General (OIG) found that Medicare beneficiaries used 88 times more telehealth services during the first year of the pandemic than they did the previous year. million in Medicare fee-for-service payments. million in Medicare fee-for-service payments. It involved an estimated $1.2

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