Compliancy Group

APRIL 17, 2024

For example, the OIG has focused on billing and coding, quality of care, data security and privacy, and Medicare compliance. Compliance officers and other healthcare leaders should stay updated on these focus areas and be able to anticipate annual changes in audit policy. and cybersecurity threats. Medicare Advantage (M.A.):

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

MedTrainer

JANUARY 10, 2024

The updated OIG guidance provides recommendations that include seven elements which are used by prosecutors when evaluating civil and monetary fines associated with the Federal Anti-Kickback Statute, Physician Self-Referral laws, the False Claims Act,Criminal Health Care Fraud Statutes, and HIPAA Privacy and Security Rules.

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Compliance Fraud HIPAA Compliance Officers 94

YouCompli

DECEMBER 19, 2023

Exclusions (page 26) : OIG recommends that any entity participating in the federal Medicaid program should check the state Medicaid program exclusion list for each applicable state. In organizations where compliance reports to legal, conflicts of interest exist and can create barriers that lead to timing and resource inefficiencies.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

YouCompli

NOVEMBER 29, 2023

“As previous OIG compliance guidance(s) are retired to ‘archival’ status, we all should recognize that the original guidance may have been the most important document ever written for healthcare compliance professionals.” — Roy Snell In 1998, the Office of Inspector General (OIG) issued its first General Compliance Program Guidance (GCPG).

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

MedTrainer

APRIL 22, 2024

A healthcare compliance committee is a cross-functional team that monitors compliance at a strategic level. An influential healthcare compliance committee supports the compliance officer in promoting ethical practices, mitigating risks, and advising on compliance program operations.

Compliance 52

Compliance Compliance Officers Governance Medicaid 52

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 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. Accreditation.

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Medicaid Medicaid Medicare Medicare 97

Compliancy Group

AUGUST 31, 2023

They cover various aspects, including: Internal Monitoring Systems Employee Training Programs Reporting Mechanisms for Potential Violations Health Insurance Portability and Accountability Act (HIPAA) HIPAA focuses on safeguarding the privacy and security of patients’ health information.

Compliance 52

Compliance Compliance Officers Fraud Compliance Framework 52

HIPAA Journal

NOVEMBER 17, 2022

HIPAA Journal is conducting interviews with healthcare professionals and service providers to find out more about their compliance journeys, how the HIPAA Rules have affected their working lives, and the successes and challenges they have faced with HIPAA compliance. What are your main challenges regarding HIPAA?

Governance 85

Governance HIPAA Compliance Nursing Homes 85

Medisys Compliance

JANUARY 30, 2023

Let us discuss the top compliance issues in the medical billing industry, shall we? HIPAA: The Health Insurance Portability and Accountability Act( HIPAA) is a federal law that establishes the national standards for protecting the privacy and security of individuals’ personal health information ( PHI).

Compliance 52

Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

YouCompli

JUNE 29, 2022

With it, compliance officers have guided their healthcare organizations in complying with changing documentation, coding, and confidentiality requirements. As virtual care requirements for telehealth evolve, we explore how compliance officers can support patient care and help their organizations stay up to date.

Compliance Officers 52

Compliance Officers Compliance Telemedicine COVID-19 52

MedTrainer

OCTOBER 23, 2023

Office of Inspector General (OIG): Prevents fraud, waste, and abuse within the department’s vast array of Department of Health and Human Services (HHS) initiatives. Centers for Medicare and Medicaid (CMS) : Evaluates providers’ adherence to state/federal regulations and guidelines at both the individual and organizational levels.

Compliance 52

Compliance Compliance Officers Fraud Governance 52

MedTrainer

DECEMBER 7, 2023

The Medicaid and Health program of Idaho provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities in the state, offering a range of medical and health-related services.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

AIHC

NOVEMBER 6, 2023

The focus of this article is to “connect the dots” between Health Insurance Portability & Accountability Act (HIPAA) and HITECH regarding privacy and security of electronically protected health information (ePHI). HITECH puts a “bite” into specific elements of the HIPAA rule, such as higher penalty amounts for non-compliance.

