Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The SRFs include low-income subsidy, dual eligibility (meaning eligible for Medicare and Medicaid) and disability. See 42 U.S.C.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Med-Net Compliance

OCTOBER 21, 2022

Because the OIG’s assessment of the risk posed by a FCA defendant may be relevant to various stakeholders, including patients, family members, and healthcare sector professionals, the information about where a FCA defendant falls on the risk spectrum is made public.

Fraud 59

Fraud Compliance Medicare Medicare 59

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare IT Today

FEBRUARY 2, 2023

These programs stress the importance of arriving at supportable diagnoses and charting the diagnoses effectively, which leads to more accurate submissions to the Centers for Medicare & Medicaid Services (or CMS). One last note about conducting quality assurance audits: Remember to close the loop.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

APRIL 5, 2022

If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back. Prior to appealing a Medicare, Medicaid, TriCare or other Federal Program claim, you should verify that your organization is compliant in this area ( click here ). If in doubt, check it out.

Fraud 52

Fraud Compliance Medicare Medicare 52

CMS.gov

NOVEMBER 16, 2018

Administrator, Centers for Medicare & Medicaid Services. One of my commitments as the Administrator of the Centers for Medicare & Medicaid Services (CMS) is to ensure we remain steadfast in our commitment to strengthen Medicare by making sure that tax dollars are spent appropriately. Fraud, waste, & abuse. Leadership. percent in 2018.

Medicare 20

Medicare Medicare Overpayments Overpayment 20

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

AIHC

MARCH 28, 2022

But first, learn more about how a complex payer audit system works. For example, the GAO states that they identified about $77.6 billion in financial benefits in fiscal year 2020— a return of about $114 for every $1 invested. Make sure to read Part 1: Managing Denials is Important to Good A/R Hygiene. Audited by a payer?

Medicare 52

Medicare Medicare Compliance Governance 52

Healthcare Law Blog

MARCH 2, 2023

Effective March 1 st , certain providers choosing to self-disclose Stark Law violations must use forms updated by the Centers for Medicare & Medicaid Services (“CMS”). Once CMS acknowledges receipt of a provider’s SRDP submission, the provider’s obligation to report and return overpayments within 60 days is suspended. See 42 C.F.R.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

AIHC

MARCH 22, 2022

Monitor Reports for Inappropriate Write-Offs Are accounts reconciled and overpayments identified and handled properly? Revenue Cycle Managers are encouraged to obtain some training in compliance auditing. The post Part 1: Managing Denials Is Important to Good A/R Hygiene appeared first on American Institute of Healthcare Compliance.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

Hall Render

AUGUST 26, 2022

CMS bulletin presses states on Medicaid nursing home spending. CMS proposes mandatory Medicaid, CHIP quality reporting. Compliance with Oct. Tie nursing home Medicaid payments to care quality, CMS tells states. Medicaid Contract Remains in Limbo. Oklahoma doctor raises concerns about life-threatening virus, polio.

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). We’ve summarized some of the key changes in the Proposed Rule. Comments on due February 13, 2023. Star Ratings.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

MARCH 22, 2024

NATIONAL 79 percent have positive outlook for senior living and care: NIC 12 key legal issues impacting health systems AHA: 94% of hospitals financially impacted by Change Healthcare’s cyberattack A conversation about the HHS plan on AI in health care A new kind of hospital is coming to rural America.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40