MedTrainer

NOVEMBER 2, 2023

This critical responsibility rests on the shoulders of the healthcare compliance officer. Read on if you’ve ever wondered about the unsung heroes as we answer the question: What does a compliance officer do in healthcare? What Is the Primary Role of a Compliance Officer in Healthcare?

Compliance Officers 52

Compliance Officers Compliance HIPAA Regulatory Compliance 52

MedTrainer

APRIL 20, 2023

That’s where compliance checklists come in. These helpful tools streamline your compliance systems and make it easier to ensure that your organization operates within the regulatory framework of your industry and specialty. Providers need a strong compliance program to inform the creation of compliance checklists.

Compliance 52

Compliance Compliance Officers Regulatory Compliance Regulations Compliance 52

Health Care Law Brief

FEBRUARY 2, 2024

While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5 billion in Medicaid investments over the next three years. Services will be delivered via a two-tiered system.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare Blog

AUGUST 23, 2023

It is critical for an organization to have strategies for promoting ethical behavior in healthcare compliance. Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization.

Compliance 56

Compliance Nurses Regulatory Compliance Medicaid 56

Compliancy Group

JANUARY 17, 2024

The OIG Work Plan, sometimes referred to as “the Work Plan” or “the Plan,” is an essential tool in securing and maintaining healthcare regulatory compliance for patient safety, privacy, and quality care. The OIG Compliance Work Plan identifies significant risks and areas that require attention within the healthcare system.

US Department of Health and Human Services 52

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

Total Medical ComplianceHIPAA

JANUARY 11, 2024

In the intricate landscape of healthcare, compliance with regulations isn’t just a choice but a necessity. Regulatory Compliance: HIPAA mandates the protection of patient information and the prevention of fraudulent practices. HIPAA stands as a beacon of privacy and security standards within the industry.

HIPAA 52

HIPAA Regulatory Compliance Malpractice Compliance 52

Medisys Compliance

MARCH 7, 2024

Healthcare professionals must familiarize themselves with these changes to avoid coding errors and ensure compliance with regulatory requirements. Healthcare professionals must stay informed about these changes to ensure accurate coding, proper reimbursement, and compliance with regulatory requirements.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Regulatory Compliance Compliance 59

HIT Consultant

FEBRUARY 9, 2023

Czekai, MPH, VP of Strategic Partnerships at Cohere Health The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. LinkedIn – [link].

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. organizations that receive any funds from Medicare, Medicaid, TRICARE, or other federal programs cannot afford to employ individuals or entities excluded from even one program. Medicare opt out.

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Medicaid 52

Healthcare Blog

APRIL 13, 2023

As hospitals have become increasingly complex organizations, effective governance, risk, and compliance (GRC) strategies have become essential for ensuring patient safety and regulatory compliance. What are the Key Components of a Successful Governance, Risk, and Compliance (GRC) Strategy? Stay Alert !

Governance 40

Governance Compliance Hospitals Regulatory Compliance 40

Verisys

DECEMBER 22, 2021

Should a group health plan, insurer, or state agency find that time is running out on achieving regulatory compliance with H.R. As a product manager at the healthcare technology and services company Verisys , he guides many of the solutions that support health plans, health systems, and state Medicare and Medicaid agencies.

Compliance 52

Compliance Regulatory Compliance Healthcare information Technology Health Insurance 52

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 are significant and will have a major impact on Medicare and Medicaid plans. Plans will need to be prepared to provide data to support their claims.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare compliance? What is GRC in Healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

Medisys Compliance

MARCH 27, 2024

Expertise in Regulatory Compliance: The regulatory landscape for healthcare billing is constantly evolving. A specialized billing partner stays updated on the latest regulations and ensures your practice adheres to all coding and billing compliance standards.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Regulatory Compliance Compliance 64

Innovaare Compliance

JULY 20, 2023

Enhanced Data Management Effective delegation oversight requires handling vast amounts of data, including: Performance metrics Compliance records Contractual information Technology solutions provide centralized and secure databases that enable efficient storage, retrieval and analysis of data.

Regulatory Compliance 40

Regulatory Compliance Compliance Medicaid Medicaid 40

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year.

Medicare 52

Medicare Medicare Compliance Medicaid 52

Innovaare Compliance

APRIL 29, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. Multiple Medicare Advantage Prescription Drug Plans (MAPDs) have already received notification of their selection. Medicare Beneficiary Identifier (MBI) has been replaced with Enrollee ID.

Regulatory Compliance 52

Regulatory Compliance Compliance Medicare Medicare 52

MedTrainer

JULY 12, 2023

Here’s a closer look at the critical role incident management software plays in risk mitigation and compliance in healthcare environments. Read this case study to discover how one organization’s use of online incident reporting, amongst other digital compliance tools, helped to add 50 additional practice locations. Risk Mitigation.

Compliance 52

Compliance Regulatory Compliance FDA Medicaid 52

MedTrainer

JULY 12, 2023

Here’s a closer look at the critical role incident management software plays in risk mitigation and compliance in healthcare environments. Read this case study to discover how one organization’s use of online incident reporting, amongst other digital compliance tools, helped to add 50 additional practice locations. Risk Mitigation.

Compliance 52

Compliance Regulatory Compliance FDA Medicaid 52

Healthcare IT Today

DECEMBER 17, 2023

Partnerships Darena Solutions, Leidos, and SLI Compliance unveiled a verification process for AI applications built using SMART on FHIR standards. Business process management company Sagility launched its Utilization Management as a Service offering , which aims to help providers with CMS regulatory compliance.

