HIT Consultant

APRIL 17, 2024

What You Should Know: Wolters Kluwer Health , a leading provider of healthcare information and analytics, has introduced a new weapon in the fight against potential financial penalties for Medicare Advantage Organizations (MAOs) – the Regulatory Audit Module. The Centers for Medicare & Medicaid Services (CMS) estimates a staggering $4.7

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Medisys Compliance

JULY 29, 2022

We are sharing Medicare guidelines for laser-assisted cataract surgery billing from a last updated CMS document. Medicare Policy Regarding Non-Covered Services. Under either method, Medicare will cover and pay for the cataract removal and insertion of a conventional intraocular lens.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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. Telehealth and other digital health modalities continue to increase in importance for Medicare populations and corresponding health care providers.

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Medicare Medicare Telemedicine Nurses 132

HIT Consultant

OCTOBER 30, 2023

The Promoting Interoperability performance category score typically can be a quarter of a clinician or group’s total MIPS score in a year. The Promoting Interoperability performance category score typically can be a quarter of a clinician or group’s total MIPS score in a year.

Medicare 98

Medicare Medicare Payment Systems Hospitals 98

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

Medicare 52

Medicare Medicare Fraud Medicaid 52

Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. This bargain is codified in the statutory mandate of 42 U.S.C. 1395w-23(a)(1)(C)(i) “to ensure actuarial equivalence.”

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Medisys Compliance

APRIL 25, 2024

Introduction The ever-evolving world of healthcare billing can feel complex, and with the introduction of MACRA (Medicare Access and CHIP Reauthorization Act) in 2015, cardiology practices have faced some adjustments. MACRA replaced the previously used Sustainable Growth Rate (SGR) formula for Medicare physician payments.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medicare Medicare 64

Healthcare Law Today

NOVEMBER 29, 2022

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) finalized new policies related to remote therapeutic monitoring (RTM) services reimbursed under the Medicare program. The six primary Medicare RTM codes are Current Procedural Terminology (CPT) codes 98975, 98976, 98977, 98978, 98980, and 98981.

Medicare 52

Medicare Medicare Telemedicine Nurses 52

Medisys Compliance

JUNE 10, 2022

Medicare covers limited chiropractic services when performed by a chiropractor who is licensed or legally authorized to furnish chiropractic services by the State or jurisdiction in which the services are furnished. In this article, we shared coding guidelines and Medicare coverage for Chiropractic Manipulative Treatment (CMT).

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Medicare Medicare Medical Billing Medical Billing Outsourcing 59

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

HIT Consultant

MARCH 21, 2023

What You Should Know: – AppliedVR , an immersive therapeutics (ITx) pioneer advancing a novel approach to medicine, today announced that the Centers for Medicare and Medicaid Services (CMS) established a unique Healthcare Common Procedure Coding System (HCPCS) Level II code (E1905) for its flagship product, the RelieVRx program.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Innovaare Compliance

MAY 26, 2022

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. Three categories of FWA allegations accounted for 78.47

Fraud 52

Fraud Medicare Medicare Medicaid 52

Health Law Advisor

JANUARY 13, 2022

The proposed decision, which is subject to public comments that are due to CMS by February 10, 2022, does not endorse nationwide Medicare coverage for these drugs. The FDA’s determination does not mandate Medicare coverage for Aduhelm. The Medicare Part B program would not cover the drugs in any other setting.

Medicare 52

Medicare Medicare FDA Medicaid 52

Compliancy Group

OCTOBER 5, 2023

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law to improve patient healthcare outcomes. Under MACRA, the Centers for Medicare and Medicaid Services (CMS) created regulations to encourage healthcare providers to use secure health information technology. The MIPS rules for 2023 are discussed below.

HIPAA 52

HIPAA Medicare Medicare Compliance 52

The Health Law Firm

JUNE 11, 2020

Board Certified by The Florida Bar in Health Law At some point in your career you may hear someone speak of a "routine" Medicare audit, there is really no such thing. Indest III, J.D., This is like saying you have a "routine IRS audit." Having too many claims for level five CPT codes might, for example, cause you to be audited.

Medicare 40

Medicare Medicare 40

Hall Render

DECEMBER 30, 2022

Medicare payment policy changes established under the CMS CY 2023 Medicare Physician Fee Schedule (“MPFS”) Final Rule , issued on November 1, 2022, become effective January 1, 2023. These services will be reported with three separate Medicare-specific G codes. Evaluation and Management (E/M) Visits. Split/Shared E/M Visits.

