Compliancy Group

JANUARY 3, 2024

This article discusses the issues related to medical billing compliance policy and the steps for providers to maintain financial integrity and adherence to all requirements. Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices.

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Medical Billing Compliance ACA Health Insurance 52

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

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Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

Innovaare Compliance

OCTOBER 6, 2022

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. In 2022, 48% of all eligible Medicare beneficiaries are enrolled in MAPD.

Medicare 52

Medicare Medicare Compliance Public Health 52

Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

Medicare 40

Medicare Medicare Due Diligence Health Insurance 40

MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the Bureau of Facility Standards , provide oversight with certain standards, adding a layer of complexity to successfully managing healthcare compliance in Idaho. Continue reading this overview for key aspects of healthcare compliance specific to the state of Idaho.

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Compliance Licensing Compliance Officers Informed Consent 52

Innovaare Compliance

JANUARY 15, 2024

The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. Medicare Part D will have three (3) phases instead of four (4) – Deductible, Initial Coverage Phase and Catastrophic Phase. generics) in the catastrophic phase.

Medicare 52

Medicare Medicare Compliance FDA 52

YouCompli

SEPTEMBER 6, 2023

It definitely wasn’t in any of mine! But very quickly, as a compliance officer, I realized that I was managing multiple projects every day. Conducting annual compliance training is a project.   What happens when you receive an order for an MRI for a Medicare beneficiary, but the CDSM info is missing or incomplete? 

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

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.

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Medicare Medicare Fraud Medicaid 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.”

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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

YouCompli

NOVEMBER 18, 2023

This overly simplistic definition fails to address the inherent challenges that keep many people from being a good listener in life and, more particularly, in the workplace. In this article, we will examine four essential listening skills that help compliance officers be more effective within their organizations.

Compliance Officers 52

Compliance Officers Compliance US Department of Health and Human Services Nurses 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

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] The IOAS exception does NOT apply.

COVID-19 52

COVID-19 Medicare Medicare Public Health 52

Medisys Compliance

APRIL 8, 2022

In this article, we briefly discussed these Medicare telehealth billing guidelines. Due to the provisions of the Consolidated Appropriations Act of 2021, the CMS continues to evaluate the inclusion of telehealth services that were temporarily added to the Medicare telehealth services list during the COVID-19 PHE (Public Health Emergency).

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Medisys Compliance

FEBRUARY 20, 2023

Healthcare providers often get confused about the appropriate use of modifiers GA, GX, GY, and GZ while billing Medicare. GA modifier indicates that an Advance Beneficiary Notice (ABN) is on file and allows the provider to bill the patient if not covered by Medicare. Medicare does not pay for all health care costs.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 52

YouCompli

OCTOBER 26, 2022

Helping our clinical colleagues feel the urgency of compliance monitoring can be a huge challenge. And the Compliance team simply doesn’t have the clinical expertise to own the monitoring of these requirements. The review found providers often did not meet the Medicare billing requirements – a whopping 83 of 200 were in error.

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Compliance Compliance Officers Overpayments Overpayment 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

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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. It definitely wasn’t in any of mine! It definitely wasn’t in any of mine! Conducting annual compliance training is a project.

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Compliance Compliance Officers Medicare Medicare 40

Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. Additionally, check out this HHS-OIG 2016 report, Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure , which revealed “vulnerabilities that could allow potentially fraudulent providers to enroll in the Medicare program.”. Case Study: S.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The SRFs include low-income subsidy, dual eligibility (meaning eligible for Medicare and Medicaid) and disability.

Medicare 52

Medicare Medicare Overpayments Overpayment 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

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.

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Compliance Medicaid Medicaid Medicare 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.

Medicare 52

Medicare Medicare Compliance Medicaid 52

McGuire Wood

JULY 5, 2022

Founded in 2001, the company solutions, designed for government-sponsored health plans, are designed to support member interactions, compliance and Medicare processes. Under the terms of the definitive merger agreement, the firm will acquire all outstanding shares of Convey common stock, representing an enterprise value of about $1.1

Medicare 52

Medicare Medicare Governance Compliance 52

AIHC

FEBRUARY 7, 2024

Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”. It covers billing, Federal Medicare policies and State Medicaid policies. It covers billing, Federal Medicare policies and State Medicaid policies.

HIPAA 59

HIPAA Medicaid Medicaid Telemedicine 59

HIPAA Journal

MAY 12, 2023

The term “continuity of care” has various definitions. Some definitions imply care is continuous within the same healthcare organization (or Organized Health Care Arrangement), while others extend the definition to multiple healthcare settings. 42 CFR Part 2). The post HIPAA Continuity of Care appeared first on HIPAA Journal.

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HIPAA Compliance Health Services Administration Medicare 67

Med Law Blog

APRIL 4, 2022

The definition of “covered entity” in the Act is far greater than covered entity as defined by HIPAA. However, the recent Medicare Compliance Reporter indicates that this will require hospitals to report cyber breaches in 72 hours and ransom payments within 24 hours to DHS.

HIPAA 52

HIPAA Medicare Medicare Compliance 52

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.

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ADA COVID-19 Medicare Medicare 98

AIHC

FEBRUARY 7, 2024

Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”. It covers billing, Federal Medicare policies and State Medicaid policies. It covers billing, Federal Medicare policies and State Medicaid policies.

HIPAA 52

HIPAA Medicaid Medicaid Telemedicine 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

YouCompli

MAY 11, 2022

It reflects remarks CJ made at HCCA’s 2022 Compliance Institute. For more insights from the Compliance Institute, download our white paper on how compliance professionals can help healthcare institutions mitigate risk.). Compliance officers should watch for: Follow the money. Billing for services not needed or received.

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Compliance Officers Fraud Compliance Medicare 52

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

Medicare 52

Medicare Medicare Nurses Medicaid 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.

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Compliance Regulatory Compliance Medicaid Medicaid 52

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.

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Compliance HIPAA FDA Due Diligence 40

Healthcare Law Today

JANUARY 11, 2023

As part of a deferred prosecution agreement, which must be approved by the court, Jet Medical admitted that it distributed misbranded devices and agreed to implement enhanced compliance measures. violated the False Claims Act by causing medical providers to submit false claims to Medicare. and Martech Medical Products Inc.,

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FDA Governance Medicare Medicare 59

Hall Render

APRIL 6, 2022

The relator alleged that these programs and subsequent reporting of the retail price, and not the discounted price, violated Medicare Part D’s requirement that a pharmacy must report the usual and customary price charged for the drugs. This footnote originated as a footnote in a memorandum issued by CMS in October of 2006.

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Medicare Medicare Medicaid Medicaid 72