MedTrainer

SEPTEMBER 8, 2023

Maintaining compliance with healthcare regulations and standards isn’t just a legal requirement; it’s a crucial element in upholding patient safety, data security, and the overall integrity of healthcare practices. Hear more on compliance essentials from a panel of expert healthcare surveyors. Why Is Healthcare Compliance Important?

Compliance 52

Compliance HIPAA Medicaid Medicaid 52

Healthcare Law Blog

OCTOBER 2, 2023

The government buys billions of dollars in healthcare-related goods and services every year, and no government procurement is perfect. If the answer is “yes”—or even “maybe”—healthcare companies may file a bid protest at the Government Accountability Office (“GAO”) or the U.S. B-417836, 2020 CPD ¶ 47 ( Nov.

Governance 52

Governance Department of Veterans Affairs Medicaid Medicaid 52

C&M Health Law

JANUARY 25, 2023

trillion spending package, which consists of all 12 fiscal year (FY) 2023 appropriations bills and funds the federal government through September 30, 2023, provides additional assistance to Ukraine, and makes numerous health care policy changes. 117-164 ) (the “Act”)—an approximately $1.7

Medicaid 104

Medicaid Medicaid Medicare Medicare 104

Verisys

DECEMBER 22, 2021

These include name, address, specialty, telephone, and electronic contact information. Should a group health plan, insurer, or state agency find that time is running out on achieving regulatory compliance with H.R. Contact us today to find out how we can help prepare you for the quickly approaching changes in 2022.

Compliance 52

Compliance Regulatory Compliance Healthcare information Technology Health Insurance 52

Compliancy Group

APRIL 17, 2024

OIG Medicare compliance audits help ensure that hospitals, clinics, and other medical facilities use program funds efficiently and in accordance with federal and state laws. Findings from OIG audits can identify compliance areas needing improvement. They also help the DHHS improve its operations and program administration.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

Bill of Health

FEBRUARY 28, 2023

Nicole Huberfeld has long advocated even greater federalization of Medicaid because the traditional cooperative federalism frame serves neither the program beneficiaries nor federalism values well. This was accomplished by the U.S. The Head Start order remains effective.

Public Health 176

Public Health COVID-19 Medicaid Medicaid 176

Compliancy Group

DECEMBER 15, 2023

Unfortunately, some Medicare and Medicaid funds are lost to fraudulent and wasteful behaviors. Knowing how to detect, report, and prevent inappropriate use of funds associated with the Centers for Medicare and Medicaid Services (CMS) is essential. Federal healthcare funds help improve overall well-being. What is Healthcare Fraud?

Fraud 52

Fraud Medicaid Medicaid Medicare 52

MRO Compliance

JUNE 1, 2022

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. HEDIS audits are important for Medicare and Medicaid health plans. What is HEDIS?

Medicare 130

Medicare Medicare Compliance Medicaid 130

Medisys Compliance

MARCH 7, 2024

These codes are integral to the billing and reimbursement process, as they enable payers, such as insurance companies and government agencies, to determine the appropriate payment for rendered services. Moreover, CPT codes facilitate data analysis, research, and quality improvement initiatives within the healthcare system.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Regulatory Compliance Compliance 59

Medisys Compliance

MAY 20, 2024

Payer type: Private insurance companies, Medicare, and Medicaid have their own reimbursement structures. Payer Websites: Insurance companies and government agencies (Medicare, Medicaid) often publish reimbursement rates on their websites.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Medicare 59

Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes, which went into effect on January 1, 2023, are designed to ensure health plans are accurately reporting their costs and that they are not overcharging the government.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Verisys

DECEMBER 5, 2023

For the medical staff services team at a hospital to properly verify a healthcare practitioner’s credentials, dozens of primary sources must be contacted directly, and those primary source organizations must then verify the credentials of the practitioner in question. What Is Considered a Primary Source? Unpublished Data.

Governance 52

Governance Licensing Malpractice Medicaid 52

Kaiser Health News

MAY 21, 2024

“We want the Centers for Medicare & Medicaid Services to hold these brokers criminally responsible for ripping people off this way,” he told KFF Health News. Other consumers unknowingly enroll when they respond to misleading marketing promising gift cards, “government subsidies,” or other financial help.

