American Medical Compliance

APRIL 24, 2024

Furthermore, there is an intricate legal landscape governing financial relationships in healthcare compliance. Moreover, they not only shape the foundation of healthcare compliance, but also ensure that medical providers do not compromise their judgment due to financial incentives. AMA PRA Category 1 Credits.

Compliance 52

Compliance Medicaid Medicaid Medicare 52

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

Medicare 52

Medicare Medicare Licensing Compliance 52

Medisys Compliance

FEBRUARY 27, 2024

Introduction Radiology billing compliance is a critical aspect of managing a successful radiology practice. With a myriad of regulations and the potential for audits looming, radiologists and billing staff need to have a solid understanding of compliance requirements.

Compliance 59

Compliance Medical Billing Outsourcing Medicare Medicare 59

MRO Compliance

MARCH 20, 2023

Three Tech Takeaways from RISE: Health Plans Focus on Engagement, Collaboration and Compliance March 20, 2023 Health IT Answers by Beth Friedman, FINN Partners It has been said that wherever Medicare goes, so do all the rest of the payers.

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Compliance Medicare Medicare 130

MedTrainer

JANUARY 10, 2024

It may seem a little early to do some spring cleaning, but not when it comes to compliance! It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024.

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

MedTrainer

APRIL 11, 2024

There is one way to describe the relationship between HR professionals and compliance officers: It’s complicated. As you see these roles work together, you might wonder about the difference between a compliance officer and human resources in healthcare. Ultimately, both roles foster a healthy, law-abiding, and efficient workplace.

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Compliance Officers Compliance Medicaid Medicaid 52

Healthicity

APRIL 11, 2024

Are you navigating the complex world of healthcare compliance, particularly when it comes to Medicare and Advanced Beneficiary Notices (ABNs)? We've got you covered in the latest episode of Compliance Conversations, featuring industry expert Keisha Wilson , founder of KW Advanced Consulting.

Compliance 52

Compliance Medicare Medicare Compliance Officers 52

Medisys Compliance

APRIL 24, 2024

HIPAA compliance helps ensure their privacy and encourages them to seek treatment without fear of their information being disclosed. Maintaining HIPAA Compliance Here are some steps to ensure your practice is HIPAA-compliant: Develop a HIPAA compliance program: This program should outline your policies and procedures for handling PHI.

HIPAA 59

HIPAA Compliance Medical Billing Outsourcing Medical Billing 59

MedTrainer

APRIL 22, 2024

Several federal agencies highly recommend having a healthcare compliance committee — the key is to make the committee helpful, not just a regulatory checkbox. Compliance committees vary based on the size of the organization, the care setting, and the committee’s charter. What is a Healthcare Compliance Committee?

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Compliance Compliance Officers Governance Medicaid 52

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. CMS’s Role and the RADV Audits Program Medicare Advantage overpayments have become alarmingly problematic in the private payer program.

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Overpayments Overpayment Medicare Medicare 52

MedTrainer

APRIL 8, 2024

As a healthcare professional, it is vital to maintain compliance with the 629 legal and regulatory requirements that govern the delivery of quality care. One effective tool to achieve this is through internal healthcare compliance audits. What Is an Internal Healthcare Compliance Audit?

Compliance 52

Compliance Governance ACA HIPAA 52

JNC Compliance

NOVEMBER 10, 2021

In this series called The Comeback Story: 9 Compliance Resources to Level Up Your Practice, we are […]. The post Healthcare Compliance Tips: Medicare Learning Network appeared first on JNC Healthcare Compliance Group. Review the MLN and sign-up for a free training.

Compliance 52

Compliance Medicare Medicare 52

Compliancy Group

FEBRUARY 12, 2024

In one incident, a New Jersey pharmacy admitted to conspiracies to defraud benefits providers, including Medicare and Medicaid, of $65 million for medications never provided to patients. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

Fraud 52

Fraud Medicare Medicare US Department of Health and Human Services 52

Compliancy Group

FEBRUARY 28, 2024

Many industries have compliance rules and regulations to meet and follow, but few would argue that healthcare is one of the most stringent. Privacy and security – Compliance with HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient privacy and data security is crucial.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

MedTrainer

MARCH 28, 2024

Healthcare compliance. Just as perplexing is who is responsible for compliance in healthcare organizations. The answer has as many layers as the definition of compliance itself. The answer has as many layers as the definition of compliance itself. Who in the Organization Is Responsible for Healthcare Compliance?

