MedTrainer

JANUARY 12, 2024

Healthcare compliance is serious business for regulators. In this blog post, we’ll outline who regulates healthcare compliance, how rules are enforced, and why organizations need a robust compliance platform to stay in the good graces of regulators. What is Healthcare Compliance? Who Regulates Healthcare Compliance?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

MedTrainer

APRIL 22, 2024

Several federal agencies highly recommend having a healthcare compliance committee — the key is to make the committee helpful, not just a regulatory checkbox. Compliance committees vary based on the size of the organization, the care setting, and the committee’s charter. What is a Healthcare Compliance Committee?

Compliance 52

Compliance Compliance Officers Governance Medicaid 52

MedTrainer

MARCH 22, 2024

Today’s healthcare workers expect more from a compliance training program. For the administrators, compliance officers, and HR professionals tasked with crafting such programs, the challenge is finding a balance between what is legally required and what is practical for their already stretched staff.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

MedTrainer

MARCH 28, 2024

Healthcare compliance. Just as perplexing is who is responsible for compliance in healthcare organizations. The answer has as many layers as the definition of compliance itself. The answer has as many layers as the definition of compliance itself. Who in the Organization Is Responsible for Healthcare Compliance?

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

MedTrainer

DECEMBER 4, 2023

Managing healthcare compliance in Mississippi effectively means adapting to the state’s specific regulations, and having the right systems in place to stay on track. To successfully oversee healthcare compliance in Mississippi, organizations need to develop efficient methods for tracking regulatory updates.

Compliance 52

Compliance Telemedicine Licensing Public Health 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.

Compliance 52

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

MedTrainer

MARCH 30, 2024

Enrollment delays cost nearly a third of organizations polled in a 2023 MedTrainer survey money, and 26% believe credentialing delays increase compliance risks that can significantly drain coffers. Download our Credentialing Reality Worksheet to find out! How much are enrollment delays costing your organization?

Malpractice 98

Malpractice Licensing Medicaid Medicaid 98

MedTrainer

MAY 4, 2023

That includes many compliance professionals. There are plenty of compliance implications for the end of the Public Health Emergency on May 11, 2023 , and an assessment is a great place to start. Download this free toolkit for resources to update your disaster preparedness plan. Hard to believe, huh?

Public Health 52

Public Health Compliance COVID-19 COVID-19 Vaccine 52

MedTrainer

MAY 16, 2024

Download the Ultimate List of Training Requirements for Ambulatory Surgery Centers to see a full list of federal and accreditation training requirements for ASC staff broken down by role, with the applicable standard, CMS violation category, and frequency. Staff should review the requirements for their specific state to remain in compliance.

Compliance 52

Compliance HIPAA Health Insurance Medicaid 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. That mean, maintaining compliance standards, efficient reporting, and conducting thorough internal audits are vital.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

AIHC

FEBRUARY 7, 2024

Medicaid policies on this issue vary from state to state. Download the 1-Page “ A Framework for Defining Telehealth ” Fact Sheet. 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.

HIPAA 59

HIPAA Medicaid Medicaid Telemedicine 59

AIHC

FEBRUARY 7, 2024

Medicaid policies on this issue vary from state to state. Download the 1-Page “ A Framework for Defining Telehealth ” Fact Sheet. 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.

HIPAA 52

HIPAA Medicaid Medicaid Telemedicine 52

HIPAA Journal

JANUARY 30, 2023

The National HIPAA Summit is the leading forum on healthcare EDI, privacy, breach notification, confidentiality, data security, and HIPAA compliance, and the deadline for registration for the Virtual 40th National HIPAA Summit is fast approaching.

US Department of Health and Human Services 85

US Department of Health and Human Services HIPAA Compliance Medicaid 85

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. The rule requires that all healthcare payer organizations participating in a CMS program allow members to download and share their data using API’s (Application Programming Interface).

Compliance 52

Compliance Medicaid Medicaid Medicare 52

MedTrainer

MAY 10, 2024

1, 2024 , mental health counselors can enroll with Medicare as part of The Centers for Medicare and Medicaid Services ( CMS ) plan to bring approximately 400,000 marriage and family therapists (MFT) and mental health counselors (MHC) into their network. Effective Jan.

Licensing 52

Licensing ACA Medicare Medicare 52

Natalia Mazina

JULY 20, 2022

Our firm has prepared policies and procedures (and patient notices) that comply with the above requirements, available for download here. Many Medicaid programs have similar restrictions. Basically, California law mirrors Part D requirements.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

MedTrainer

MARCH 14, 2024

Download Now What are Provider Privileges? As the Centers for Medicare and Medicaid Services outlines, privileging isn’t required for every healthcare provider but is a requirement for those conducting medical services within a hospital or ambulatory surgery center (ASC). Look for these 10 attributes in a credentialing specialist.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

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

Medval Compliance Blog

MARCH 18, 2022

The Centers for Medicare & Medicaid Services (CMS) will be hosting an overview of the new “Go Paperless” feature available in the Medicare Secondary Payer Recovery Portal (MSPRP) on Thursday, April 13 at 1:00 pm ET. The webinar will feature opening remarks and a presentation, followed by a question and answer session.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

APRIL 18, 2024

Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment. Get the tools you need to eliminate delays in your provider enrollment process. CMS has guidelines around each of those relating to education, state licensure, and more.

