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. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Medisys Compliance

JULY 13, 2023

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

Medicare 52

Medicare Medicare Medical Billing Outsourcing Health Outcomes 52

YouCompli

JANUARY 4, 2023

The healthcare enterprise risk approach takes compliance in new directions . Featured speakers: James Bryant , Vice President and Chief Compliance Officer, Brigham and Women’s Hospital; Timothy C. Bryant, Hogan, and Wroth addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance forum in December 2022.

Compliance Officers 52

Compliance Officers Compliance ADA Hospitals 52

Medisys Compliance

MAY 5, 2022

On 22 nd April 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. Sections 120 and 402 of the CAA made two key changes to Medicare enrollment rules.

Medicare 52

Medicare Medicare Medical Billing Outsourcing Medical Billing 52

HIT Consultant

MARCH 9, 2023

Rajesh Sharma, Vice President and General Manager of Systems Integration, Data Analytics and Interoperability Product Offerings, Gainwell Technologies The Centers for Medicare and Medicaid Services (CMS) has laid the critical groundwork to create a connected healthcare system in which patients, providers, and payers can easily exchange information.

Health Outcomes 94

Health Outcomes Governance Compliance Medicaid 94

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”). With a few exceptions, the Final Rule is a wholesale codification of the proposed rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

MARCH 24, 2024

According to the National Health Care Anti-Fraud Association, the financial losses due to healthcare fraud are estimated to be in the billions of dollars annually. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 References: National Health Care Anti-Fraud Association.

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

MedTrainer

MARCH 8, 2024

FQHCs can receive financial rewards for deploying an individualized, patient-centered care model that builds trust between patients and providers, which has shown to improve health outcomes. FQHCs can participate in APMs through Medicare and Medicaid Managed Care Organizations (MCOs).

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

AIHC

OCTOBER 20, 2023

Part 1 in a Series of Leadership Articles on Value-Based Care Written by Joanne Byron, LPN, BS, CCA, CIFHA, CHA, COCAS, CORCM, CHCO, OHCC, CMDP, ICDCT-CM/PCS ​ Edited by Julie Rickman , MBA, CHC, CHPC, CHCO ​ This article is the first in a series sponsored by the American Institute of Healthcare Compliance (AIHC) Volunteer Education Committee.

Health Outcomes 59

Health Outcomes Medicare Medicare Governance 59

AIHC

NOVEMBER 29, 2023

Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. percent of the gross domestic product (GDP) on healthcare, which was almost two times the average of other high-income countries, while the health outcomes in the U.S. healthcare system were exorbitant.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Bill of Health

APRIL 13, 2022

This policy improves coverage and helps reduce churn , which is associated with poor health outcomes. Along with guidance for the timeline of conducting redeterminations, the new CMS guidance requires states to submit monthly data on their processing of applications and renewals for at least 14 months.

Medicaid 144

Medicaid Medicaid COVID-19 Public Health 144

AIHC

NOVEMBER 29, 2023

Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. percent of the gross domestic product (GDP) on healthcare, which was almost two times the average of other high-income countries, while the health outcomes in the U.S. healthcare system were exorbitant.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

YouCompli

APRIL 6, 2022

enrolled in the Medicare program – almost 20 percent of the U.S. Under the revised rule, the goal is for value-based arrangements to shift financial risks from Medicare to the healthcare provider or organization. . Again, the intent is to improve the quality of patient care and health outcomes. Compliance learning curve.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

HIT Consultant

NOVEMBER 7, 2022

Jessica Badichek, Chief Informatics and Compliance Officer, MediTelecare. Payers and insurance providers want better patient outcomes due to the high cost of poor health, while health providers want to ensure their patients aren’t overlooked and are appropriately cared for.

Health Insurance 98

Health Insurance Compliance Officers Health Outcomes Compliance 98

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. CMS has authorized up to $2.2

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

SEPTEMBER 2, 2021

Expanding data sources and enhancing analytics capabilities allows health plans to develop the capacity for more precise, holistic member engagement while improving the most impactful health outcomes in individuals and populations. Pandemic-Era Compliance Levels.

COVID-19 52

COVID-19 Compliance Medicare Medicare 52

Medisys Compliance

NOVEMBER 17, 2023

The healthcare landscape is undergoing a dynamic transformation, driven by a growing emphasis on value-based care and patient-centered outcomes. At the forefront of this shift is the Primary Care First Model, a voluntary alternative payment model introduced by the Centers for Medicare & Medicaid Services (CMS).

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medicare Medicare 59

Healthcare Law Today

JANUARY 2, 2023

The Centers for Medicare and Medicaid Services (CMS) approved The Joint Commission’s proposed elimination and revision of standards, and confirmed that the eliminated and revised standards would not diminish or reduce CMS’ own regulatory requirements. The review also took into account the opinions of experts within the field.

Hospitals 52

Hospitals Licensing Health Outcomes Medicaid 52

Healthcare IT Today

FEBRUARY 15, 2024

To mitigate this, continuous investment in cybersecurity measures and adding modern security and compliance protocols is essential. Sarah Carroll, Senior Vice President, Center for Care Transformation at AVIA Health Medicaid and Medicare have become one of the biggest quiet crises in health systems today.

