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. The Risk-Adjustment Program. See Vista Health Plan, Inc. at 15,432 ); and.

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Healthcare Law Blog

JANUARY 11, 2023

What do Centene, CVS Health-Aetna and Humana all have in common? Morgan Healthcare Conference, you would know that all three are waiting to see what the upcoming final rule on Medicare Advantage risk adjustment data validation (known as RADV) audits will mean for the industry when it drops in February.

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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. According to Grimm, the risk of alleged fraud and abuse in Medicare Advantage by plans, vendors, and providers is not to be ignored.

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YouCompli

AUGUST 22, 2023

OIG’s audits, evaluations, and investigations have demonstrated that risks of fraud, waste, and abuse in managed care are real and significant.” The allegations were initially brought to the government’s attention by a whistleblower – a former manager in the organization’s risk adjustment operations group.

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MedTrainer

FEBRUARY 16, 2023

Yet, where there’s a high staff turnover rate, there’s also an increased risk of errors and deviations from established protocols. By prioritizing steadfast compliance, healthcare organizations can minimize the risk of these incidents, to protect patients and their reputation in times of change.

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YouCompli

JUNE 6, 2023

An effective compliance program requires risk mitigation. Sharon Parsley, JD, MBA, CHC, CHRC contributes a regular post on compliance officer effectiveness for the YouCompli blog. In this article she discusses risk assessment strategies for success. First, a definition: a “risk assessment” can take a lot of forms.

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Healthcare IT News - Telehealth

JUNE 29, 2020

Schneider and VP for delivery system reform Tanya Shah in a blog post accompanying the report. "The health of Americans is at risk because of reduced access to services," said Schneider and Shah. "While these results are from a sample of practices accounting for approximately 5 percent of ambulatory visits in the U.S.,

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Hall Render

JULY 14, 2023

The market basket increase must be adjusted for productivity and budget neutrality. This calculation includes an adjustment for behavioral changes in response to Patient Driven Groupings Model (“PDGM”), discussed below. There are a number of reasons for the breadth of this rule, including CMS’s need to implement statutory changes.

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OSHA Law Blog

JUNE 12, 2023

Small business employers will find it more difficult to obtain any downward adjustment on assessed penalties based on the employers’ size. What constitutes a “comprehensive inspection” now falls within the professional judgment of the inspector from case to case. The first report is due no later than September 15, 2024.

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Total HIPAA

JUNE 28, 2023

Policies and procedures copied from another company Your team didn’t create these policies, and from an auditor’s standpoint, these are just a placeholder for what actually happens. You may have been wondering if this means you’ll have to do something about “HIPAA”. This means you need to be HIPAA compliant as an employer.

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Hall Render

NOVEMBER 28, 2023

Annual Home Health Payment Update Once the pre-publication copy was released, news traveled quickly through the industry that CMS had determined not to impose the full adjustment it had proposed over the summer. As a result, CMS exercised its discretion to impose a smaller permanent adjustment than initially proposed.

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Healthcare Law Blog

JANUARY 9, 2024

What did NVIDIA discuss? Somatus often provides care in the home in 2-3 hour visits, which together with its payor data, risk adjustment data and lab data, can be used to predict the presence or progression of chronic kidney disease. At the first day of the J.P. Recognize that famous line?

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MedTrainer

APRIL 13, 2023

Apart from following the rules and regulations of federal and state compliance standards, one of the greatest challenges is understanding the scope of inspections and knowing what needs to be prepared ahead of time to satisfy a surveyor. OSHA Healthcare Inspections What are OSHA Inspections? What is an OSHA Inspector Looking For?

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Healthcare Law Blog

OCTOBER 18, 2023

Below are our top 10 takeaways from what we heard, and did not hear, at HLTH 2023. There continues to be concern over enforcement activity relating to the Medicare Advantage program, whether as a result of Medicare Advantage risk adjustment, ACO REACH, underutilization or otherwise. A Need for Holistic Care and Coordination.

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MedTrainer

JULY 7, 2022

Unfortunately, hospital staff already have a lot on their plates, meaning compliance risk management can increase their workload even further. But how can risks be mitigated through compliance software? However, once implemented, they can transform how you approach risk management and mitigation in more ways than one.

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MedTrainer

JANUARY 16, 2024

What Exactly Is a Healthcare Compliance Program? Together, these elements mitigate risks, nurture a culture of compliance, and safeguard both the organization and its patients from potential legal and ethical breaches. Risk Assessment and Mitigation: Regular identification of compliance risks and the implementation of control measures.

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YouCompli

FEBRUARY 22, 2023

It is “prospective” because hospitals and other providers know ahead of time what they will be reimbursed. Compliance officers can help protect revenue and reduce the risk of penalties by collaborating with the Finance and Reimbursement departments to navigate the dynamics of outlier payments and prospective repayment.

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YouCompli

SEPTEMBER 6, 2023

Performing my annual risk assessment was a project. I consider this the “who, what, when, where, why, and how” phase. Clearly define the “why” behind the project and “what” the project to designed to achieve.  Every hotline concern that warrants investigation became a project. Conducting annual compliance training is a project.  

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MedTrainer

OCTOBER 29, 2023

To effectively manage compliance, healthcare organizations must establish a robust system for monitoring and interpreting these changes and swiftly implement necessary adjustments. Many of these laws and regulations are above and beyond what is required by the federal government.

