MRO Compliance

JUNE 1, 2022

Information You Need to Know about a HEDIS Audit from Revenue Cycle Experts. Each year HEDIS rating criteria is updated, meaning your organization needs to stay up-to-date on the latest news and trends for HEDIS compliance audits. HEDIS works as a government rating tool. Compliance with HEDIS specifications.

Medicare 130

Medicare Medicare Compliance Medicaid 130

MedTrainer

NOVEMBER 14, 2023

While federal operations are slowed, reduced, or put on pause during a government shutdown, healthcare services must continue to operate. Compliance officers, human resource leaders, credentialing teams, and administrators are all asking themselves these critical questions. What Is a Government Shutdown?

Governance 52

Governance Medicaid Medicaid Medicare 52

MedTrainer

NOVEMBER 30, 2023

Like other regions in the United States, Wisconsin is characterized by its unique blend of rules and mandates that govern healthcare compliance within the state. This post sheds light on certain aspects of healthcare compliance in Wisconsin, with tips for effectively managing your healthcare organization.

Compliance 52

Compliance Medicaid Medicaid Licensing 52

MedTrainer

NOVEMBER 14, 2023

When it comes to healthcare delivery, compliance is not just a matter of ticking boxes; it’s the backbone of patient trust and safety. In this blog post, we’ll explore the many reasons why healthcare compliance isn’t just important — it’s vital. What Is Healthcare Compliance?

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Compliance HIPAA Governance Medicare 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?

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Compliance Compliance Officers Governance Medicaid 52

MedTrainer

DECEMBER 4, 2023

Responsible healthcare providers and compliance professionals in each state of the United States must follow specific regulations, and achieving healthcare compliance in Kentucky is no exception. Regulations Unique to Kentucky To meet the standards of healthcare compliance in Kentucky , there are a few additional regulations.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

HIT Consultant

JULY 20, 2022

Kristen Ballantine, VP of Government Relations at Gainwell. However, with the CMS Interoperability and Patient Access Final Rule , consumers, specifically Medicaid members, there is a greater push to give access to, and ownership of, this data. About Kristin Ballantine.

Governance 96

Governance Medicaid Medicaid Public Health 96

MedTrainer

NOVEMBER 27, 2023

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

Compliance 52

Compliance Licensing 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

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

DECEMBER 7, 2023

Healthcare compliance in New Mexico mirrors the state’s diverse culture, with unique regulations that differ from other states, such as credentialing documentation requirements for managed care organizations. New Mexico’s parity law requires insurers to cover telemedicine services to the same extent as in-person services.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

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. Are the claims accurate and complete?

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 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. My professional goals changed over time.

Governance 86

Governance HIPAA Compliance Nursing Homes 86

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.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

MedTrainer

NOVEMBER 27, 2023

As is the case with every state, there are distinctive challenges in the management of healthcare compliance in North Carolina, shaped by its own unique regulations. Keep scrolling for a summary of the crucial elements of healthcare compliance relevant to North Carolina.

Compliance 52

Compliance Licensing Telemedicine Medicaid 52

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Compliance 59

MedTrainer

DECEMBER 4, 2023

Healthcare compliance in North Dakota differs in several ways from other states, primarily influenced by the state’s rural character and unique healthcare priorities. Additionally, the state’s approach to Medicaid expansion involves unique waivers, impacting eligibility criteria and cost-sharing provisions.

Compliance 52

Compliance Licensing Health Outcomes Medicaid 52

MedTrainer

NOVEMBER 17, 2023

Managing healthcare compliance in Illinois requires healthcare organizations and professionals to stay informed about state-specific regulations while also adhering to federal healthcare compliance standards. Medical licensing is provided by the Illinois Department of Financial and Professional Regulation.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

OCTOBER 4, 2023

To ensure organizations meet these standards, federal healthcare compliance requirements have been put in place. Let’s look at some of the key federal healthcare compliance requirements, state-specific variations, and accreditation standards healthcare organizations must adhere to. What Are Federal Healthcare Compliance Requirements?

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Compliance Fraud HIPAA Governance 52

MedTrainer

NOVEMBER 27, 2023

What does healthcare compliance in Georgia look like? Like all states, Georgia has its own distinct rules and regulations that compliance management teams must follow. Keep reading for resources, tips, and regulations unique to healthcare compliance in Georgia. These requirements are unique to Georgia.

Compliance 52

Compliance Licensing Medicaid Medicaid 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. Robust, flexible, and reliable compliance programs must be developed to maintain compliance in Hawaii.

Compliance 52

Compliance Compliance Officers Licensing Medicaid 52

Bill of Health

SEPTEMBER 9, 2022

Here is what we know — despite the secrecy that shields penal institutions — about carceral health care. There are no national mandatory standards governing health care access or delivery behind bars. health law and policy is the exclusion of people in custody in prisons, jails, and detention centers from Medicaid.

