AIHC

SEPTEMBER 30, 2024

Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS Does your compliance program include auditing and monitoring documentation and coding related to risk adjustments and your value-based care reimbursement? This short article provides a basic overview of this complex topic.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

Compliancy Group

JUNE 28, 2024

On June 24, 2024, the Department of Health and Human Services (HHS) released a final rule establishing disincentives for healthcare providers who have engaged in information blocking. Information blocking is a practice by a provider that is likely to interfere with the access, exchange, or use of electronic health information (EHI).

Medicare 59

Medicare Medicare Hospitals HIPAA 59

Med-Net Compliance

OCTOBER 21, 2022

The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. As a result, the OIG is not seeking to exclude them from those programs or to require a CIA.

Fraud 59

Fraud Compliance Medicare Medicare 59

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

MedTrainer

AUGUST 5, 2024

The provider privileging process can be a significant pain point for healthcare executives due to its time-consuming and resource-intensive nature. Understanding what is privileging in healthcare— the process of verifying and authorizing a healthcare provider to perform specific procedures—is crucial.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

AIHC

MAY 31, 2022

If you are a health care provider, remember that payers trust you to provide medically necessary, cost-effective, quality care. When the federal government covers items or services rendered to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

AIHC

NOVEMBER 29, 2023

Over the past decades, the traditional method of reimbursing providers was in a fee-for-service (FFS) model. A provider would see a patient, document the visit, and select the procedure code(s) for the service(s). Therefore, the provider would be reimbursed a fee for each service (CPT code) provided.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

NOVEMBER 29, 2023

Over the past decades, the traditional method of reimbursing providers was in a fee-for-service (FFS) model. A provider would see a patient, document the visit, and select the procedure code(s) for the service(s). Therefore, the provider would be reimbursed a fee for each service (CPT code) provided.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time.

Fraud 52

Fraud Medicare Medicare Compliance 52

AIHC

MARCH 28, 2022

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. Government Accountability Office (GAO), improper payments have been estimated to total almost $1.7 trillion government-wide from fiscal years 2003 through 2019.

Medicare 52

Medicare Medicare Compliance Governance 52

HIPAA Journal

MAY 12, 2023

One of the permissible disclosures of PHI in this category is for “case management and care coordination”. The Privacy Rule ( HIPAA §164.502(b)(2) ) also states the minimum necessary standard does not apply to disclosures to or requests by a health care provider for treatment. 42 CFR Part 2). 42 CFR Part 2).

HIPAA 65

HIPAA Compliance Health Services Administration Medicare 65

Hall Render

DECEMBER 4, 2023

The Centers for Medicare & Medicaid Services (“CMS”) finalized significant updates to the Hospital Price Transparency regulation for the first time since the rule took effect on January 1, 2021. Below are additional details about the updates, including effective dates and implementation timelines. Register for the webinar here.

Hospitals 52

Hospitals Compliance Patient Advocacy Medicare 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”). Enrollee Participation in Dual Eligible Special Needs Plan (“D-SNP”) Governance (§ 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

NOVEMBER 18, 2022

On November 2, 2022, CMS announced revisions to the Calendar Year 2023 Payment Policies that impact Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare and Medicaid Provider Enrollment Policies (“CY 2023 PFS Final Rule”).

Nurses 40

Nurses Nursing Homes Medicare Medicare 40

Health Law RX

JULY 18, 2023

Those subject to the CMP Final Rule should consider prioritizing their compliance efforts because the OIG will begin enforcing the Rule on September 1, 2023. 2] The information blocking provisions of the Cures Act apply to three categories of actors: healthcare providers, Developers, and HIN/HIEs. 1005.2.

Fraud 52

Fraud Compliance Medicaid 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. These generally fall into two categories – HIPAA medical records retention and HIPAA records retention requirements.

HIPAA 129

HIPAA Medicare Medicare Compliance 129

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 108

HIPAA Compliance Hospitals Medicare 108

Redox

DECEMBER 4, 2020

Those challenges can be broken down into two general categories: How do we get it to everyone? Even in jurisdictions with laws requiring children to be inoculated, places such as Alaska were seeing as high as 30% non-compliance. – Administration of the vaccine and associated understanding of our progress in that area.

Public Health 52

Public Health Governance Doctors Medicare 52

Healthcare Law Blog

JANUARY 26, 2023

In this article we provide a brief summary of the Proposed Rule, while also examining the statutory amendments and previous rulemakings that create its foundation. BACKGROUND The Proposed Rule is the latest in a long line of federal legislation and rulemakings governing the conscience rights of healthcare providers and entities.

ACA 105

ACA Medicaid Medicaid Compliance 105

Health Law Advisor

AUGUST 10, 2023

Introduction Hardly a day goes by when we don’t see some media report of health care providers experimenting with machine learning, and more recently with generative AI, in the context of patient care. But the question is, to what extent do health care providers need to worry about FDA requirements as they use AI?

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FDA Licensing Hospitals Medicaid 98

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Health Equity in Medicare Advantage. These changes include: Amending 42 C.F.R. These changes include: Amending 42 C.F.R.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

JANUARY 9, 2023

Such major HIPAA updates placed a significant burden on HIPAA-covered entities and considerable time and effort were required to introduce new policies and procedures to ensure continued HIPAA compliance. Changing the Privacy Rule to make sharing PHI with other providers mandatory rather than permissible.

HIPAA 112

HIPAA COVID-19 COVID-19 Vaccine Compliance 112

Drug & Device Law

JANUARY 16, 2022

It concern’s the Supreme Court’s 6-3 decision to permit the government to continue enforcement of its requirement that healthcare workers (at least those in facilities that accept Medicare/Medicaid, which is most of them) be vaccinated to avoid infecting themselves and their patients with COVID-19. Initially the U.S.

COVID-19 40

COVID-19 Compliance Medicaid Medicaid 40