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

Provider Trust

MAY 17, 2022

So what does that mean for your healthcare organization’s compliance program? Is your organization properly vetting and monitoring compliance of your entire vendor network? Which regulations govern vendor compliance?

Compliance 52

Compliance Medicare Medicare Due Diligence 52

C&M Health Law

JANUARY 18, 2023

On January 4, in its most recent effort to expand federal support for addressing health-related social needs (HRSNs), the Centers for Medicare & Medicaid Services (CMS) issued guidance to clarify an existing option for states to address HRSNs through the use of “in lieu of” services and settings policies in Medicaid managed care.

Medicaid 52

Medicaid Medicaid Health Outcomes Federal Policy 52

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. However, healthcare receives federal funding, and thus OFAC is an additional sanction list that you should add to your vendor compliance plan/program. In addition, the suit involved alleged submission of false claims for reimbursement to the Massachusetts Medicaid Agency.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 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. Tell the readers about your career in the healthcare industry.

Governance 88

Governance HIPAA Compliance Nursing Homes 88

Innovaare Compliance

OCTOBER 6, 2022

According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. MAOs have to ensure that TPMOs use a standardized disclaimer in their marketing materials that meet the definition of marketing whether they are in print, on the website, or in television advertising. or Contact Us.

Medicare 52

Medicare Medicare Compliance Public Health 52

AIHC

FEBRUARY 7, 2024

Medicaid policies on this issue vary from state to state. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”.

HIPAA 59

HIPAA Medicaid Medicaid Telemedicine 59

HIT Consultant

NOVEMBER 22, 2021

July 1, 2021 was the enforcement date for the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule. Compliance Challenges. In this light, the most significant cost of delayed compliance is a lost strategic growth opportunity. John Kelly, Principal Business Advisor, Edifecs.

Compliance 52

Compliance Medicaid Medicaid Medicare 52

AIHC

FEBRUARY 7, 2024

Medicaid policies on this issue vary from state to state. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”.

HIPAA 52

HIPAA Medicaid Medicaid Telemedicine 52

Innovaare Compliance

FEBRUARY 14, 2022

Healthcare organizations establish Compliance Departments with the primary purpose of providing compliance oversight for the organization. Operational teams—such as the Member Services Department and the Appeals & Grievances Department—have significant compliance regulations, so they must know to maintain compliance.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Medisys Compliance

JANUARY 4, 2024

This article equips primary care providers with the latest knowledge and technical expertise to navigate the process seamlessly, maximizing new patient visit billing accuracy and minimizing compliance risks. However, specific definitions might differ depending on payers and specialties.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Compliance Medical Billing Services 59

Hall Render

JANUARY 11, 2023

Federal Food, Drug, and Cosmetic (“FD&C”) Act – If an app includes a software function that meets the definition of a medical device under section 201(h) of the FD&C Act, the app may be subject to regulatory oversight by the FDA. Hall Render blog posts and articles are intended for informational purposes only.

Compliance 40

Compliance HIPAA FDA Due Diligence 40

Verisys

JULY 12, 2023

A big thanks to our compliance team, who monitors state, federal, and international updates. Updates include requirements for credentialing providers in state Medicaid services, state employee medical programs, health maintenance organization contracts, hospital quality assessments, and health plan and insurer requirements.

Licensing 52

Licensing COVID-19 Medicaid Medicaid 52

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”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2 and 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

JUNE 7, 2023

Many of our concerns center on the proposed implementation timeframes associated with various concepts included in HTI-1, as well as ONC’s failure to sufficiently consider the burden compliance will place on provider organizations and health IT developers. 31, 2024, compliance timeline is unrealistic.

FDA 79

FDA Compliance Regulatory Compliance Medicaid 79

HIPAA Journal

JANUARY 12, 2024

The key provisions of the HIPAA Omnibus Rule were: Make business associates of covered entities directly liable for HIPAA compliance. One of the concerns with regards to the lack of HIPAA compliance is that large scale changes to HIPAA are forecast over the next few years.

HIPAA 85

HIPAA Compliance Health Insurance Medicaid 85

Healthcare Law Blog

JANUARY 26, 2023

Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat. The Medicaid and Medicare statutes also contain conscience provisions related to the performance of advanced directives, religious nonmedical healthcare providers and their patients.

ACA 105

ACA Medicaid Medicaid Compliance 105

Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of LTSS spending. [5]

Nursing Homes 52

Nursing Homes Medicaid Medicaid Medicare 52

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

C&M Health Law

OCTOBER 18, 2023

Section 504 covers all health care and human services programs and activities funded by HHS, from providers, like hospitals and doctors that accept Medicare or Medicare, to state child welfare programs, as well as Medicare Advantage Plans, and Medicaid Managed Care Plans. Web and mobile accessibility.

ADA 98

ADA COVID-19 Medicare Medicare 98

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. The Readiness List is comprehensive and touches on all aspects of administering a Medicare Advantage plan (MA), a Prescription Drug Plan (PDP), an 1876 Cost Plan, and a Medicare-Medicaid Plan (MMP).