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COVID-19 COVID-19 Vaccine Medicaid Medicaid 349

MedTrainer

NOVEMBER 29, 2023

One critical aspect of managing healthcare compliance in South Carolina is the adherence to both federal laws and state-specific regulations, including those pertaining to telehealth, which has seen significant growth in the state. Read on for vital information about maintaining healthcare compliance in South Carolina.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 14, 2023

Healthcare compliance regulations can vary significantly from one state to another, so managing healthcare compliance in Virginia may be different compared to other states. Regulations Unique to Virginia To meet the standards of healthcare compliance in Virginia, there are a few additional regulations.

Compliance 52

Compliance Licensing Governance Hospitals 52

MedTrainer

NOVEMBER 28, 2023

Healthcare compliance in Arizona involves a unique set of rules and standards that impact compliance management for all medical organizations. This overview highlights important aspects that are particularly relevant to healthcare compliance in Arizona.

Compliance 52

Compliance Licensing Public Health Medicaid 52

MedTrainer

NOVEMBER 29, 2023

Nestled among Massachusetts’ historic landmarks and vibrant communities, lies a challenging yet critical aspect for healthcare professionals: navigating the intricate maze of healthcare compliance regulations. This article reveals the must-knows for confidently achieving compliance in Massachusetts.

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Compliance Public Health Health Insurance Hospitals 52

MedTrainer

OCTOBER 29, 2023

California has the most rules of any state, so it’s no surprise that there is additional complexity when it comes to managing healthcare compliance in California. To effectively manage compliance, healthcare organizations must establish a robust system for monitoring and interpreting these changes and swiftly implement necessary adjustments.

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Compliance COVID-19 HIPAA Governance 52

MedTrainer

NOVEMBER 28, 2023

Healthcare providers, organizations, and compliance officers in Michigan State need to be aware of their state-specific laws and regulations in order to navigate compliance successfully. This article serves as a quick-reference guide for maintaining healthcare compliance in Michigan State.

Compliance 52

Compliance Licensing Public Health Compliance Officers 52

MedTrainer

NOVEMBER 29, 2023

With its distinctive legal environment, Louisiana poses a few unique healthcare compliance challenges that differ from other states. Managing healthcare compliance in Louisiana successfully means that providers and organizations can skillfully navigate their state-specific regulatory framework.

Compliance 52

Compliance Licensing Medicaid 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

MedTrainer

NOVEMBER 6, 2023

When it comes to healthcare, compliance is not just a buzzword — it’s critical to ensuring quality of care, protecting patient privacy, and staying on the right side of the law. But what exactly is a compliance plan in healthcare, and why is it so crucial? Why Is a Compliance Plan Important in Healthcare?

Compliance 52

Compliance Fraud Nursing Homes Governance 52

MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the West Virginia Department of Health and Human Resources (DHHR) and the Bureau for Medical Services (BMS) , oversee and enforce these regulations. Effective management of healthcare compliance in West Virginia requires consistent adherence to both federal and state agency standards.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Healthcare It News

APRIL 28, 2023

"We serve the same families in our Administration for Children and Families that we serve with Medicare and Medicaid, that we serve in our Substance Abuse and Mental Health Services Administration," said Palm. How are we thinking about the way Medicare and Social Security work together?" " asked Palm.

US Department of Health and Human Services 241

US Department of Health and Human Services Medicaid Medicaid Governance 241

MedTrainer

JANUARY 12, 2024

HIPAA compliance is a fundamental aspect of healthcare operations in the United States, playing a pivotal role in safeguarding patient privacy and data security. How does HIPAA compliance affect healthcare facilities? What is Healthcare Compliance?

HIPAA 52

HIPAA Compliance Health Insurance Hospitals 52

MedTrainer

NOVEMBER 29, 2023

A unique set of rules and standards can pose a unique set of challenges for overseeing healthcare compliance in Indiana. Just as in other states, Indiana health professionals and groups must have a firm grasp of state-specific regulations in order to effectively manage their healthcare compliance.

Compliance 52

Compliance Licensing Governance Public Health 52

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. To become a provider for Ohio Medicaid, you must first enroll in the Ohio Medicaid program. Here are the steps of provider enrollment for Ohio Medicaid: Provider Enrollment for Ohio Medicaid 1.

Medicaid 52

Medicaid Medicaid Licensing Medical Billing Outsourcing 52

MedTrainer

NOVEMBER 30, 2023

Minnesota, distinct from other states, carries a unique landscape of regulations and standards that govern its healthcare compliance. Navigating and managing compliance in Minnesota can certainly be a challenge for providers and facilities.

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Compliance Licensing Public Health Governance 52