Healthicity

JUNE 23, 2022

As compliance officers, we often focus (and rightfully so) on enforcement efforts.

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Compliance Officers Medicaid Medicaid Medicare 98

Compliancy Group

APRIL 23, 2024

When OIG Evaluation of Corporate Compliance Programs Turns Up Wrongdoing Compliance officers, and the compliance programs they oversee, represent the backbone of stringent adherence to federal, state, and internal standards of conduct. Minimizing their importance can be costly. Most CIAs last five years.

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Compliance Compliance Officers Regulatory Compliance Medicare 59

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?

Compliance 52

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YouCompli

JANUARY 4, 2022

Featured speakers: Craig Bennett , Vice President and Chief Compliance Officer, Boston Medical Center; Rachel Lerner , Esq., New compliance issues. This included the Medicare Final Physician Fee Schedule and noted that the Appropriate Use Criteria changes are delayed until the January first that follows the end of the pandemic.

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Compliance Officers Public Health Compliance COVID-19 40

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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Compliance Compliance Officers Fraud Medicaid 52

Provider Trust

MAY 26, 2023

Thursday, June 22, 2023 | 12-1pm CST Join us for an information session where Donna Thiel, Chief Compliance Officer at ProviderTrust, will share her expertise and valuable feedback from the 2023 HCCA Compliance Institute.

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Compliance Compliance Officers Medicaid Medicaid 52

YouCompli

SEPTEMBER 13, 2023

Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse.

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US Department of Health and Human Services Compliance Officers Compliance Fraud 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.

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Compliance Compliance Officers Governance Medicaid 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. “Not

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Compliance Officers Compliance Telemedicine COVID-19 52

Provider Trust

MAY 9, 2024

But it siloed us and created a lot of duplicative work,” said the organization’s Corporate Compliance Officer. “We grew up doing what had to be done. The laws have come so fast and so furiously. Partnering with ProviderTrust allowed the client to automate their exclusion monitoring and primary source verification processes fully.

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Compliance Compliance Officers Licensing Medicaid 52

Healthcare Law Blog

NOVEMBER 9, 2023

Of particular significance is the guidance pertaining to the role of a Compliance Officer. 4] This ensures the independence of the Compliance Officer to identify and advise on how to mitigate risks. 4] This ensures the independence of the Compliance Officer to identify and advise on how to mitigate risks.

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Compliance Compliance Officers Fraud Medicare 52

Compliancy Group

FEBRUARY 29, 2024

When a hospital, doctor’s office, or other healthcare organization is guilty of a regulatory or compliance violation , the U.S. Office of Inspector General (OIG) can invoke civil or criminal prosecution or licensure or other penalties, fines, exclusions from federal programs like Medicare, or revocation of billing privileges.

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Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

APRIL 5, 2023

The seven elements in the OIG’s effective compliance program are also useful as we consider how to best deliver quality patient care post-PHE. Each element is an opportunity for compliance officers to position their organization to provide the best patient care. Be sure to implement ongoing staff education programs.

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Compliance Officers COVID-19 Compliance COVID-19 Vaccine 52

MedTrainer

MAY 3, 2024

From sophisticated Medicare fraud to a rising prevalence of telehealth fraud , healthcare organizations need to be diligent in understanding these threats. Designating a Compliance Officer: Compliance officers provide expert oversight and ensure the organization’s practices are in full compliance with all legal requirements.

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Fraud Compliance Compliance Officers Licensing 52

HIPAA Journal

MARCH 30, 2023

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.) under the direction of a compliance officer.

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Compliance Compliance Officers Fraud HIPAA 97

Provider Trust

MAY 16, 2024

This landmark milestone represents a continued commitment by ProviderTrust and its nearly 1,000 healthcare client organizations to ensure Medicare and Medicaid dollars are protected from fraud, waste, and abuse.

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Fraud Medicaid Medicaid Licensing 52

MedTrainer

DECEMBER 7, 2023

All healthcare organizations, along with their providers and compliance officers, must understand the requirements of each regulatory state agency that provides oversight. Compliance officers need to have a deep understanding of OHCA’s role in the licensing of healthcare facilities, agencies, and organizations.

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Compliance Compliance Officers Licensing Medicaid 52

YouCompli

MAY 11, 2022

They offer clues for compliance professionals to spot training opportunities before they become enforcement actions. In March of 2022, a New Jersey rheumatologist was convicted by a federal jury for defrauding Medicare and other health insurance programs. Compliance officers should watch for: Follow the money.

