MedTrainer

JUNE 29, 2023

Compliance isn’t a concept with a lot of grey area — you’re either compliant with regulations or you’re not! Unfortunately, this yes or no perspective often leads to the misconception that compliance tracking is easy. And, in fact, there are times when tracking compliance can be as difficult as meeting the compliance standard itself!

Compliance 52

Compliance FDA Health Insurance Medicaid 52

AIHC

AUGUST 30, 2023

What compliance issues need to be considered when drafting a marketing strategy? Let’s take a closer look at potential compliance risks. As a reminder, telemarketing in healthcare must follow strict privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-191 in the United States.

Compliance 52

Compliance Fraud Medicare Medicare 52

Medisys Compliance

JUNE 7, 2022

Defining Medicare Secondary Payer (MSP). Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility i.e., when another entity has the responsibility for paying before Medicare. When Medicare Pays First. Primary payers must pay a claim first.

Medicare 59

Medicare Medicare Medical Billing Medical Billing Outsourcing 59

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. To become certified, please visit us at: American Medical Compliance (AMC).

Fraud 52

Fraud Medicare Medicare Compliance 52

Compliance Now

AUGUST 10, 2023

This request is not mandatory for employers, and there are significant compliance considerations for employers that extend the enrollment window for this population. What are some of the compliance considerations a plan sponsor will need to address if they choose to extend?

Medicaid 100

Medicaid Medicaid Compliance Health Insurance 100

C&M Health Law

JANUARY 25, 2023

Telehealth Section 4113 of the Act extends certain Medicare telehealth flexibilities that were allowed during the COVID-19 PHE for two years, through 2024. The section ensures that telehealth flexibilities under Medicare are extended for two years, regardless of the status of the PHE.

Medicaid 104

Medicaid Medicaid Medicare Medicare 104

MedTrainer

MAY 16, 2024

ASC Compliance Training Requirements There isn’t a universal list of training requirements for all ASC employees. Staff should review the requirements for their specific state to remain in compliance. Below are courses common to many roles in ASC facilities that meet federal requirements for orientation or annual continuing education.

Compliance 52

Compliance HIPAA Health Insurance Medicaid 52

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Refining Definitions for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Innovaare Compliance

MAY 28, 2024

The Centers for Medicare & Medicaid Services (CMS) has added another category of drugs—immunosuppressants—to their national audits in collaboration with the Integrity Medicare Drug Integrity Contractor (PPI MEDIC). Before January 1, 2021, beneficiaries with ESRD could not join a Medicare Advantage (MA) plan.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

JUNE 28, 2023

Benefits of the CFE in Healthcare Compliance Working with a CFE gives providers access to specialized skills, knowledge, and resources for effectively managing fraud risks. They can also help strengthen compliance programs and protect against financial losses due to fraudulent activities. Compliance Program Enhancement.

Fraud 52

Fraud Compliance Governance Compliance Officers 52

Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 Managed care now covers more than half of Medicare enrollees and over 80% of Medicaid enrollees.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

HIT Consultant

MARCH 22, 2023

The Centers for Medicare and Medicaid Services recently announced that in 2021, the nation spent $4.3 Unfortunately, facilities aren’t incentivized to publish this information, nor is there large-scale accountability for non-compliance. trillion on healthcare, nearly twice the average of other nations in the developed world.

Patient Satisfaction 96

Patient Satisfaction Compliance Hospitals Health Insurance 96

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. Strengthen the limitations on uses and disclosures of Protected Health Information. Expand individuals’ rights to restrict disclosures of Protected Health Information.

HIPAA 83

HIPAA Compliance Health Insurance Medicaid 83

Health Law RX

DECEMBER 21, 2023

Department of Health and Human Services (HHS) Office for Civil Rights (OCR) is signaling that it is cracking down on healthcare organizations that fail to identify and address cybersecurity vulnerabilities as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA Rules).

HIPAA 52

HIPAA Ransomware Compliance Medicaid 52

HIPAA Journal

MARCH 31, 2023

This article aims to clarify what records should be retained under HIPAA compliance rules, and what other data retention requirements Covered Entities and Business Associates may have to consider. Providers and suppliers need to maintain medical records for each Medicare beneficiary that is their patient.

HIPAA 129

HIPAA Medicare Medicare Compliance 129

HIPAA Journal

JULY 24, 2023

The HHS OIG Exclusions List is a database of individuals and organizations that are prohibited from participating in federal health care programs. The list now covers more than just Medicare and State Health Care Programs and includes programs such as CHIP, TRICARE, and Veterans Affairs. What is the HHS OIG Exclusions List?

Fraud 52

Fraud Medicare Medicare Medicaid 52

Compliancy Group

MAY 27, 2022

Let’s Simplify Compliance HIPAA and cybersecurity go hand-in-hand. × HIPAA Compliance Simplified. The hospital has provided those affected with a 12-month membership to credit monitoring services, a $1 million identity-theft reimbursement insurance policy, and access to identity theft recovery services if necessary.

HIPAA 98

HIPAA Ransomware Compliance Hospitals 98

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.

