MedTrainer

FEBRUARY 7, 2024

The complex world of healthcare compliance demands a clear understanding of responsibilities. For those new to the role of compliance officer, the question often arises: “Who is responsible for compliance in healthcare?” Who is Responsible for Compliance in Healthcare?

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MedTrainer

JANUARY 30, 2024

The professionals who manage compliance are the front lines of preventing medical errors, deterring fraud, and staying in good standing with federal payers like the Centers for Medicare and Medicaid Services (CMS). Certified Compliance and Ethics Professional (CCEP) offered by the Compliance Certification Board (CCB).

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HIPAA Journal

MARCH 30, 2023

The biggest influence for the creation of the seven elements of a compliance program (fraud prevention) is sometimes overlooked. The first of the seven elements of a compliance program is a suitable example of why it is important to view a compliance program holistically because it calls for the development of standards (etc.)

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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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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. “Not

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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.

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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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Healthcare Law Blog

NOVEMBER 9, 2023

OIG emphasizes that the summaries are not meant to establish or interpret any program rules or regulations, but rather to create awareness and provide tools and resources to aid compliance efforts. Of particular significance is the guidance pertaining to the role of a Compliance Officer. parent, the board of the U.S.

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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.

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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.

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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).

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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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MedTrainer

DECEMBER 7, 2023

Healthcare Facility Standards In Idaho, the Bureau of Facility Standards plays a key role that is particularly relevant for healthcare executives and compliance officers. For healthcare executives and compliance officers, thorough understanding and adherence to the Bureau’s standards is required.

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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.

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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.

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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.

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MedTrainer

APRIL 8, 2024

These requirements include but are not limited to: Health Insurance Portability and Accountability Act (HIPAA): Protects the privacy and security of patients’ health information. Medicare Access and CHIP Reauthorization Act (MACRA): Promotes value-based care and rewards healthcare providers for quality and performance.

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MedTrainer

OCTOBER 4, 2023

Compliance Governing Agencies There are a number of federal agencies and governing bodies responsible for passing down healthcare compliance requirements to healthcare organizations, providers, and practicing professionals. CMS plays a crucial role in overseeing federal healthcare programs, including Medicare and Medicaid.

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MedTrainer

JULY 28, 2023

OIG Inspections in Healthcare The OIG focuses its resources on oversight of Medicare and Medicaid — programs that represent a large portion of the federal budget. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

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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?

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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.

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MedTrainer

JANUARY 31, 2024

Here are some key ways in which these programs have evolved: Increased Regulatory Complexity: As healthcare regulations have become more complex and numerous, compliance programs have had to keep pace.

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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.

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AIHC

MARCH 2, 2023

I do a lot of training of compliance officers and realize the time that is being spent could be improved. The role of Compliance Officer for an association with 200 doctors had its challenges. My task was to educate providers and staff through seminars on rules and regulations with Medicare.

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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.

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HIPAA Journal

JANUARY 12, 2023

This is often interpreted as a failure to understand which uses and disclosures are permissible without patient authorizations; however, it could be just as likely there is a failure to understand the HIPAA meaning of Protected Health Information. The HIPAA Meaning of Individually Identifiable Health Information.

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HIPAA Journal

DECEMBER 28, 2022

Discussing HIPAA compliance for hospitals in a single article is challenging. This means there is no one-size-fits-all guide to HIPAA compliance for hospitals, but rather checklists that can help hospitals cover the basics of the compliance requirements. What is Required to Comply with HIPAA?

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YouCompli

AUGUST 10, 2022

Medicare may have a published policy that explains what is considered medically necessary for reimbursement purposes. A HIPAA concern can present a more black and white issue. What can compliance professionals implement in their organizations now? However, medical necessity can be defined differently by different parties.

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MedTrainer

JUNE 29, 2023

Today, compliance reporting software typically also plays a significant role in automating and streamlining processes related to data collection, analysis, documentation, and reporting.

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MedTrainer

FEBRUARY 12, 2024

Civil Lawsuits: Patients or other affected parties may file civil lawsuits against healthcare providers or organizations if non-compliance leads to harm or damages. Failure to report non-compliance can be used against the provider or organization in such lawsuits.

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