Medisys Compliance

APRIL 25, 2024

MIPS focuses on four key performance categories: Quality: This measures the quality of care you provide to your patients based on specific metrics established by the Centers for Medicare & Medicaid Services (CMS). Improvement Activities: This category focuses on ongoing practice improvement initiatives to enhance patient care.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medicare Medicare 64

Healthcare Law Today

NOVEMBER 30, 2022

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released its final 2023 Medicare Physician Fee Schedule (PFS) rule. Following its standard evaluation process for such requests, CMS considered whether they met appropriate categories. When using G3003, 15 minutes must be met or exceeded.)).

Medicare 132

Medicare Medicare Telemedicine Nurses 132

American Medical Compliance

APRIL 24, 2024

AMA PRA Category 1 Credits. Also, it prohibits providers from exchanging from any form of remuneration to induce or reward providers for the referral of patients for services and products covered by the federally funded healthcare programs, such as Medicare and Medicaid.

Compliance 52

Compliance Medicaid Medicaid Medicare 52

Healthcare IT Today

NOVEMBER 27, 2023

SafeRide Health’s ability to improve member experience and reduce costs for Medicaid and Medicare Advantage beneficiaries also attracted a strategic investment from Memorial Hermann Health System in this latest round. SafeRide serves the country’s largest Medicare Advantage, Medicaid, and provider programs.

Medicaid 77

Medicaid Medicaid Medicare Medicare 77

NY Health Law

FEBRUARY 13, 2024

On January 9, 2024, the federal Centers for Medicare and Medicaid Services (CMS) finally approved New York State’s 1115 waiver amendment to establish the New York Health Equity Reform (NYHER) Program. Workforce: Workforce investments with a goal of equitable and sustainable access to care in Medicaid.

Medicaid 52

Medicaid Medicaid Nurses Medicare 52

Bill of Health

FEBRUARY 6, 2024

Code § 1396n and apply for § 1115 waivers identified as supportive of substance use prevention or treatment and care transitions for incarcerated persons.

Governance 300

Governance Public Health Local Policy Medicaid 300

Compliancy Group

OCTOBER 5, 2023

Under MACRA, the Centers for Medicare and Medicaid Services (CMS) created regulations to encourage healthcare providers to use secure health information technology. Providers who earn a total score (based on their performance in all four categories) of 75.1% The PI category comprises 25% of the total score.

HIPAA 52

HIPAA Medicare Medicare Compliance 52

Innovaare Compliance

MARCH 11, 2024

The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data Processing System (DDPS) since inception of Part D in 2006. Effective January 1, 2024, category 4 beneficiaries will have the same Part D benefit parameters as beneficiaries in LIS category 1 [7].

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 14, 2022

This includes CMS regulations for Medicare Plans, regulations for Commercial Plans and Medicaid regulations for state plans. Determine the grievance categories using a Grievance management system. Then, determine which grievance categories and subcategories are mandatory to fulfil the reporting requirements. Determine ?

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Compliancy Group

NOVEMBER 16, 2022

Under MACRA, the Centers for Medicare and Medicaid Services created regulations for healthcare providers’ use of health information technology. MIPS is composed of four performance categories, on which providers are graded. These categories include quality, cost, improvement activities, and promoting interoperability.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

American Medical Compliance

APRIL 17, 2024

American Medical Compliance designates this activity for a maximum of 1 AMA PRA Category 1 Credits. Expand the Medicaid program to cover all adults with income below 138% of the FPL. Not all states have expanded their Medicaid programs. Physicians should only claim this credit for their complete participation in this activity.

ADA 52

ADA ACA Compliance Health Care Reform 52

Med-Net Compliance

OCTOBER 21, 2022

The OIG applies published criteria to assess future risk and places each party to an FCA settlement into one of five categories on a risk spectrum. The OIG uses its exclusion authority differently for parties in each category and bases its assessment on the information it has reviewed in the context of the resolved FCA case.