Medicare 52

Medicare Medicare Compliance Medicaid 52

Total HIPAA

FEBRUARY 23, 2023

Definition of HIPAA Breaches A simple oversight or event may qualify as a HIPAA breach. Here are a few examples from the HHS website: A municipal social service agency disclosed PHI while processing Medicaid applications. You must train your employees on this process so they can help your organization maintain HIPAA compliance.

US Department of Health and Human Services 52

US Department of Health and Human Services HIPAA Compliance Medicaid 52

Total HIPAA

JANUARY 18, 2022

Definition of HIPAA Breaches. Here are a few examples from the HHS website: A municipal social service agency disclosed PHI while processing Medicaid applications. You must train your employees on this process so they can help your organization maintain HIPAA compliance. A simple oversight or event may qualify as a HIPAA breach.

HIPAA 92

HIPAA US Department of Health and Human Services Compliance Medicaid 92

HIT Consultant

JUNE 16, 2022

Lynne Rinehimer, Esq, GRC Sales Engineer and Compliance SME for symplr. As a result, the Centers for Medicare and Medicaid Services (CMS) has since issued new guidance regarding the IDR process for disputing parties. has worked in health care compliance and consulting for 24 years. healthcare system. About Lynne Rinehimer.

Medical Billing 52

Medical Billing Compliance Health Insurance Hospitals 52

Healthcare IT Today

NOVEMBER 12, 2023

News The 2024 Medicare Physician Fee Schedule continues many telehealth flexibilities first adopted during the public health emergency, such as an expanded scope of originating sites an expanded definition of qualified practitioners. As a result, these flexibilities will be in place until at least Dec.

Payment Systems 110

Payment Systems Public Health Medicare Medicare 110

Health Law Advisor

AUGUST 14, 2023

1] With the end of the PHE having occurred over three months ago, that temporary waiver of sanctions ended and can no longer be relied upon for legal compliance with the Stark Law. [2] 4] and (B) each such physician (not their staff) personally perform all DMEPOS Supplier requirements. [5] 2, 2023). [2] 2, 2023). [4] 4] 72 Fed.

COVID-19 52

COVID-19 Medicare Medicare Public Health 52

Medisys Compliance

JULY 10, 2023

This article aims to provide a comprehensive guide to modifiers for mental health billing, exploring their definitions, purposes, and relevant keywords. Compliance promotes consistency and accuracy in mental health billing practices. What are Modifiers?

Medical Billing Outsourcing 52

Medical Billing Outsourcing Licensing Doctors Medicare 52

Verisys

JANUARY 19, 2022

As the number of satellite facilities per provider increases and the definition of healthcare expands, it adds to healthcare organizations’ burdens–not just in providing care, but also in terms of the administrative burden and costs necessary to maintain a practice. 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

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Healthcare IT Today

FEBRUARY 15, 2024

To mitigate this, continuous investment in cybersecurity measures and adding modern security and compliance protocols is essential. Sarah Carroll, Senior Vice President, Center for Care Transformation at AVIA Health Medicaid and Medicare have become one of the biggest quiet crises in health systems today.

Medical Device Industry 110

Medical Device Industry Medicaid Medicaid Nurses 110

Verisys

JUNE 13, 2023

A big thanks to our compliance team, who monitors state, federal, and international updates. Changes include: Definition updates. Here is our monthly regulatory update. See below for changes from several states introducing legislation.

COVID-19 Vaccine 52

COVID-19 Vaccine US Department of Health and Human Services COVID-19 Licensing 52

Healthcare Compliance Blog

JUNE 9, 2022

Those claims were for presumptive and definitive Urine Drug Tests (UDTs) that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients. Providers must ensure that the claims they submit to Medicare and Medicaid are true and accurate.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

Total HIPAA

FEBRUARY 23, 2023

Definition of HIPAA Breaches A simple oversight or event may qualify as a HIPAA breach. Here are a few examples from the HHS website: A municipal social service agency disclosed PHI while processing Medicaid applications. You must train your employees on this process so they can help your organization maintain HIPAA compliance.

US Department of Health and Human Services 52

US Department of Health and Human Services HIPAA Compliance Medicaid 52

Healthcare Law Today

JANUARY 20, 2022

Finally, billing and coding mistakes can have an adverse effect on earnings, value, and create compliance concerns. Thus, compliance with the AKS is vital to the health of the overall relationship. The entity is also prohibited from billing Medicare or, possibly, Medicaid for such referrals. Section1320a-7b).

Compliance 52

Compliance Medicare Medicare COVID-19 52

Innovaare Compliance

AUGUST 24, 2023

To ensure good stewardship of the Medicare Trust Fund, the Centers for Medicare & Medicaid Services (CMS) perpetually makes changes to improve various aspects of the program – quality of care, health equity and payment methodology, to name a few.

Medicare 52

Medicare Medicare Fraud Medicaid 52

Healthcare Blog

OCTOBER 19, 2023

Compliance with any policy has a much better success rate when it is understood. If your policy affects visitors, you must get the information out to the public to assure compliance. The Centers for Medicare and Medicaid Services has a vast information depository on regulations and guidance for healthcare policy. 2021, May 6).

Public Health 95

Public Health Compliance Hospitals Health Insurance 95