Medical Device Industry 109

Medical Device Industry Medicaid Medicaid Nurses 109

Medisys Compliance

APRIL 18, 2022

In October 2021, the Center for Medicare and Medicaid Innovation (CMMI) announced a goal of having every Medicare beneficiary and the majority of Medicaid beneficiaries covered by some type of alternative payment model (APM) by 2030. In order to do so, a clinician must be in a Medicare Advanced APM.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicaid 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

HIT Consultant

NOVEMBER 24, 2022

Health plans could, for example, consider covering OTC hearing devices as part of the hearing benefits package provided to their Medicare Advantage plan members. Health plans offering the OTC benefit can also leverage the opportunity to educate members about the significant role hearing aids can play in improving their overall health.

FDA 98

FDA Public Health Medicare Medicare 98

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

HIT Consultant

OCTOBER 26, 2021

Telehealth appointments save patients over 100 minutes of time compared to an in-person visit, and providers are able to tap into new markets and drive better health outcomes for their patients. In fact, 57% of Medicare patients are released from the hospital without any post-discharge monitoring. About Nora Zetsche, MD .

COVID-19 52

COVID-19 Health Outcomes Doctors Hospitals 52

AIHC

FEBRUARY 7, 2023

Through their roles in providing direct care, advocacy, education, and service coordination, they can make an invaluable contribution to helping individuals and families achieve improved health outcomes. The post Primary Care Community Health Workers: Roles and Functions appeared first on American Institute of Healthcare Compliance.

Public Health 52

Public Health Doctors Medicare Medicare 52

C&M Health Law

JANUARY 18, 2023

On January 4, in its most recent effort to expand federal support for addressing health-related social needs (HRSNs), the Centers for Medicare & Medicaid Services (CMS) issued guidance to clarify an existing option for states to address HRSNs through the use of “in lieu of” services and settings policies in Medicaid managed care.

Medicaid 52

Medicaid Medicaid Health Outcomes Federal Policy 52

AIHC

NOVEMBER 3, 2023

The use of AI has advanced patient safety by evaluating data to produce insights, improve decision-making and optimize health outcomes. The Agency for Healthcare Research and Quality (AHRQ) conducted a systematic literature review of AI in patient safety outcomes. According to the American Hospital Association (AHA), yes.

Department of Veterans Affairs 59

Department of Veterans Affairs Hospitals Compliance Nurses 59

Health Care Law Brief

APRIL 11, 2022

As the OIG explained, the safe harbor was created “to improve quality, health outcomes, and efficiency”—recognizing “the important role that digital health technology plans in advancing [HHS’s] goals in connection with the Regulatory Sprint, including improving the coordination and management of patient care.” at 77790, 77791.

Fraud 52

Fraud Medicare Medicare Compliance 52

Healthcare Law Blog

DECEMBER 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthicity

APRIL 1, 2024

This is a short, video that we do, and it's a series that we do, here at Healthicity where we take a headline that we see all the time, coders, auditors, compliance professionals. It was on a Medicare administrative contractor's website. It was on a Medicare administrative contractor's website. We see these headlines.

Medicare 52

Medicare Medicare Doctors Compliance 52

Healthcare IT Today

MARCH 27, 2023

of the total market share due to increased adoption to manage chronic conditions and monitor health outcomes. OpenLoop White-Label Telehealth Solutions OpenLoop was founded with the mission to expand access to care and improve community health outcomes. Additionally, telehealth services hold 45.7%

Health Outcomes 93

Health Outcomes Licensing Medicaid Medicaid 93

HIT Consultant

JANUARY 17, 2024

– Public reporting: Similar to Medicare FFS, impacted payers must report prior authorization metrics, increasing transparency and accountability. – Clearer communication: All payers must provide specific reasons for denial, allowing for easier resubmissions or appeals.

Compliance 97

Compliance Health Outcomes Doctors Nurses 97

Hall Render

SEPTEMBER 1, 2023

ALABAMA American Family Care opens new health care center in Northeast Birmingham doctors secure $13.9M Elizabeth Medical Center to receive nearly $400k in federal funds to combat substance abuse UofL lands nearly $12 million grant from National Institute of Health Winchester physician Michael Kuduk, M.D.,

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

HIT Consultant

MARCH 15, 2023

OpenLoop White-Label Telehealth Solutions: OpenLoop was founded with the mission to expand access to care and improve community health outcomes. Their API-driven platform can be aligned to meet brand needs and securely houses patient PII with its built-in HIPAA compliance software.

Medicaid 98

Medicaid Medicaid Compliance Medicare 98

Healthcare IT Today

JANUARY 5, 2023

Despite this, an organization’s flexibility and compliance with new regulations will help ensure success. Transparent, useful, ethical AI will create better health outcomes for everyone. Grace Nam, Strategic Solutions Manager at Laserfiche. Almost 75% say that this impacts patient care moderately to severely.

Nurses 101

Nurses Hospitals Licensing Health Outcomes 101

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. Focus on preventive care: Employers and health insurers will focus on preventive care, as a way to reduce costs and improve health outcomes.

Hospitals 75

Hospitals Compliance Health Outcomes Medicare 75

Healthcare Law Blog

NOVEMBER 13, 2023

On November 6, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released the contract year 2025 proposed rule for Medicare Advantage (“MA”) organizations and Part D sponsors (the “Proposed Rule”). This proposal would shift the burden from CMS to the MA organization to demonstrate compliance with this standard.

Medicare 59

Medicare Medicare Medicaid Medicaid 59