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.

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Medical Billing Compliance ACA Health Insurance 52

Compliancy Group

MARCH 19, 2024

Hospitals and private practices aren’t the only enterprises with compliance obligations within this sector. Regulatory compliance in healthcare ensures quality care for patients. In this blog, we’ll outline the fundamentals and importance of regulatory compliance in healthcare in the U.S. name, phone number).

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Regulatory Compliance Compliance US Department of Health and Human Services ACA 52

Verisys

FEBRUARY 8, 2024

– The best resource for monthly healthcare regulatory compliance updates. The bill requires the board to post an online statement directing the public to contact the board for more information concerning a formal name change. MD Medicaid Update Beginning January 1, 2024, Maryland Genetic Counselors are required to be licensed.

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Regulatory Compliance Compliance Licensing Nurses 52

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. New York Social Services Law § 363-d.

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Compliance Overpayments Overpayment Compliance Officers 52

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

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Compliance Framework Governance Compliance Medicaid 52

Compliancy Group

FEBRUARY 2, 2024

Regarding compliance in the healthcare field, a practice, doctor’s office, or healthcare organization is constantly in the spotlight. A Department of Justice (DOJ) evaluation of a corporate compliance program involves an examination of its effectiveness in preventing and detecting instances of noncompliance.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

Medisys Compliance

APRIL 19, 2023

The Medicaid program in Florida provides medical services and assistance to low-income individuals and families. To participate in the Medicaid program, healthcare providers must meet several general requirements set forth by the Agency for Health Care Administration (AHCA).

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Medicaid Medicaid Medical Billing Outsourcing Licensing 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.

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Medicaid Medicaid Licensing Medical Billing Outsourcing 52

YouCompli

DECEMBER 19, 2023

Last month, the Office of Inspector General (OIG) published a new, user-friendly, 91-page General Compliance Program Guidance (GCPG). Exclusions (page 26) : OIG recommends that any entity participating in the federal Medicaid program should check the state Medicaid program exclusion list for each applicable state.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

Compliancy Group

FEBRUARY 9, 2023

Navigating the complexities of HIPAA compliance takes work, especially for healthcare providers and their vendors. Because of the vague nature of the law and the fact that HIPAA compliance is an all-or-nothing endeavor, too many organizations depend on hope more than knowledge. Learn More × Get HIPAA Compliant! Find Out More!

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HIPAA Compliance Regulations Compliance Medicaid 52

AIHC

AUGUST 30, 2023

What compliance issues need to be considered when drafting a marketing strategy? Let’s take a closer look at potential compliance risks. Is your engagement with the telemarketing firm include providing that firm with patient names and contact information? So, what is telemarketing in healthcare ? Great idea, right?

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Compliance Fraud Medicare Medicare 52

YouCompli

NOVEMBER 29, 2023

“As previous OIG compliance guidance(s) are retired to ‘archival’ status, we all should recognize that the original guidance may have been the most important document ever written for healthcare compliance professionals.” — Roy Snell In 1998, the Office of Inspector General (OIG) issued its first General Compliance Program Guidance (GCPG).

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Compliance Compliance Officers Medicaid Medicaid 52

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?

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Compliance HIPAA Medicaid Medicaid 52

Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. General Legal Duties and Antitrust Laws.

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Fraud Medicaid Medicaid Medicare 59

Verisys

JANUARY 8, 2024

The Gold Standard in Sanction and Exclusion Data Management – Maximize Your Healthcare Compliance! The diversity and breadth of these sources mean that FACIS® covers a wide spectrum of potential compliance issues and risks. Contact our FACIS professionals for more information.

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Compliance Licensing Medicaid Medicaid 52

Innovaare Compliance

OCTOBER 6, 2022

When health plans want compliance support, and technical solutions that drive healthcare compliance, can they turn to one company to do it all? Healthcare organizations increasingly need compliance support, given the amount of federal and state regulatory changes they must adapt to on an ongoing basis. The short answer is Yes!

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Compliance Medicaid Medicaid Medicare 52

Innovaare Compliance

DECEMBER 11, 2023

The Contract Year (CY) 2024 Readiness Compliance Checklist for Medicare Advantage Organizations, Prescription Drug Plan Sponsors, 1876 Cost Plans, and Medicare-Medicaid Plans released by the Centers for Medicare & Medicaid Services (CMS) on October 13, 2023, is an excellent place to start. the disabled.

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Medicare Medicare Compliance Medicaid 52

C&M Health Law

JANUARY 25, 2023

For more information, or to better understand how the Act impacts your organization, please contact the professionals listed below, or your regular Crowell & Moring contact. These requirements would also apply to state Medicaid fee-for-service programs.

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Medicaid Medicaid Medicare Medicare 104

Health Law RX

SEPTEMBER 14, 2021

Medicare and Medicaid certified facilities will be required to ensure that their employees are vaccinated for COVID-19, the Centers for Medicare & Medicaid Services (CMS) announced on September 9, 2021. The Interim Final Rule will apply to any healthcare facility receiving Medicare or Medicaid reimbursement. The OSHA ETS.