Medicare 40

Medicare Medicare Licensing Health Services Administration 40

Healthcare Law Today

NOVEMBER 9, 2022

Starting January 1, 2023, Medicare will expand and increase coverage of certain services and providers to advance access to prevention and treatment services for substance use disorders (SUD) and mental health services. CMS noted it did not have the authority to create new statutory categories for reimbursable practitioner types.

Medicare 52

Medicare Medicare COVID-19 Licensing 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

Healthcare Law Today

NOVEMBER 9, 2022

Starting January 1, 2023, Medicare will cover telehealth-based treatment services delivered by federally-accredited opioid treatment programs (OTPs), commonly referred to as “methadone clinics.” Background and History of Medicare Telehealth Coverage of SUD Treatment. New Changes to Medicare OTP Telehealth Services.

Medicare 52

Medicare Medicare COVID-19 Telemedicine 52

Innovaare Compliance

JANUARY 19, 2021

It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the past several years—and especially with changes implemented for the 2021 Plan Year—that member experience and medication adherence is of utmost importance to the CMS. Medicare Star Ratings 2021 Changes.

Medicare 52

Medicare Medicare COVID-19 Compliance 52

Healthcare IT News - Telehealth

APRIL 22, 2024

These codes can be split into two categories to help understand their uses. Medicare was the first to cover RPM. It is also worth noting that Medicare is not necessarily required to update its coding rules to reflect AMA's CPT code rules. These have been the four most common general RPM codes for a few years now.

Medicare 160

Medicare Medicare Medicaid Medicaid 160

Compliancy Group

NOVEMBER 16, 2022

In 2015, legislation known as the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted. 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.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

Healthcare Law Today

JANUARY 20, 2023

The panel suggested providers ask themselves “What is your core competency” and “Where do local Medicare Advantage plans have gaps in their coverage and care delivery models” 2. A “shakeout” to identify the top winners per category in the long run would better position those companies with plans as well.

Medicare 52

Medicare Medicare Patient Satisfaction Payment Systems 52

NCG Medical Blog

JANUARY 19, 2022

If you’re a Medicare provider , then you might want to know about MIPS—a healthcare incentive program that helps gather data of quality and performance outcomes over time while rewarding medical practices that demonstrate improvements. This program utilizes a “score” system comprised of four categories.

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Payment Systems Medicare Medicare Medical Billing 52

Jane Sarashon

MAY 9, 2024

Some of the policies would add to the supply of licensed health care workers to provide telehealth services, and to bolster rural clinics and Federally Qualified Health Centers to offer (and be covered for) virtual care under Medicare.

Telemedicine 56

Telemedicine Licensing Hospitals Medicare 56

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

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.

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Compliance Medicaid Medicaid Medicare 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

Compliance Now

AUGUST 1, 2022

Covered plans are required to automatically cover a least one form of contraception in each of the categories below without applying medical management. Other types of contraceptive services or products approved by the FDA must also be covered, even if they do not fall into one of the categories listed above. Medical Management.

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FDA Medicare Medicare Governance 100

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 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.

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Medicaid Medicaid Medicare Medicare 77

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] health system.” [9] 1] [link] at 4. [2]

Payment Systems 52

Payment Systems Medicare Medicare Nurses 52

Hall Render

FEBRUARY 14, 2023

Targeted Audits In the rule and accompanying release, CMS provided that it will conduct RADV audits targeted at diagnosis categories that it deems more likely to be reported in error (referred to as high-risk Hierarchical Condition Categories, rather than its previous method of an untargeted random sample methodology.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

HIT Consultant

NOVEMBER 24, 2022

For the first time, all hearing aids will fall under two categories: prescription hearing aids and OTC hearing aids. Health plans could, for example, consider covering OTC hearing devices as part of the hearing benefits package provided to their Medicare Advantage plan members. These OTC hearing aids do not require a prescription. .

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FDA Public Health Medicare Medicare 98

Healthcare IT Today

DECEMBER 28, 2022

The health system said that patients on Medicare will pay fees ranging from $3 to $10, while consumers with Medicare Advantage or private insurance might face co-pays similar to those paid for video visits or in-person consultations. Private pay consults for patients without insurance will cost $35.

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Medicare Medicare Hospitals Telemedicine 78