ACA 93

ACA Medicaid Medicaid Doctors 93

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. John Kelly, Principal Business Advisor, Edifecs. The healthcare industry is now closer than ever to its quest for true interoperable data exchange.

Compliance 52

Compliance Medicaid Medicaid Medicare 52

AIHC

MAY 31, 2022

When the federal government covers items or services rendered to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply. Implementing a successful compliance program not only assists in protecting your organization but individuals within the organization. Now, let’s talk more about qui tam action.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Verisys

NOVEMBER 13, 2022

Many use the end of the year to evaluate current compliance programs. A compliance program uses effective processes and procedures to define, detect, and prevent legal and state and federal violations in healthcare. Fraud in a program (other than a healthcare program) funded by any federal, state, or local government agency.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

HIT Consultant

APRIL 16, 2024

Eric Demers, CEO Madaket Health In 2022, the Centers for Medicare & Medicaid Services (CMS) proposed the creation of a centralized physician directory. Studies have consistently revealed high error rates in directory listings, with inaccuracies ranging from incorrect contact information to outdated network affiliations.

Regulatory Compliance 52

Regulatory Compliance Compliance Health Insurance Medicaid 52

YouCompli

JANUARY 18, 2023

Featured speakers : Eric Gold , Chief, Massachusetts Attorney General’s Office Healthcare Division; Jennifer Goldstein , Managing Attorney, Medicaid Fraud Division, Massachusetts Attorney General’s Office; and Steven Sharobem , Assistant US Attorney, District of Massachusetts. Priorities for Massachusetts’s Medicaid Fraud Division.

Fraud 52

Fraud COVID-19 Compliance Medicaid 52

Hall Render

FEBRUARY 27, 2023

Whistleblowers continue to be one of the federal government’s greatest assets in FCA cases, as whistleblowers filed 652 qui tam suits in 2022 with recovery totaling $1.9 The government initiated 296 FCA cases on its own last year without input of a relator, which is the highest volume of DOJ initiated cases since the 1986 FCA amendments.

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

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. The effective date for this requirement is January 1, 2025. The effective date for this requirement is January 1, 2024.

Hospitals 52

Hospitals Compliance Patient Advocacy Medicare 52

Hall Render

AUGUST 8, 2022

The web server contained ePHI, including patients’ names, Medicaid numbers, health care provider names, dates of service, dates of birth, addresses and treatment information. Appoint a person or entity to monitor the compliance of the CAP. Further, data governance is key to proactively managing ePHI. Practical Takeaways.

HIPAA 73

HIPAA Governance Medicaid Medicaid 73

MedTrainer

MARCH 14, 2024

The specialist contacts other parties and primary sources to verify the provider’s information – prior employers, references, and educational institutions. Meets compliance standards: Both processes verify a provider has met compliance standards. Maintaining compliance helps protect against fraud, waste, and abuse.

Malpractice 52

Malpractice Licensing Hospitals Compliance 52

Verisys

MARCH 1, 2022

For the medical staff services team at a hospital to properly verify a healthcare practitioner’s credentials, dozens of primary sources must be contacted directly, and those primary source organizations must then verify the credentials of the practitioner in question. Government and Non-Government Sources. Criminal history.

Governance 52

Governance Licensing Malpractice Medicaid 52

Hall Render

MARCH 3, 2022

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Realizing Equity, Access, and Community Health (“REACH”) Model. These entities must have a strong compliance record and agree to comply with the ACO REACH Model requirements in order to continue in the program. Application. Key Deadlines.

Compliance 74

Compliance Medicaid Medicaid Medicare 74

Hall Render

DECEMBER 5, 2022

The FAQ does note that some states chose to be the primary enforcers of the GFE requirements, rather than the federal government. Your primary Hall Render contact. Hall Render blog posts and articles are intended for informational purposes only.

