Hall Render

JULY 28, 2023

Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”). Jent at (317) 977-1402 or bjent@hallrender.com ; Lauren G.

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Medicare Medicare Compliance COVID-19 40

CMS.gov

NOVEMBER 2, 2018

CMS BLOG: Medicare for All? Seema Verma, Administrator, Centers for Medicare & Medicaid Services . Medicare Part C. Medicare Part D. Medicare for All? When listening to those advocating ‘Medicare for All’ it’s good to be skeptical about their promises. keya.joy-bush@…. Fri, 11/02/2018 - 21:32.

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Governance Medicare Medicare ACA 55

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

Provider Trust

MARCH 21, 2023

Grimm gave a lecture at the 2023 RISE National Conference in early March 2023 about Medicare Advantage, or Medicare Part C, and the increased risk of fraud due to the rapid growth of healthcare programs. This year, 50% of Medicare enrollees are expected to sign up for Medicare Advantage.

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Fraud Medicare Medicare US Department of Health and Human Services 52

Healthcare Law Blog

MAY 22, 2023

With the Medicare Comprehensive Error Rate Testing program projected error rate for skilled nursing facilities (SNFs) showing a significant increase in 2022 (15.1%, up from 7.9% If you have questions about CMS’ probe and education review process, the Healthcare Team at Sheppard Mullin is available to assist.

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Medicare Medicare Medicaid Medicaid 52

Healthcare It News

OCTOBER 31, 2022

"Our combined efforts are expected to demonstrate how best to advance our nation’s technical infrastructure to enable SDOH interoperability as supported by ONC’s United States Core Data for Interoperability (USCDI) Version 2," ONC authors Ryan Argentieri, Samantha Meklir and Jawanna Henry wrote in ONC's HealthITbuzz blog.

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Licensing Health Outcomes Medicaid Medicaid 272

Hall Render

MAY 16, 2023

Could it be that CMS is implementing changes in the Medicare Communications and Marketing standards that will change the content and tone of the omnipresent television and radio advertisements targeted at potential enrollees? CMS realized that people are making choices about which plan to choose based on this information.

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Medicare Medicare 40

MedTrainer

OCTOBER 13, 2023

Because no one talks about it. But, the fact is, no one ever talks about going back to black and white TV. Just like no one talks about going back to a paper credentialing process. Learn more about digital credentialing in the Secrets to Speed Up Your Credentialing Process.

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Healthcare Law Blog

JANUARY 17, 2024

workflow and performance assessment, data analytics, and certain Medicare eligibility and performance assistance). On December 28, 2023, the Office of Inspector General (the “OIG”) issued a favorable Advisory Opinion (No. The OIG explained that the Requestor provides consulting services for practice optimization to physician practices (i.e.,

Medicare 52

Medicare Medicare Payment Systems Compliance 52

Health Law Attorney

DECEMBER 18, 2020

The Centers for Medicaid & Medicare Services ( CMS ) recently released the 2021 Physician Fee Schedule ( PFS ) Final Rule. Since the beginning of the pandemic, CMS has added 144 telehealth services to the list of Medicare-covered services. million Medicare beneficiaries receiving telemedicine services during the pandemic.

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Medicare Medicare COVID-19 Telemedicine 40

MedTrainer

JUNE 29, 2023

Individuals or entities found in violation of Stark Law may face exclusion from participation in federal healthcare programs such as Medicare and Medicaid. Organizations that violate Stark Law may also face the loss of Medicare and Medicaid reimbursements. Professional Reputational Damage.

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Compliance Compliance Officers Medicaid Medicaid 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The SRFs include low-income subsidy, dual eligibility (meaning eligible for Medicare and Medicaid) and disability.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Hall Render

FEBRUARY 21, 2023

It highlights the desire by CMS to receive accurate and up-to-date information about owners and operators to ensure that they are providing high-quality care to patients. For SNFs, the data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”).

