MedTrainer

MAY 3, 2024

Non-compliance with these regulations can result in jail time, large fines, and even loss of license. Keeping compliance and fraud prevention top of mind can help to protect both your organization and its staff. For those who are not, there are five main federal laws they are likely violating related to healthcare fraud.

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

MedTrainer

JANUARY 12, 2024

At its core, healthcare compliance ensures the quality of care, patient safety, and integrity of healthcare systems. Over the years, healthcare compliance has evolved significantly, driven by changing regulations, advances in technology, and a growing emphasis on patient-centric care. What is Healthcare Compliance?

Compliance 52

Compliance HIPAA Telemedicine ACA 52

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

DECEMBER 7, 2023

To sail smoothly through the complex rules and requirements, you need a deep knowledge of the most essential aspects of healthcare compliance in Maine. A successful compliance program involves adaptability, comprehensive planning, and insight into key compliance factors, including credentialing requirements.

Compliance 52

Compliance Licensing Compliance Officers Medicaid 52

MedTrainer

NOVEMBER 20, 2023

Managing healthcare compliance in Texas is nuanced and challenging. For successful compliance management in Texas, healthcare organizations need to develop a strong system for tracking and interpreting regulatory changes, and promptly adapt to these modifications.

Compliance 52

Compliance Licensing Public Health Governance 52

Health Law RX

FEBRUARY 21, 2024

The Centers for Medicare & Medicaid Services (CMS) has revised certain payment policies under the Medicare physician fee schedule, and updated provider and supplier enrollment regulations. CMS recently published a final rule (the Final Rule ) effective January 1, 2024. The stay ends on or before the 60th day of the stay period. “A

Medicare 52

Medicare Medicare Licensing Compliance 52

Verisys

NOVEMBER 3, 2023

Each month we will give a roundup of recent healthcare fraudsters and compliance busters. With Verisys, you can instantly validate identities, licenses, and ensure there are no sanctions, exclusions, or debarments associated with anyone in your business network. Healthcare Fraud Crackdown! to Pay $32.5

Fraud 52

Fraud Compliance Medicare Medicare 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?

Compliance 52

Compliance HIPAA Governance Medicare 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

Healthcare IT News - Telehealth

JUNE 8, 2022

based attorney in the health law practice of Baker, Donelson, Bearman, Caldwell & Berkowitz about what providers should be doing to ensure compliance when the PHE finally sunsets. What do you see as the primary compliance issues providers will have to contend with? We spoke recently with Allison M. Cohen, a Washington, D.C.-based

US Department of Health and Human Services 175

US Department of Health and Human Services Compliance Overpayments Overpayment 175

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. To participate in the Medical Cannabis Program, providers must complete a Medical Provider application.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

JANUARY 26, 2024

Non-compliance in healthcare refers to the failure of healthcare providers, institutions, or individuals to adhere to the laws, regulations, and standards established to protect patient welfare, maintain data security, and ensure the efficient and ethical delivery of healthcare services. What is Healthcare Compliance?

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

MedTrainer

NOVEMBER 17, 2023

This model involves specific regulations and agreements with Medicare and Medicaid, impacting how healthcare providers in the state bill for services and receive payments. Both the Maryland Department of Health – Behavioral Health Administration and the Board of Physicians license medical and mental/behavioral health providers.

Compliance 52

Compliance Licensing Hospitals Health Insurance 52

Innovaare Compliance

OCTOBER 6, 2022

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. In 2022, 48% of all eligible Medicare beneficiaries are enrolled in MAPD.

Medicare 52

Medicare Medicare Compliance Public Health 52

Healthcare Compliance Blog

APRIL 19, 2022

A Mississippi man conspired with other individuals to provide fraudulent statements to Medicare for reimbursements of claims for patient treatment and prescriptions. The events took place between January 2016 through March 11, 2019, during which time the man claimed to be a licensed physician in the state of Mississippi.

Licensing 59

Licensing Medicare Medicare Governance 59

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

MedTrainer

OCTOBER 16, 2023

This is the essence of corporate compliance in healthcare. Just as every piece of the puzzle must fit perfectly, every compliance element in healthcare needs precise integration to ensure seamless, ethical, and effective operations. Dive with us as we explore the complexities and necessities of compliance in the healthcare sector.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Medicaid 52

Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”).

Medicare 40

Medicare Medicare Licensing Malpractice 40

Innovaare Compliance

JANUARY 15, 2024

The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. Medicare Part D will have three (3) phases instead of four (4) – Deductible, Initial Coverage Phase and Catastrophic Phase. generics) in the catastrophic phase.

Medicare 52

Medicare Medicare Compliance FDA 52

Provider Trust

SEPTEMBER 29, 2022

Mendez, who was a physician assistant at CCI Therapy Counseling Centers International, was working with a suspended medical license. However, despite his suspended medical license, Mendez continued to treat patients at various mental health clinics in Brownsville, Harlingen, and Pharr, TX. How Often Should You Verify Employee Licenses?