Medicare 52

Medicare Medicare Licensing Compliance 52

Medval Compliance Blog

FEBRUARY 8, 2022

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that it will be hosting a Workers’ Compensation Medicare Set-Aside (WCMSA) webinar next Thursday, February 17, 2022 at 1:00 pm ET. Check back following the webinar for a recap, where we will share key takeaways and highlights from the session.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

NOVEMBER 17, 2023

Download Now What Does a Credentialing Expert Do in Healthcare? Credentialers also manage payer enrollment, ensuring a provider’s organization can be reimbursed by insurance companies and government agencies (Medicare and Medicaid) for care patients receive. Look for these 10 attributes in a credentialing specialist.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Provider Trust

SEPTEMBER 29, 2022

A 49-year-old Brownsville, TX man named Fernando Mendez was taken into custody in early September after being charged with defrauding Medicaid. From August 2021 to February 2022, Mendez provided patient assessments and evaluations and ordered treatments and prescriptions, all while billing Medicaid for his services.

Licensing 52

Licensing Fraud Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 7, 2022

Health plans (collectively, “plan sponsors”) that contract with the Centers for Medicare & Medicaid Services (CMS) to provide health services to eligible Medicare beneficiaries are responsible for legal, contractual, and fiduciary obligations whether performed by the plan or those to whom the company delegates those obligations.

Compliance 52

Compliance Medicare Medicare Medicaid 52

Innovaare Compliance

JUNE 28, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of CMS program audits in February 2022. Download 2022 ODAG Audit Universe Changes . Compliance Standard and Method of Evaluation are outlined in the protocol. . What to Look for During a CMS Program Audit . Contact us today! .

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

HIT Consultant

FEBRUARY 27, 2024

Co-Pilots have the capacity to enhance productivity and compliance without disrupting existing workflows. When it comes to clinical policies that a typical state Medicaid publishes, on average, there are more than 5,000 documents that a clinician must first sample and then evaluate for relevancy.

Medicaid 111

Medicaid Medicaid Compliance 111

YouCompli

APRIL 12, 2022

YouCompli is the only compliance solution that not only monitors all of the regulatory changes but also transforms them into a change management solution specifically for healthcare. Our healthcare compliance experts monitor all state and federal regulatory sources to identify and interpret every regulatory change for your service lines.

Compliance 40

Compliance Medicaid Medicaid Medicare 40

Verisys

DECEMBER 5, 2023

The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs. Delivery of data ranges from a print-out sent by mail, a spreadsheet sent through email, a CSV download from a secure server, or an online searchable database. Unpublished Data.

Governance 52

Governance Licensing Malpractice Medicaid 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. What Additional Information Should I Know for Compliance?

HIPAA 52

HIPAA Compliance COVID-19 Compliance Officers 52

HIPAA Journal

JANUARY 2, 2023

HIPAA compliance is about reducing risk to an appropriate and acceptable level. It is therefore important for HIPAA-covered entities to conduct regular HIPAA compliance reviews (this is required by the HIPAA law) to make sure HIPAA violations are discovered and corrected before they are identified by regulators.

HIPAA 109

HIPAA Compliance Hospitals Medicare 109

Verisys

MARCH 1, 2022

The Centers for Medicare & Medicaid Services (CMS) Medicare and state Medicaid lists show practitioners who have opted out of those programs. Delivery of data ranges from a print-out sent by mail, a spreadsheet sent through email, a CSV download from a secure server, or an online searchable database. Unpublished Data.

Governance 52

Governance Licensing Malpractice Medicaid 52

HIPAA Journal

DECEMBER 31, 2022

You can download a complaint form , complete it, send it to OCR by mail or as an email attachment. Consequently, it is not possible to report a HIPAA violation anonymously via the OCR Complaints Portal. There are Other Ways of Filing a Complaint with OCR. The Complaints Portal is not the only way to file a complaint with OCR.

HIPAA 93

HIPAA Medicaid Medicaid Medicare 93

AIHC

JANUARY 5, 2022

These don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. Download the CMS Model Notice and Consent forms. EMTALA Compliance Basics is a short course offered at a low price to help increase awareness for your workforce.

Medical Billing 52

Medical Billing Health Insurance Hospitals Medicare 52

HIPAA Journal

JANUARY 31, 2024

Report: Security Breaches in Healthcare (Direct Download PDF, 1.9MB, 16 pages) An unwanted record was set in 2023 with 725 large security breaches in healthcare reported to the Department of Health and Human Services (HHS) Office for Civil Rights (OCR), beating the record of 720 healthcare security breaches set the previous year.

Ransomware 122

Ransomware HIPAA Hospitals Compliance 122

CMS.gov

JUNE 20, 2018

Over the past year, the Centers for Medicare & Medicaid Services (CMS) has engaged with the provider community in a discussion about regulatory burden issues. The RFI can be downloaded from the Federal Register at: [link].

Medicare 30

Medicare Medicare Fraud Medicaid 30

Health Law Gurus

MAY 22, 2019

The Centers for Medicare and Medicaid Services (CMS) is launching new value-based programs with great fervor as a central strategy to bend the healthcare cost curve. (This is the first in a two-part article on healthcare data transparency and how providers and payers can leverage transparency as a population health opportunity.).

Medicare 52

Medicare Medicare Medicaid Medicaid 52