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YouCompli

MARCH 15, 2023

Project Management Methodologies for Healthcare Compliance Sharon Parsley, JD, MBA, CHC, CHRC contributes a regular post on compliance officer effectiveness for the YouCompli blog. Performing my annual risk assessment was a project. I consider this the “who, what, when, where, why, and how” phase. And so are you.

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MedTrainer

AUGUST 9, 2023

It ensures that all employees receive consistent and up-to-date information, to reduce the risk of knowledge gaps or inconsistent practices that may lead to non-compliance. What Are the Key Features and Functionalities of HIPAA Training Software? Failure to comply can mean huge penalties and legal action. Standardization.

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MedTrainer

OCTOBER 17, 2023

In this blog post, we’ll discuss the answer to: “Why do healthcare facilities have corporate compliance programs?” Many healthcare organizations risk financial penalties because of billing inaccuracies or fraudulent activities. What Are the Key Components of Healthcare Corporate Compliance Programs?

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MedTrainer

JULY 13, 2023

Common Uses of AI in Healthcare AI has enabled the integration of big data to identify disease risk, changes in physical/cognitive conditions, and provide decision support for healthcare providers, clinical team members, billing specialists, and leadership. These are some of the most common concerns around AI and healthcare compliance.

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Healthcare Law Blog

JANUARY 12, 2023

It is what happens when you have simultaneous disruption and transformation that both damages the existing system and creates (hopefully) a new and better system. So, as we have seen in successful management of seniors, wrapping care around high-risk/high-utilizing members can improve their health and reduce the total cost of care.

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MedTrainer

JUNE 29, 2023

But what if instead of selling you a car, they were in charge of giving you medical advice? What is Stark Law or Designated Health Services? What are Designated Health Services? Penalties for Violating Stark Law What happens if you violate Stark Law, even inadvertently? Exclusion from Federal Healthcare Programs.

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Healthcare Law Blog

JULY 1, 2022

Although many states include exemptions in their abortion laws for health or medical risk as well as cases of rape or incest, these exemptions may require the pregnant individual to report their case to law enforcement and meet other requirements before the pregnant individual can proceed with an abortion.

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MedTrainer

APRIL 11, 2024

Symplr software focuses on healthcare governance, risk management, and compliance within the healthcare sector. What is Symplr? Symplr provides healthcare governance, risk, and compliance solutions and services. Poor User Experience : System is still very manual with data entry, and dashboards are not very user-friendly.

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MedTrainer

DECEMBER 5, 2023

Your team would much rather spend time with patients than worrying about what kind of software to use or how to deploy it. This risk underscores the importance of finding a technology partner that is ready to truly partner with you and who can help you beyond just the technology they provide. We work with many manual processes.

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MedTrainer

JUNE 5, 2023

What is USP <800>? The United States Pharmacopeia (USP) <800> General Chapter for Hazardous Drugs Handling in Healthcare Settings focuses on the safe handling of hazardous drugs to protect healthcare workers, patients, and the environment from potential risks associated with these substances.

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MedTrainer

APRIL 24, 2022

What Are HIPAA Privacy Officer Requirements and Duties? So, What Are HIPAA Privacy Officer Responsibilities? By regularly monitoring legal changes, they’ll be able to make adjustments to their organization’s HIPAA programs, so there aren’t any unexpected surprises. Communicate Changes. Developing and Implementing Training.

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Healthcare Law Blog

AUGUST 31, 2023

2] The Court also vacated certain rules specific to the QPA and Federal Independent Dispute Resolution (“IDR”) process for out-of-network air ambulance services. The QPA, Generally The Act sets forth the rates at which out-of-network emergency services and out-of-network non-emergency services furnished at in-network facilities must be reimbursed.

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Healthcare Law Blog

JANUARY 10, 2023

I was struck on the first day of the 41 st Annual J.P. Morgan Healthcare Conference by Sanjay Doddamani (CEO of UpStream Healthcare) saying that “ Health is a state of independence.” A simple statement, but a very profound and interesting lens through which to view the Day One Medicare Advantage-focused company presentations. medications.

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Health Law Advisor

AUGUST 10, 2023

But the question is, to what extent do health care providers need to worry about FDA requirements as they use AI? In this blog post, we take on the question of when machine learning software developed by those involved in delivering health care is FDA regulated. The allure is obvious. Very brief.

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AIHC

FEBRUARY 16, 2024

The American Institute of Healthcare Compliance (AIHC TM ) has released a 2024 Corporate Compliance Officer training program which is not only based on the new GCPC, but goes beyond to address quality, safety, HIPAA and other high-risk areas. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.” The result?

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AIHC

FEBRUARY 16, 2024

The American Institute of Healthcare Compliance (AIHC TM ) has released a 2024 Corporate Compliance Officer training program which is not only based on the new GCPC, but goes beyond to address quality, safety, HIPAA and other high-risk areas. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.” The result?

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Health Care Law Brief

APRIL 12, 2023

As discussed below, the Final Rule also has some notable omissions compared to what CMS previously proposed in December (“Proposed Rule,” published at 87 Fed. 79452 (2022)). The Final Rule is effective June 5, 2023. 405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R.

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MedTrainer

APRIL 20, 2023

Strengthening Your Organization with CCEPs By employing CCEPs, organizations can significantly reduce the risk of non-compliance, fines, and reputational damage. Once a CCB certification specialist reviews your submissions, CEU values or types may be adjusted. What Happens If You Fail Your Exam? You Passed!

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