AIHC

MAY 31, 2022

You control the documentation describing services they receive, and your documentation serves as the basis for claims you submit. Generally, the health care system pays claims based solely on your representations in the claims documents. Ensure your documentation supports the claims you submit for payment.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

AIHC

NOVEMBER 29, 2023

A claim would be generated and submitted to the payer. As the cost of providing care grew, payers started instituting methods to curb expenses and how claims were paid. These different Acts initiated the testing of alternate forms of delivering care and payment methodologies.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare Law Blog

DECEMBER 7, 2022

The numbers in the last three categories highlighted in the last paragraph more closely align with the yearly numbers presented for fiscal years 2019 and 2020, which might indicate that the COVID-19 pandemic prevented or delayed OIG representatives from handing out penalties. 4] See MorseLife Nursing Home Health System Agrees to Pay $1.75

Nursing Homes 52

Nursing Homes Nurses US Department of Health and Human Services COVID-19 52

AIHC

NOVEMBER 29, 2023

A claim would be generated and submitted to the payer. As the cost of providing care grew, payers started instituting methods to curb expenses and how claims were paid. These different Acts initiated the testing of alternate forms of delivering care and payment methodologies.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Care Law Brief

APRIL 3, 2023

This Rate Announcement follows CMS’s February 1 notice of planned changes to rates and the risk adjustment methodology, which provided an opportunity for the public to submit comments during a 30-day period (Advance Notice), as required by Section 1853(b)(2) of the Social Security Act (the Act). diabetes, depression, heart disease).

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Hall Render

JULY 14, 2023

LUPA Thresholds and Case Mix Weights CMS proposes to revise the Low Utilization Payment Adjustment (“LUPA”) thresholds and case mix weights based upon CY 2022 home health claims linked to OASIS assessment data. Deactivation Medicare can currently deactivate a provider who has not billed a claim for 12 months.

Medicare 52

Medicare Medicare Payment Systems Governance 52

AIHC

AUGUST 30, 2023

As a reminder, telemarketing in healthcare must follow strict privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-191 in the United States. Know how the Health Insurance Portability and Accountability Act (HIPAA) effects your practice. Some will try surveys.

Compliance 52

Compliance Fraud Medicare Medicare 52

Health Law RX

JULY 18, 2023

Information Blocking Background In 2016, the 21st Century Cures Act (Cures Act) made sharing electronic health information (EHI) the new normal in healthcare, with the twin goals of encouraging and incentivizing the free flow of patient information among stakeholders and driving efficiencies in healthcare.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Health Care Performance

JULY 20, 2022

A New York ENT physician was convicted of filing false claims with Medicare and Medicaid. The physician submitted claims totaling about $585,000 to Medicare and Medicaid and was paid roughly $191,000. The fraudulent act was upcoding of ear exams or ear wax removal to an incision procedure of the external ear.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

Hall Render

NOVEMBER 28, 2023

The data purported to show reimbursement exceeded costs by 45%, which CMS used to support its claim of “high profit margins.” This could be what is driving the absolute numbers in each category down. Hospice Risk-Screening Category. CMS referred back to the cost report data, which it had outlined in the proposed rules.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

SQA

FEBRUARY 26, 2024

The products had been improperly regularized in ANVISA as cosmetics since they are indicated for injectable use, a form that is not authorized for this category of product. The purpose of the note is to clarify that products for invasive aesthetic treatments cannot be regularized in the category of cosmetics.

FDA 52

FDA Compliance COVID-19 Public Health 52

Drug & Device Law

JULY 31, 2023

The less widely adopted Uniform Computer & Information Technology Act, §102(a)(35), similarly defines intangible “information” separately from “goods.” 230(c)(1), that bars liability claims against internet website operators. . 230(c)(1), that bars liability claims against internet website operators. 3d 1283 (Fed.

Governance 52

Governance Payment Systems Hospitals Licensing 52

Drug & Device Law

APRIL 28, 2022

In other words, the regulation distinguished between on-site and off-site advertising, something apparently common since the Highway Beautification Act of 1965. The dissent claimed the majority had replaced the standard from Reed with “an incoherent and malleable standard.” at **20-21. Colorado , 530 U.S. at **36-37.

FDA 59

FDA Governance 59

Drug & Device Law

JANUARY 15, 2024

2006) – a precedential holding that the same Pennsylvania rule barring strict liability claims against prescription drugs also applied to prescription medical devices − should not be followed because the plaintiffs in Creazzo were supposedly “pro se.” That was false, based on a printer’s error, and that error has now been corrected.

Compliance 52

Compliance FDA Governance State Policy 52

Drug & Device Law

OCTOBER 16, 2023

But we got our act together, and we present in this post our latest additions (and we added to the cheat sheet itself ). Plaintiff’s answers to discovery were willfully false. Plaintiff acted deliberately and with intent to deprive the defendant of the information. Much of the deleted social media activity is now unrecoverable.

Compliance 59

Compliance 59