Licensing 52

Licensing Fraud 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?

Compliance 52

Compliance Fraud HIPAA Governance 52

Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How the OIG Exclusion Database Came to Be HHS oversees the CMS (Center for Medicare Services), which administers the Medicare program.

Medicare 52

Medicare Medicare Fraud HIPAA 52

Verisys

NOVEMBER 13, 2022

Waiver of State Licensure Requirements: Any health care professional listed below that holds a valid, unrestricted, unencumbered license in any state may provide services authorized under their existing license. No statements concerning the Department of Health or licensed medical professionals were included in the emergency order. .

Compliance 52

Compliance Licensing Nurses COVID-19 52

MedTrainer

MAY 10, 2024

It can also be a prerequisite for enrolling with an insurance network or Medicare for the first time. Here’s what a typical credentialer’s workflow looks like: Like other providers, mental health professionals must be licensed in states where they offer services and enrolled with payers doing business in those areas. Effective Jan.

Licensing 52

Licensing ACA Medicare Medicare 52

Provider Trust

MAY 9, 2024

But it siloed us and created a lot of duplicative work,” said the organization’s Corporate Compliance Officer. “We grew up doing what had to be done. The laws have come so fast and so furiously. Partnering with ProviderTrust allowed the client to automate their exclusion monitoring and primary source verification processes fully.

Compliance 52

Compliance Compliance Officers Licensing Medicaid 52

Verisys

MAY 9, 2023

Data Compliance: 3 Focus Areas for Mitigating Organizational Risk A three-part compliance series that focuses on using technology to help you achieve your compliance goals. There is no question that healthcare organizations should have an effective healthcare compliance program.

Compliance 52

Compliance Fraud Governance Licensing 52

MedTrainer

MARCH 30, 2024

Enrollment delays cost nearly a third of organizations polled in a 2023 MedTrainer survey money, and 26% believe credentialing delays increase compliance risks that can significantly drain coffers. Any delay in the provider enrollment process means less revenue for the organization – and the longer the holdup, the harder the hit.

Malpractice 98

Malpractice Licensing Medicaid Medicaid 98

Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. Watch the Webinar During the Keynote Speech at the HCCA Compliance Institute this year, Office of Inspector General (OIG) Christi A.

Compliance 52

Compliance Nursing Homes Nurses Fraud 52

MedTrainer

MAY 4, 2023

That includes many compliance professionals. There are plenty of compliance implications for the end of the Public Health Emergency on May 11, 2023 , and an assessment is a great place to start. This article will focus on the federal changes, but make sure to check with all states where your providers are licensed to stay up-to-date.

Public Health 52

Public Health Compliance COVID-19 COVID-19 Vaccine 52

Verisys

FEBRUARY 23, 2022

As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Accordingly, maintaining compliance has become a key focus for healthcare facilities. Nine Responsibilities of Healthcare Compliance Officers.

Compliance Officers 52

Compliance Officers Compliance US Department of Health and Human Services Governance 52

Verisys

JUNE 8, 2023

Data Compliance: How to Identify and Close Data Risk Gaps Using Technology A three-part compliance series that focuses on using technology to help you achieve your compliance goals. Hiring a provider with red flags, even if in the past, can put your organization at risk for non-compliance.

Compliance 52

Compliance Fraud Licensing Medicare 52

Medisys Compliance

MAY 19, 2022

During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. In this article, we shared revised Medicare billing and coding guidelines which will help in billing Medicare telehealth during COVID-19 PHE.

COVID-19 52

COVID-19 Medicare Medicare Medical Billing 52

Healthcare IT Today

DECEMBER 29, 2023

For example, third-party payors did not always provide coverage, there was a lack of general public acceptance, and state licensing and regulatory requirements limited delivery models. On the federal level Medicare policy broadened the acceptance of virtual care.

Licensing 101

Licensing COVID-19 Public Health Medicare 101

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 (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. Compliance with HEDIS specifications.

Medicare 130

Medicare Medicare Compliance Medicaid 130

Verisys

MARCH 8, 2024

February 2024 Bad Actor Roundup By Verisys Each month we will give a roundup of recent healthcare fraudsters and compliance busters. Million Medicare and Medicaid Fraud Full Story Pharmacist Fraud Pharmacy Owner and Operations Manager Convicted of $2.3M Peters Physician Pleads Guilty to False Statements, Resulting in $1.4

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

Medicare 52

Medicare Medicare Licensing Health Insurance 52

Medisys Compliance

FEBRUARY 7, 2022

Medicare pays a physician for an Annual Wellness Visit (AWV) service. This visit is planned to develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA) which is covered once every 12 months by Medicare. Medicare also waives the AWV coinsurance or co-payment and the Medicare Part B deductible.

Medicare 52

Medicare Medicare Medical Billing Outsourcing Medical Billing 52