Medicaid 72

Medicaid Medicaid Medicare Medicare 72

Hall Render

FEBRUARY 4, 2022

That figure does not include even more funds recovered for state Medicaid programs. The government collected almost $100 million from FCA settlements and judgments and has intervened in two qui tam actions alleging fraudulently inflated payments under Medicare Advantage Plans. billion of the funds collected. Health Care Fraud Actions.

Fraud 40

Fraud Governance Medicare Medicare 40

Medisys Compliance

JUNE 14, 2023

Regulatory Compliance Another significant challenge in medical billing is ensuring compliance with the complex web of healthcare regulations. To address this challenge, healthcare organizations must implement robust compliance programs. Inadequate or incorrect documentation can result in claim denials and payment delays.

Medical Billing 52

Medical Billing Medical Billing Services Medical Billing Outsourcing Regulatory Compliance 52

Medisys Compliance

MARCH 26, 2024

Understanding CPT Codes for Holter Monitoring The Current Procedural Terminology (CPT) codes govern Holter monitor billing. Contact Medisys Today Don’t let Holter monitor billing become a burden. Contact Medisys Data Solutions (MDS) today to discuss how our services can help your cardiology practice thrive.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Governance Medical Billing Services 64

MedTrainer

FEBRUARY 20, 2024

Insurance credentialing is the process where a healthcare organization registers a healthcare professional through specific insurance networks or government payers , like Medicare or Medicaid, to receive reimbursement for services rendered during a patient’s visit. What is Insurance Credentialing?

Licensing 52

Licensing Medical Billing Compliance Medicaid 52

Hall Render

DECEMBER 18, 2023

government with uncovering these crimes, but it will also help international efforts to expose individuals that defraud governments around the world. Next Steps Reporting Companies should consider seeking professional guidance from an attorney to ensure compliance with the final rule. The CTA will not only assist the U.S.

Governance 40

Governance Compliance Licensing Medicaid 40

Innovaare Compliance

AUGUST 8, 2023

Inadequate healthcare compliance reporting : Third-party compliance reports often fail to report whether hospitals are complying with the Hospital Price Transparency Rule due to communication errors. However, these codes have proven to be insufficient, in terms of bundling services, due to these written notations.

Medical Billing 40

Medical Billing Compliance Hospitals Doctors 40

MedTrainer

JUNE 15, 2022

When changes are made to government regulations, they have far-reaching effects. The proposed reforms made by the Centers for Medicare & Medicaid Services (CMS) are more influential than ever before and would lead to $650 million in increased ACO shared saving payments. . Contact MedTrainer Today. What Is an ACO?

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

JUNE 6, 2021

Although you may be familiar with the concept of accreditation, it’s essential to know precisely what accreditation means and what is involved with maintaining compliance in a healthcare setting. MedTrainer offers comprehensive accreditation programs that cover a wide selection of healthcare compliance initiatives.

Compliance 40

Compliance Governance Medicaid Medicaid 40

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”). Enrollee Participation in Plan Governance (§ 422.107).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Medisys Compliance

MARCH 27, 2023

These terminologies are briefly discussed below for better understanding: Provider enrollment: This refers to the process of enrolling a healthcare provider with an insurance plan or government program, such as Medicare or Medicaid. Hope this article has answered the question ‘what is provider credentialing in healthcare?’

Malpractice 52

Malpractice Medical Billing Outsourcing Governance Patient Satisfaction 52

Medisys Compliance

OCTOBER 8, 2023

Medicare and Medicaid: Mental health providers should be aware of Medicare and Medicaid regulations, as these government programs have specific rules for billing depression services. To learn more about our mental health billing services, contact us at 888-720-8884 / info@medisysdata.com.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Medicare Medicare 59

Medisys Compliance

APRIL 25, 2023

Need of Choosing Oncology Billing Company As an oncology practice, selecting the right billing company is a crucial decision that can significantly impact your financial success and regulatory compliance. On the other hand, a wrong choice can lead to delayed payments, billing mistakes, and even regulatory non-compliance issues.

Regulatory Compliance 52

Regulatory Compliance Compliance ACA Medical Billing Outsourcing 52