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Nurses Medicaid Medicaid Medicare 40

Healthcare IT Today

DECEMBER 22, 2023

Wave HDC offers several insurance “curators” including Coordination of Benefits, Eligibility, and Medicare Beneficiary Identifiers, and serves hospitals, laboratories, billing companies, and physician groups. To learn more about how providers can benefit from these enhanced offerings from Experian Health, read our Global News Blog.

Medical Billing 100

Medical Billing Hospitals Medicare Medicare 100

Hall Render

MARCH 21, 2022

Aetna, one of CVS’s clients, had years earlier conducted an internal investigation in which its attorneys analyzed statements made by CVS about its commercial pricing and Medicare rates—the issues at the core of the ongoing FCA action. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 40

Medicare Medicare 40

MedTrainer

JUNE 15, 2022

This is the case for proposed changes to the Medicare Shared Savings Program, as they’ll impact ACOs in more ways than one if they’re enacted. Before we discuss the proposed changes to the Medicare Shared Savings Program, let’s take a moment to review ACOs. What Are the Changes to the Medicare Shared Savings Program?

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MRO Compliance

SEPTEMBER 21, 2023

We then chatted about the need for payers and providers to work together in order to improve patient experience, and more broadly, requester experience. We are starting to talk about clinical data more broadly than just medical records. You can think about images and the components of a medical record.

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Medicare Medicare 169

MedTrainer

SEPTEMBER 20, 2023

If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Accreditation.

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Medicaid Medicaid Medicare Medicare 97

MRO Compliance

AUGUST 3, 2022

This blog post serves as a summary to increase efficiency and security in the audit process. Consider auditing software that can instantly transmit charts, discussions, and appeal filings to Medicare, Medicaid and commercial auditors, preventing file loss and delivery delay. Audit Software Helps You Work Smarter, Not Harder.

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Compliance Officers Medicare Medicare Compliance 130

Healthcare Law Blog

JANUARY 31, 2023

This blog is the second installment of our Digital Health Trends series. vii] With the onslaught of public and private companies offering virtual services for behavioral health, there are data and privacy concerns particularly with consumers wondering about who owns the data from these virtual visits. In December 2022, the U.S.

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COVID-19 Medicare Medicare Medicaid 105

Hall Render

JANUARY 24, 2024

CMS introduced an updated Medicare Cost Report e-Filing system (“MCReF”) and related templates to allow Medicare Part A providers the ability to electronically file to their Medicare contractor supporting documentation in addition to their cost report for fiscal years ending on or after December 31, 2017.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Kaiser Health News

APRIL 4, 2024

Meanwhile, President Joe Biden, gearing up for the general election campaign, is highlighting his administration’s health accomplishments, including drug price negotiations for Medicare. Little-Known Rules May Ease the Choice in Medicare Advantage ,” by Susan Jaffe. Learn more about KFF. ” by Jeff C.

Medicare 71

Medicare Medicare ACA Public Health 71

Healthcare Law Blog

JANUARY 9, 2024

Somatus, a kidney care company, talked about the challenge of identifying early stage kidney disease in patients – a difficult challenge – which, if possible, can potentially result in the delay or halting of decline into end stage kidney disease. So let’s take a look at what was said about cancer today at J.P. Morgan’s conference.

Medicare 59

Medicare Medicare Hospitals Doctors 59

Health Law Advisor

SEPTEMBER 1, 2023

On August 29, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the ten (10) Medicare Part D drugs selected for the first round of negotiations of the Medicare Drug Price Negotiation Program (Program)—a few days before the September 1, 2023, statutory deadline imposed by the Inflation Reduction Act (IRA).

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Medicare Medicare Licensing Medicaid 69

Hall Render

FEBRUARY 15, 2022

In December 2021, the Office of Inspector General (“OIG”) of the Department of Health and Human Services published an Issue Brief titled “Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than Wholly Owned Settings” (“Brief”)(available here ). Issue Brief Findings.

Medicare 40

Medicare Medicare Hospitals Compliance 40

McBrayer Law Blog

FEBRUARY 8, 2022

Posted In Centers for Medicare & Medicaid Services (“CMS”) , COVID-19 , Mandatory vaccination policies More > Tags: Centers for Medicare & Medicaid Services , CMS , COVID-19 , employer mandate , Healthcare Compliance Issues , Healthcare Provider , Healthcare Providers , Mandatory vaccination.