Fraud 59

Fraud Compliance Medicare Medicare 59

Hall Render

OCTOBER 10, 2023

As nursing homes look for funds to allow them to improve care and train nursing home staff, Centers for Medicare & Medicaid Services (“CMS”) released QSO-23-23-NH (“CMS Memo”), which reopens and recasts the Civil Money Penalty Reinvestment Program (“CMPRP”).

Nursing Homes 40

Nursing Homes Nurses Medicaid Medicaid 40

Kaiser Health News

JANUARY 12, 2024

For those with very low incomes, the law expanded eligibility for Medicaid, which is a state-federal program. However, 10 states, including Texas, where Retton lives, have chosen not to expand coverage, meaning some people in this category cannot get either Medicaid or ACA subsidies.

Health Insurance 133

Health Insurance ACA Medicaid Medicaid 133

HIT Consultant

APRIL 17, 2024

The Centers for Medicare & Medicaid Services (CMS) estimates a staggering $4.7 Prioritized Reviews: Embedded logic and AI prioritize charts based on a confidence score for each Hierarchical Condition Category (HCC). billion in potential recoveries from Risk Adjustment Data Validation (RADV) audits through 2032.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

APRIL 5, 2024

The synergy between the two companies will empower pharmaceutical companies, healthcare providers, Medicaid agencies, insurance companies, and public health departments with AI-driven tools to proactively respond to and address illness. Early detection supports rapid interventions throughout the public and private healthcare ecosystem.

Public Health 65

Public Health Medicaid Medicaid Governance 65

Redox

JUNE 30, 2023

Top stories Digital tech categories in the danger zone Dissatisfied with their pandemic-incited purchases, many health systems are ready to rip and replace their telemedicine and RPM solutions.

Telemedicine 52

Telemedicine Medicaid Medicaid Medicare 52

MedTrainer

MAY 16, 2024

Download the Ultimate List of Training Requirements for Ambulatory Surgery Centers to see a full list of federal and accreditation training requirements for ASC staff broken down by role, with the applicable standard, CMS violation category, and frequency. Staff should review the requirements for their specific state to remain in compliance.

Compliance 52

Compliance HIPAA Health Insurance Medicaid 52

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

Healthcare IT Today

MAY 16, 2024

The category of insurance benefit – pharmacy vs. medical – should not dictate a lower level of transparency or efficiency for prior authorizations. Centers for Medicare & Medicaid Services and the National Coordinator for Health IT. Cameron Deemer, CEO at DrFirst.

Medicaid 99

Medicaid Medicaid Medicare Medicare 99

Bill of Health

JANUARY 18, 2022

The Court decisions each addressed questions of whether federal agencies — the Occupational Safety and Health Administration (OSHA) and the Centers for Medicare and Medicaid Services (CMS) — have authority to set these vaccination-related requirements. The Court placed COVID-19 in the latter category.

COVID-19 Vaccine 184

COVID-19 Vaccine COVID-19 Medicaid Medicaid 184

HIPAA Journal

AUGUST 31, 2023

In order to prevent a repeat of the incident, PurFood states in its breach notification letter that the company has taken a number of steps to strengthen its security network and is reviewing its existing policies and procedures to identify any additional measures and safeguards that may be necessary.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

Medisys Compliance

APRIL 18, 2022

In October 2021, the Center for Medicare and Medicaid Innovation (CMMI) announced a goal of having every Medicare beneficiary and the majority of Medicaid beneficiaries covered by some type of alternative payment model (APM) by 2030. Incentives for Medicaid clinicians who also treat Medicare patients. Advanced & MIPS APMs.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

C&M Health Law

DECEMBER 23, 2022

The below summary does not focus on the Medicaid and Children’s Health Insurance Program (CHIP) Fee for Service (FFS) proposals. This proposed reporting would be at the organizational level for MA, the state level for Medicaid and CHIP FFS, the plan level for Medicaid and CHIP managed care, and the issuer level for QHP issuers on the FFEs. (iv)