HIPAA 59

HIPAA Compliance Governance Health Insurance 59

MedTrainer

MARCH 28, 2024

Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations. This is one of seven components recommended in the OIG’s compliance guidelines. For all-size organizations, the owner(s)/executive team has a legal and ethical responsibility to maintain compliance.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

MedTrainer

JUNE 28, 2023

CFEs collaborate with various stakeholders — including compliance officers, legal teams, auditors, and law enforcement agencies — to address fraud and compliance-related issues. The FCA prohibits submitting false or fraudulent claims for payment to government healthcare programs, such as Medicare and Medicaid.

Fraud 52

Fraud Compliance Governance Compliance Officers 52

AIHC

NOVEMBER 6, 2023

The focus of this article is to “connect the dots” between Health Insurance Portability & Accountability Act (HIPAA) and HITECH regarding privacy and security of electronically protected health information (ePHI). HITECH puts a “bite” into specific elements of the HIPAA rule, such as higher penalty amounts for non-compliance.

HIPAA 52

HIPAA Compliance Governance Health Insurance 52

MedTrainer

FEBRUARY 1, 2024

Ensure Legal and Regulatory Compliance: This helps healthcare facilities stay in compliance with federal, state, and accreditation regulations, including laws like the Health Insurance Portability and Accountability Act (HIPAA). Compliance Officer: Have a designated individual responsible for overseeing the compliance program.

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

MedTrainer

JANUARY 30, 2024

Compliance is Mandatory for Federal Programs One constant is that organizations and facilities that participate in federal healthcare programs, such as Medicare and Medicaid, must have a compliance program. Laboratories: Clinical laboratories that perform tests covered by Medicare or Medicaid.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

MedTrainer

APRIL 20, 2023

Providers need a strong compliance program to inform the creation of compliance checklists. The Seven Core Compliance Program Requirements The Centers for Medicare & Medicaid Services (CMS) criteria promote an effective compliance program in healthcare organizations.

Compliance 52

Compliance Compliance Officers Regulatory Compliance Regulations Compliance 52

MedTrainer

JANUARY 12, 2024

The protection of patient data, adherence to privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the United States, and the prevention of cyber threats have become paramount concerns. Compliance in healthcare began to encompass billing, fraud, and abuse prevention.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

MedTrainer

SEPTEMBER 8, 2023

These two healthcare compliance news stories — and many others — highlight the significant damage that can come from non-compliance or a willful violation of compliance standards. This settlement was the largest HIPAA settlement at that time. Loss of reimbursements. License revocation or suspension. Patient privacy.

Compliance 52

Compliance HIPAA Medicaid Medicaid 52

MedTrainer

JANUARY 26, 2024

Here are some common non-compliance activities: Failure to Maintain HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) sets strict guidelines for safeguarding patient health information. These actions can lead to financial losses for patients and payers.

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

MedTrainer

NOVEMBER 14, 2023

Exclusion from Government Programs: Entities found non-compliant may be barred from participating in government healthcare programs like Medicare and Medicaid. Criminal Charges: Knowingly committing compliance violations can lead to criminal charges against individuals responsible.

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Compliance HIPAA Governance Medicare 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

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Fraud Compliance Medicaid Medicaid 98

MedTrainer

OCTOBER 4, 2023

These federal compliance governing agencies regulate the industry at the national level: Centers for Medicare & Medicaid Services (CMS). CMS plays a crucial role in overseeing federal healthcare programs, including Medicare and Medicaid. Office for Civil Rights (OCR).

Compliance 52

Compliance Fraud HIPAA Governance 52

AIHC

APRIL 25, 2022

Written by: Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, COCAS, CORCM, OHCC, ICDCT-CM/PCS This article addresses how to track telehealth policies while addressing HIPAA compliance and mobile device management as the United States enters into a post-pandemic era. Are You a Mobile Health App Developer?