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COVID-19 Medicaid Medicaid Medicare 52

Healthcare Law Blog

DECEMBER 1, 2023

HHS-OIG conducted investigations resulting in 661 criminal actions against individuals related to Medicare and Medicaid, as well as 726 civil actions, including false claims, unjust-enrichment lawsuits, and civil monetary penalty settlements. Enhancing program integrity in noninstitutional care settings, such as home health and hospice care.

COVID-19 52

COVID-19 Fraud Telemedicine Medicaid 52

Healthcare IT Today

DECEMBER 29, 2020

The piece, which appears in the Health Affairs blog, looks at the state of telehealth in the U.S. It also makes some recommendations on how to think about telehealth in the […]. Today I read an interesting piece by Sean Cavanaugh, chief policy officer of ACO sponsor Aledade Inc. and how we got where we are.

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Medicare Medicare Telemedicine Hospitals 128

Hall Render

FEBRUARY 22, 2024

In the FY 2024 IPPS Final Rule (the “Final Rule”), the Centers for Medicare & Medicaid Services (“CMS”) incorporated certain social risk factors into the Hospital Value-Based Purchasing (“VBP”) Program (“the Program”). Hall Render blog posts and articles are intended for informational purposes only.

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Hospitals Medicare Medicare Medicaid 66

MedTrainer

MAY 15, 2024

What’s Unique About Medical Credentialing in Florida 1. The state requires a process similar to Medicare , which includes obtaining DMEPOS accreditation from a CMS-approved organization, enrolling in Medicare, and posting a surety bond to the enrollment contractor. This is a requirement for any Medicaid/Medicare network.

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Medicaid Medicaid Medicare Medicare 52

Healthcare IT News - Telehealth

FEBRUARY 18, 2021

million commercially insured and Medicare Advantage enrollees from January through June 2020. Still, overall visit volume decreased by 35%, raising concerns about the impact of deferred care in the future. During the COVID-19 period of the study, researchers found that 30.1% WHY IT MATTERS. THE LARGER TREND.

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COVID-19 Telemedicine Medicaid Medicaid 215

Hall Render

JULY 18, 2023

Over the last 12 months, the Centers for Medicare & Medicaid Services (“CMS”) has received many  reports  of hospice fraud. In addition, CMS has seen the number of enrolled hospices increase significantly in Arizona, California, Nevada and Texas, raising concerns about market oversaturation.

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Medicare Medicare Fraud Medicaid 40

Pharmacy Law Blog

FEBRUARY 13, 2018

On November 22, 2017, a Florida woman who was accused of a $45 million Medicare fraud, received a six-and-a-half-year prison sentence, following a 2016 U.S. Prior to her guilty plea, she was accused of Medicare fraud and Anti-Kickback Statute violations allegedly through paying patients. By George F. Indest III, J.D.,

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Fraud Medicare Medicare Governance 40

Hall Render

JUNE 23, 2023

On June 5, 2023, the Centers for Medicare & Medicaid Services (“CMS”) implemented a national skilled nursing facility (“SNF”) probe and educate program (“SNF P&E Program”). CMS determined that SNFs had the highest improper payment rate of all Medicare Fee-for-Service providers. for SNF services in 2022, up from 7.79% in 2021.

Nurses 40

Nurses Medicare Medicare COVID-19 40

Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

MedTrainer

JANUARY 12, 2024

In this blog post, we’ll outline who regulates healthcare compliance, how rules are enforced, and why organizations need a robust compliance platform to stay in the good graces of regulators. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

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Compliance Fraud Medicaid Medicaid 52

Hall Render

APRIL 4, 2024

The Requestor’s services further include offering physician practices training related to the Medicare Merit-Based Incentive Payment System (“MIPS”), which could result in higher Medicare reimbursement to the Requestor’s clients. Hall Render blog posts and articles are intended for informational purposes only.

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