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Medisys Compliance

DECEMBER 29, 2023

Other Therapeutic Cardiovascular Procedures Beyond the categories mentioned above, this range also encompasses various additional therapeutic procedures, including: Pericardiocentesis (93505): Removal of fluid from the pericardial sac surrounding the heart. All rights reserved.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Medicaid Medicaid 59

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. What are Designated Health Services? Professional Reputational Damage.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

Healthcare IT News - Telehealth

SEPTEMBER 20, 2021

"We have seen all too often criminals who engage in health care fraud – stealing from taxpayers while jeopardizing the health of Medicare and Medicaid beneficiaries," said Deputy Inspector General for Investigations Gary L. More than $1.1 billion of that loss involved allegedly fraudulent claims related to telemedicine.

Fraud 163

Fraud Telemedicine Medicare Medicare 163

Hall Render

JANUARY 12, 2022

Recent regulations from the Centers for Medicare & Medicaid Services (“CMS”) based on the GME changes in the Consolidated Appropriations Act, 2021 (“CAA”) create new funding opportunities for many teaching hospitals. Category B Hospitals: Hospitals with a low PRA and or DGME/IME FTE caps of less than 3.0

Hospitals 40

Hospitals Medicaid Medicaid Medicare 40

Verisys

OCTOBER 11, 2023

Understanding FACIS ® results When FACIS ® matches your monitored population with an event, it returns a match category. Here is a quick guide to help you understand what each match category means. The post Understanding FACIS Match Category Results appeared first on Verisys.

Compliance 52

Compliance Medicaid Medicaid 52

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

Provider Trust

JANUARY 26, 2022

Let’s start with the role of the OIG, which is tasked with ensuring that dollars for federal healthcare programs such as Medicare, Medicaid, CHIPS, and TriCare, as well as other healthcare federal grant monies, are judiciously spent and awarded as reimbursements for quality care that is not fraudulent. So what are the risk categories?

Fraud 52

Fraud US Department of Health and Human Services Medicaid Medicaid 52

Health Law Advisor

APRIL 10, 2023

This interpretation provided to be difficult to apply in real world situations because while we all might think of Amazon and WalMart as big-box stores, it was not clear what other stores might also fall into this category and present a compliance risk. OIG Advisory Opinion (AO) 23-03 On March 29, 2023, the OIG posted AO 23-03 to its website.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Law Advisor

MAY 2, 2023

The Centers for Medicare & Medicaid Services (“CMS”) is using its annual rulemaking process to update the CMS payment system rules for fiscal year (“FY”) 2024 as a mechanism to advance health equity systematically across various CMS payment programs. health system.” [9]

Payment Systems 52

Payment Systems Medicare Medicare Nurses 52

Medisys Compliance

APRIL 15, 2024

Additionally, new Category I codes (64596, 64597, and 64598) have been introduced for integrated peripheral nerve stimulation procedures. These changes highlight the evolving landscape of neuromodulation therapies in urology.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medical Billing Services Medicaid 64

Healthcare IT News - Telehealth

SEPTEMBER 28, 2021

Centers for Medicare and Medicaid Services proposed for the first time a set of CPT codes for remote therapeutic monitoring. Nevertheless, new categories of digital health reimbursement have become increasingly clear. In the latest Medicare Physician Fee Schedule, the U.S.

COVID-19 205

COVID-19 Medicare Medicare Hospitals 205

Healthcare IT Today

FEBRUARY 27, 2024

Trepp , President and Chief Executive Officer at Hamilton Beach Brands Holding Company, said, “This acquisition is a key step in support of our strategic initiative to expand in the fast-growing home health and wellness market, and it strengthens our participation in the home medical category.

FDA 81

FDA Licensing Medicaid Medicaid 81

Healthcare Law Blog

MARCH 20, 2023

The Kaiser Family Foundation surveyed forty-four state Medicaid officials about strategies to address behavioral health workforce shortages and found the following four categories to be most critical. [6] 6] Increase provider reimbursement strategies. Redefining the workforce. 7] American Medical Association. 12, 2022).

Medicaid 52

Medicaid Medicaid Licensing ACA 52