HIPAA 52

HIPAA Compliance COVID-19 Compliance Officers 52

MedTrainer

NOVEMBER 29, 2023

TennCare is Tennessee’s managed Medicaid agency. It administers and oversees the state’s Medicaid programs, providing essential healthcare services to low-income individuals and families in Tennessee.

Compliance 52

Compliance Licensing HIPAA Medicaid 52

MedTrainer

OCTOBER 16, 2023

Health Insurance Portability and Accountability Act (HIPAA) HIPAA is a pivotal regulation that focuses on the protection of patient health information, enforced by the U.S. Stark Law The Stark Law , primarily enforced by Centers for Medicare & Medicaid Services (CMS), deals specifically with physician referrals.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Medicaid 52

Verisys

JANUARY 19, 2022

According to recent surveys of major metropolitan hospitals , departments that typically share the responsibility for credentialing include: The Compliance Office. Checks credentialing for Health Insurance Portability and Accountability Act (HIPAA) compliance. Human Resources. Medical Staffing Services.

US Department of Health and Human Services 52

US Department of Health and Human Services Hospitals Malpractice Compliance Officers 52

MedTrainer

NOVEMBER 27, 2023

Through its various departments, such as the Office of Compliance, DPH ensures adherence to ethical standards, regulations, and policies to maintain quality care. The Medical Assistance Plans Division oversees Georgia’s Medicaid and PeachCare for Kids® programs.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

OCTOBER 29, 2023

The California Department of Health Care Services (DHCS) manages Medi-Cal, the state’s Medicaid program, providing essential healthcare services to low-income individuals and families. Healthcare organizations in California must adhere to both the Health Information Portability and Accountability Act (HIPAA) as well as the CCPA.

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Compliance COVID-19 HIPAA Governance 52

MedTrainer

AUGUST 25, 2023

For healthcare facilities that are accredited and contracted with federally-funded programs, such as Medicare and Medicaid, compliance with CMS regulations becomes paramount. Privacy Concerns Healthcare compliance often involves sensitive patient information.

Compliance 52

Compliance HIPAA ADA Medicaid 52

MedTrainer

NOVEMBER 14, 2023

In Virginia, healthcare compliance may differ in Medicaid policies, telehealth regulations, scope of practice for healthcare professionals, certificate of need (CON) laws, and specific state mandates related to healthcare reporting and licensing.

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Compliance Licensing Governance Hospitals 52

MedTrainer

JUNE 29, 2023

This helps you ensure compliance with various (ever-changing) healthcare regulations, including those posed by: Centers for Medicare and Medicaid Services (CMS) Health Insurance Portability and Accountability Act (HIPAA) Occupational Health and Safety Administration (OSHA) Food and Drug Administration (FDA) Office of Inspector General (OIG) General (..)

Compliance 52

Compliance FDA Health Insurance Medicaid 52

MedTrainer

FEBRUARY 12, 2024

Failure to report non-compliance can be used against the provider or organization in such lawsuits. These actions can include fines, sanctions, or even revocation of licenses or certifications.

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Compliance Licensing Governance Fraud 52

MedTrainer

AUGUST 30, 2023

Medicaid Managed Care. Some state Medicaid programs contract with managed care organizations to provide healthcare services to eligible beneficiaries. These plans follow managed care principles to control costs and improve care coordination for Medicaid recipients. Quality of Care Standards. Data Security and Privacy.

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Compliance Regulatory Compliance Medicaid Medicaid 52

MedTrainer

NOVEMBER 15, 2023

It conducts audits, investigations, and evaluations to ensure efficiency and integrity in HHS programs, including Medicare and Medicaid. The OIG also enforces standards for healthcare providers and suppliers to prevent fraud and imposes penalties for non-compliance. Designate a compliance officer and/or compliance committee.

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Compliance Framework Governance Compliance Medicaid 52