US Department of Health and Human Services 52

US Department of Health and Human Services Hospitals Malpractice Compliance Officers 52

HIPAA Journal

MAY 29, 2023

It has been 27 years since President Clinton signed the Health Insurance Portability and Accountability Act (HIPAA) into law, but compliance is still proving a challenge for many HIPAA-regulated entities. The 2016-2017 HIPAA audit program identified many areas of noncompliance.

HIPAA 96

HIPAA Compliance Due Diligence COVID-19 96

Health Populi

FEBRUARY 17, 2021

Those patients trying to stay medication-adherent tried various strategies such as stretching out their prescriptions, skipping doses, or reducing those doses — not sticking to the prescribed regimen, which can result in an adverse event or compromise the intended health outcome.

COVID-19 141

COVID-19 Health Insurance Health Outcomes Medicaid 141

Hall Render

FEBRUARY 4, 2022

” Medicare Part C. Medicare Advantage Programs were another target in 2021. Participating private health insurance carriers are paid a capitated amount for each patient enrolled in their plans, rather than receiving payment under the typical fee-for-service model. Individual Accountability.

Fraud 40

Fraud Governance Medicare Medicare 40

Health Care Law Brief

FEBRUARY 2, 2024

The Waiver Amendment was approved on January 9, 2024, by the Centers for Medicare & Medicaid Services (“CMS”) under Section 1115(a) of the Social Security Act and will expire on March 31, 2027. The rates must be at least 80% of Medicare rates. billion in Medicaid investments over the next three years.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare Law Blog

MARCH 8, 2023

With these changes, the growing publicity surrounding ChatGPT, and the expected growth of artificial intelligence in the healthcare industry, entities and individuals in the healthcare industry will need to carefully consider and evaluate their use of ChatGPT to ensure their compliance with applicable privacy laws.

HIPAA 52

HIPAA Licensing Compliance Health Insurance 52

Health Populi

JUNE 6, 2021

Commercial Member Health Plan Study. exploring consumer satisfaction with some 150 health insurance plans operating in 22 regions around the U.S. Power assessed the opinions of 32,066 commercial health plan members between January and March 2021. Power has conducted the U.S. This year, J.D.

Patient Satisfaction 81

Patient Satisfaction COVID-19 Telemedicine Medicaid 81

AIHC

DECEMBER 2, 2021

At a recent AIHC HIPAA training event, this topic came up. I am a Certified HIPAA Compliance Officer (CHCO) through the AIHC organization and a compliance specialist. Our compliance committee wants the “industry standard” of this statement and evidence that this is industry standard. not to mention insurers.

HIPAA 52

HIPAA Compliance Compliance Officers Health Insurance 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

Healthcare Law Blog

MARCH 25, 2022

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger insurers. Once the new rules were published, Vista Health Plan, Inc., 2018 Final Rule, 83 Fed.

ACA 52

ACA US Department of Health and Human Services Health Insurance Medicaid 52

Healthcare Law Today

NOVEMBER 30, 2022

Proposed changes to the federal substance use disorder law will increase provider efficiency and alignment with the Health Insurance Portability and Accountability Act (HIPAA). Self-pay patients have the right to restrict disclosures to health plans. Health Care & Life Sciences Sector Top Trends for 2022.

HIPAA 52

HIPAA Telemedicine Compliance Health Insurance 52

Healthcare IT Today

SEPTEMBER 19, 2023

Eden Avraham-Katz, VP of Legal & Compliance at 1upHealth While I appreciate the efforts to simplify the prior authorization process with FHIR APIs, the underlying issues with prior authorization are fundamentally systemic. This critical information can help identify or avoid serious adverse events, including hospital readmissions.

Hospitals 133

Hospitals HIPAA Nurses Governance 133

Health Care Law Brief

NOVEMBER 9, 2021

We note the challenges associated with this new requirement to furnish good faith estimates to these individual patients, and have concerns that the January 1, 2022 effective date may not allow providers or facilities sufficient time to develop and implement systems for compliance. Patient-Provider Dispute Resolution. 2] See 86 Fed.

Medical Billing 75

Medical Billing Due Diligence Compliance Patient Satisfaction 75

Healthcare IT Today

JANUARY 18, 2024

By balancing compliance, innovation, and budget constraints, healthcare organizations will drive better health outcomes, ushering in a more efficient era in healthcare. Gabriel Mecklenburg, Co-Founder & Executive Chairman at Hinge Health Gabriel Mecklenburg shares his predictions on how technology will shape healthcare in 2024.

Hospitals 75

Hospitals Compliance Health Outcomes Medicare 75

Hall Render

MARCH 8, 2024

NATIONAL 34.5% NATIONAL 34.5% NATIONAL 34.5%

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

AUGUST 11, 2023

healthcare company keeps expanding How Mount Sinai uses AI to predict death risk Catholic Health opens New York ASC Report highlights maternal health care disparities in New York Local hospitals to see massive Medicare payment increase. But that wasn’t the whole story. Mary’s. Cramer: HHS Awards $1.2

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nursing Homes Nurses 40

Hall Render

MAY 5, 2023

acquisition of Oak Street Health to expand primary care footprint Did Hospitals Violate EMTALA by Failing to Provide Abortion Care? of Iowa Health Care denies sharing patient data with Facebook, but are they right? of Iowa Health Care denies sharing patient data with Facebook, but are they right?

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nurses Hospitals 40