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Medicaid Medicaid Medicare Medicare 75

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. Hard to believe, huh? Long term care facilities must continue to annually review their emergency program.

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Public Health Compliance COVID-19 COVID-19 Vaccine 52

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.

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Compliance Regulatory Compliance Healthcare information Technology Health Insurance 52

Hall Render

JULY 28, 2023

Background In a previous article , we reported on the Center for Medicare & Medicaid Services (“CMS”) implementation of new billing edits that will Return to Provider any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare-enrolled location identified in PECOS.

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Med Com Blog

DECEMBER 5, 2022

Austin, Texas) Med Claims Compliance (MCC) is pleased to announce one of their newest customers in Northeast Texas. This streamlined approach enables care providers to focus solely on their patients – without the burden of data entry and complex coding while knowing a high standard of regulatory compliance is upheld.

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Compliance Hospitals Electronic Medical Records Regulatory Compliance 40

Med Com Blog

DECEMBER 2, 2022

Austin, Texas) Med Claims Compliance (MCC) is pleased to announce one of their newest customers in Northeast Texas. This streamlined approach enables care providers to focus solely on their patients – without the burden of data entry and complex coding while knowing a high standard of regulatory compliance is upheld. December 2, 2022

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Compliance Hospitals Electronic Medical Records Regulatory Compliance 40

Hall Render

OCTOBER 31, 2022

The Centers for Medicare & Medicaid Services (“CMS”) has retooled guidance it armed surveyors with regarding how to survey skilled nursing facilities for compliance with the CMS staff vaccine requirements. Key Surveyor Guidance Revisions. Key Surveyor Guidance Revisions. Enforcement. Surveyor Review.

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Nurses Compliance COVID-19 COVID-19 Vaccine 40

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.

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Medicaid Medicaid Health Outcomes Federal Policy 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.

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Compliance Officers Compliance Medicare Medicare 52

Hall Render

JUNE 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) recently imposed financial penalties for the first time against two hospitals for failure to comply with the Hospital Price Transparency Rule requirements. CMS began auditing compliance with the Hospital Price Transparency Rule in early 2021. Your primary Hall Render contact.

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Compliance Hospitals Licensing Medicaid 40

Innovaare Compliance

DECEMBER 14, 2023

In recent news, the healthcare industry has been abuzz with significant developments that carry vital lessons for Medicare Advantage plans, particularly in the areas of compliance and risk assessment. For operation and compliance professionals in US health plans, these developments indicate the evolving landscape of healthcare compliance.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Medisys Compliance

JANUARY 11, 2024

Audits: Increased scrutiny from Medicare and Medicaid for potential coding discrepancies. Documentation Burden Detailed documentation is crucial for supporting claims and ensuring compliance with regulations. Regulatory Landscape Medicare and Medicaid regulations change frequently, demanding constant adaptation.

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Medical Billing Outsourcing Medical Billing Medicaid Medicaid 59

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?

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Fraud Medicaid Medicaid Medicare 52

Medisys Compliance

APRIL 25, 2024

MIPS focuses on four key performance categories: Quality: This measures the quality of care you provide to your patients based on specific metrics established by the Centers for Medicare & Medicaid Services (CMS). We offer a comprehensive suite of services designed to streamline MACRA compliance.

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Medical Billing Outsourcing Medical Billing Medicare Medicare 64

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. Compliance with HEDIS specifications. HEDIS audits are important for Medicare and Medicaid health plans. What is HEDIS? HEDIS works as a government rating tool. Data integrity.

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Medicare Medicare Compliance Medicaid 130

Innovaare Compliance

JANUARY 3, 2022

The Centers for Medicare & Medicaid Services (CMS) began call-center monitoring for timeliness and accessibility in 2015 and has continued since. Expanded scope of Healthcare compliance oversight by CMS. Special applications can lift the burden of Healthcare Organization’s compliance monitoring. Contact Us.

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Compliance Medicare Medicare Medicaid 40

Innovaare Compliance

OCTOBER 6, 2022

According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. If you have any questions, or you’d like to discuss these changes with one of our compliance experts, please call us at 1.408.850.2235. or Contact Us. In 2022, 48% of all eligible Medicare beneficiaries are enrolled in MAPD.

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Medicare Medicare Compliance Public Health 52

Hall Render

FEBRUARY 1, 2024

Practical Takeaways Health care entities should consider reviewing the Federal Conscience Statutes closely to ensure that they understand the protections afforded individuals under those laws and have an appropriate plan in place to ensure compliance. Hall Render blog posts and articles are intended for informational purposes only.

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Compliance Medicaid Medicaid 74

MedTrainer

FEBRUARY 29, 2024

Agencies such as CMS (Centers for Medicare & Medicaid Services), NIH, and HHS (Health and Human Services) emphasize the importance of reporting and managing these incidents to not only avoid these penalties but to also improve healthcare delivery processes. Compliance reporting doesn’t need to be hard. Contact us to learn more.

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US Department of Health and Human Services Compliance Nurses World Health 52