Hospitals 97

Hospitals Nurses Compliance Regulatory Compliance 97

HIT Consultant

JANUARY 26, 2023

The Improving Seniors’ Timely Access to Care Act mandates the adoption of electronic PA for Medicare Advantage (MA) plans and requires plans to offer greater policy transparency, approval rates, and rationale for denials. It is time for intelligent utilization management, beginning with prior authorization. LinkedIn – [link].

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Medicaid 52

Health Care Law Brief

JUNE 2, 2022

In addition, the PHE fueled a boom in the number of direct-to-consumer (“DTC”) telehealth platforms, many of which have relied upon COVID-19 regulatory waivers to launch and operate in multiple states across the nation. Does the state apply different standards, for example, to Medicaid encounters?

Public Health 52

Public Health Compliance COVID-19 Licensing 52

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 Medical Billing Outsourcing ACA 52

Healthcare IT Today

JUNE 7, 2023

Many of our concerns center on the proposed implementation timeframes associated with various concepts included in HTI-1, as well as ONC’s failure to sufficiently consider the burden compliance will place on provider organizations and health IT developers. 31, 2024, compliance timeline is unrealistic.

FDA 80

FDA Compliance Regulatory Compliance Medicaid 80

Innovaare Compliance

FEBRUARY 14, 2022

Healthcare organizations establish Compliance Departments with the primary purpose of providing compliance oversight for the organization. Operational teams—such as the Member Services Department and the Appeals & Grievances Department—have significant compliance regulations, so they must know to maintain compliance.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Healthcare Law Today

JANUARY 20, 2022

Finally, billing and coding mistakes can have an adverse effect on earnings, value, and create compliance concerns. Thus, compliance with the AKS is vital to the health of the overall relationship. This is especially important given new legislation and regulatory guidance regarding surprise billing. Section1320a-7b).

Compliance 52

Compliance Medicare Medicare COVID-19 52

Health Care Law Brief

JANUARY 19, 2022

Medicare and Medicaid have had similar price transparency rules, but now those rules will apply across all lines of business in New York. The new statute authorizes DFS to examine any registrant or licensee at any time they deem it expedient to ensure compliance. Disclosure requirements. 1] [link].

Prescription Drug Pricing 52

Prescription Drug Pricing Licensing Compliance Medicaid 52

Health Care Law Brief

JUNE 26, 2022

Under the traditional, or fee-for-service (FFS), Medicare program, CMS directly pays providers a predetermined rate for the items and services furnished to patients under Medicare Parts A and B. CMS’s Payments to MA Plans. In turn, an MA plan pays providers a negotiated rate for the items and services they render to enrollees.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Florida Health Care Law Firm

FEBRUARY 22, 2022

In yet another take-down of an illicit scheme to defraud the Medicare Program and ChampVA, as well as other insurers, Patsy Truglia has been sentenced to 15 years in federal prison. million from Medicare, ChampVA, and insurance using a scheme of telemarketing, telemedicine, and multiple DME providers or “store fronts.”.

Medicare 52

Medicare Medicare Telemedicine Fraud 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.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

MedTrainer

AUGUST 30, 2023

Let’s explore what it means for an MCO to coordinate care for members, and the compliance implications that come with this healthcare services model. Medicare Advantage (Part C). Medicare Advantage plans are managed care plans offered by private insurance companies as an alternative to traditional Medicare (Parts A and B).

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Health Care Law Brief

NOVEMBER 9, 2021

We note the challenges associated with this new requirement to furnish good faith estimates to these individual patients, and have concerns that the January 1, 2022 effective date may not allow providers or facilities sufficient time to develop and implement systems for compliance. Patient-Provider Dispute Resolution. 2] See 86 Fed.

Medical Billing 75

Medical Billing Due Diligence Compliance Patient Satisfaction 75

Health Care Law Brief

NOVEMBER 17, 2021

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its final rules for the 2022 Medicare Physician Fee Schedule (PFS Final Rule) and 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS Final Rule). 77492 (Dec. 2, 2020); 86 Fed.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

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. The regulatory landscape only strengthens CMS’ case for a centralized physician directory.

Regulatory Compliance 52

Regulatory Compliance Compliance Health Insurance Medicaid 52

MedTrainer

OCTOBER 5, 2023

As a key member of your facility’s healthcare compliance programming, you understand the significance of regulatory compliance and the critical role it plays in ensuring the privacy and security of patient information. Your organization’s ability to practice regulatory compliance is only as good as what’s been documented.

HIPAA 98

HIPAA Compliance Regulatory Compliance ADA 98

MedTrainer

AUGUST 2, 2023

After that, the credentialing process is periodically reviewed and renewed to ensure ongoing compliance with standards and regulations. However, it’s important to remember how critical this process is for mitigating risk, improving compliance, and earning trust. Why Is Provider Credentialing Important?

Malpractice 52

Malpractice Due Diligence Compliance Licensing 52

Innovaare Compliance

MAY 13, 2021

If health plans aren’t continuously monitoring all CMS universes for compliance issues, not only can errors creep into regulatory compliance tables, it highlights how member care isn’t being positioned as a high priority. Have you updated the Notice of Denial of Medicare Prescription Drug Coverage?

Compliance 40

Compliance Regulatory Compliance Medicare Medicare 40