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Compliance Officers Fraud Compliance Medicare 52

YouCompli

APRIL 27, 2022

As more healthcare professionals obtain licensure under compacts, compliance officers need to be aware of interstate licensure requirements – and their effects on patient care. And healthcare compliance officers have processes and procedures to update. Compliance considerations.

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Compliance Officers Licensing Compliance Nurses 52

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

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Innovaare Compliance

AUGUST 31, 2022

Medicare Advantage Organizations (MAOs) are private health plans that contract with the Centers for Medicare & Medicaid Services (CMS) to provide a menu of health care services similar to those offered under Original Medicare. 1 They pay for the services with monthly fixed payments (capitation) from CMS. or Contact Us .

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Medicare Medicare Compliance Officers Fraud 52

YouCompli

APRIL 6, 2022

enrolled in the Medicare program – almost 20 percent of the U.S. Under the revised rule, the goal is for value-based arrangements to shift financial risks from Medicare to the healthcare provider or organization. . From a compliance perspective, the early days of implementation – as with any regulatory change – may be frustrating.

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Compliance Officers Compliance Medicare Medicare 52

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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Compliance Compliance Officers Licensing Regulatory Compliance 52

Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. Measuring effectiveness: Who is your designated compliance officer?

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Compliance Compliance Officers ADA Governance 52

AIHC

MAY 31, 2022

When the federal government covers items or services rendered to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply. Government programs, such as the Centers for Medicare & Medicaid Services (CMS), find the investment in their audit and monitoring programs are effective.

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Fraud Compliance Officers Compliance Medicare 52

YouCompli

MARCH 22, 2023

Department of Health and Human Services Office of Inspector General (OIG) has expressed concerns about UDT billing. According to the OIG, prior error rate testing has suggested an improper payment rate of almost 30% for Medicare. The report recommended Medicare do the following four things to prevent improper payment for UDT.

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Overpayments Overpayment Compliance Medicare 52

MedTrainer

JANUARY 10, 2024

Centers for Medicare and Medicaid Services (CMS) requires nursing homes and ambulatory surgery centers (ASCs) to have an individual who is qualified by experience and training to serve as an infection control preventionist. Evaluate your current infection control and prevention plan.

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Compliance Fraud HIPAA Compliance Officers 94

YouCompli

MARCH 15, 2023

Project Management Methodologies for Healthcare Compliance Sharon Parsley, JD, MBA, CHC, CHRC contributes a regular post on compliance officer effectiveness for the YouCompli blog. But very quickly, as a compliance officer, I realized that I was managing multiple projects every day.

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Compliance Compliance Officers Medicare Medicare 40

MedTrainer

SEPTEMBER 20, 2023

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. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Accreditation.

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Medicaid Medicaid Medicare Medicare 97

Healthicity

APRIL 11, 2024

Are you navigating the complex world of healthcare compliance, particularly when it comes to Medicare and Advanced Beneficiary Notices (ABNs)? We've got you covered in the latest episode of Compliance Conversations, featuring industry expert Keisha Wilson , founder of KW Advanced Consulting.

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Compliance Medicare Medicare Compliance Officers 52

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year.

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Medicare Medicare Compliance Medicaid 52

Compliancy Group

AUGUST 31, 2023

The Critical Role of Compliance Officers: Laying Down the Law Compliance officers play a critical role in overseeing the implementation of compliance programs within healthcare organizations. Their presence ensures that the organization remains vigilant in maintaining ethical standards and preventing breaches.

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Compliance Compliance Officers Fraud Compliance Framework 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.

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Compliance Compliance Officers Regulatory Compliance Regulations Compliance 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.

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Compliance Compliance Officers Fraud Governance 52

YouCompli

SEPTEMBER 6, 2023

But very quickly, as a compliance officer, I realized that I was managing multiple projects every day. Let’s say you are helping your facility-based radiology departments comply with applicable Appropriate Use Criteria (AUC) requirements for advanced imaging services provided to Medicare beneficiaries.

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Compliance US Department of Health and Human Services Compliance Officers Medicare 52

Healthcare Compliance Blog

APRIL 13, 2022

On April 7, 2022, a civil complaint was filed against the two men, which alleges that they conspired to violate the False Claims Act by submitting false and fraudulent claims to Medicare for medically unnecessary hospice and home health services. These included hospice and home health certifications that were material to Medicare payments.

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Fraud Medicare Medicare Compliance 59

YouCompli

NOVEMBER 18, 2023

In this article, we will examine four essential listening skills that help compliance officers be more effective within their organizations. Maybe you also heard that the individual who was doing Medicare coverage analyses for the oncology research area was recently promoted. Fortunately, being a better listener is possible.

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Compliance Officers Compliance US Department of Health and Human Services Public Health 52