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

Medisys Compliance

JANUARY 31, 2024

Introduction Understanding the details of Medicare coding and claims submission can be daunting for anyone. This article serves as a guide to help you avoid billing mistakes for Medicare and ensure smooth claims processing for your Medicare patients. Ensure they have current Medicare coverage and no pending eligibility changes.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 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?

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Compliance HIPAA Telemedicine ACA 52

MedTrainer

FEBRUARY 7, 2024

The complex world of healthcare compliance demands a clear understanding of responsibilities. For those new to the role of compliance officer, the question often arises: “Who is responsible for compliance in healthcare?” Who is Responsible for Compliance in Healthcare?

Compliance 52

Compliance Compliance Officers Health Insurance Medicaid 52

Health Law RX

NOVEMBER 22, 2023

Department of Health and Human Services (the OIG) recently released an updated General Compliance Program Guidance document (GCPG). The GCPG discusses general compliance risks and compliance considerations. The GCPG discusses general compliance risks and compliance considerations. Other Compliance Considerations.

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Compliance Officers Compliance Medicare Medicare 52

YouCompli

AUGUST 22, 2023

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs.

Medicare 52

Medicare Medicare US Department of Health and Human Services Compliance 52

Verisys

JANUARY 8, 2024

OIG compliance refers to adherence to the guidelines and regulations set forth by the Office of Inspector General (OIG) of the U.S. The OIG is responsible for combating fraud, waste, and abuse in health and human services programs, including Medicare and Medicaid. The post What is OIG Compliance? appeared first on Verisys.

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Compliance Fraud Medicaid Medicaid 52

MedTrainer

MARCH 22, 2024

Today’s healthcare workers expect more from a compliance training program. For the administrators, compliance officers, and HR professionals tasked with crafting such programs, the challenge is finding a balance between what is legally required and what is practical for their already stretched staff.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

Verisys

JANUARY 8, 2024

A healthcare compliance audit is a thorough review and examination of an organization’s adherence to regulatory guidelines. This type of audit is essential in the healthcare industry for several reasons: Regulatory Compliance It ensures that the healthcare organization complies with various federal and state laws and regulations.

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Compliance Regulatory Compliance Health Insurance Medicaid 52

MedTrainer

FEBRUARY 12, 2024

Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. How are healthcare organizations ensuring compliance and minimizing exposure risks to false claims?

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Compliance Fraud Medicaid Medicaid 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?

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Compliance Fraud Medicaid Medicaid 52

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.

Medical Billing 52

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).

Regulatory Compliance 52

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

Compliancy Group

APRIL 4, 2024

These are just some of the things that OIG compliance guidelines help prevent. Operating under the Department of Health & Human Services (HHS), the OIG is essential for ensuring efficiency across multiple programs like Medicare and Medicaid.

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Compliance Fraud Medicaid Medicaid 40

Healthicity

OCTOBER 16, 2023

Medicare Advantage Compliance Under the Spotlight: Lessons from Cigna's $172 Million Settlement $172 million is a lot of money. It's also the amount that the Cigna Group recently agreed to pay to resolve allegations it violated the False Claims Act in relation to its Medicare Advantage (MA) plan enrollees.

Medicare 52

Medicare Medicare Governance Compliance 52

Total Medical ComplianceHIPAA

APRIL 12, 2024

As healthcare providers navigate the complex web of rules and regulations in compliance, one aspect that needs more attention is exclusion screening of those working with federally funded healthcare programs. Non-compliance with these requirements could result in financial penalties and jeopardize participation in Federal healthcare programs.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 5, 2024

Health Care Service Corporation (HCSC) has entered into a definitive agreement to purchase Cigna’s Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses for $3.3 With Cigna’s Medicare plans serving 3.6 million members, HCSC will substantially increase its Medicare footprint.

Medicare 52

Medicare Medicare Due Diligence Health Insurance 52

Hall Render

JULY 28, 2023

Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”).

Medicare 40

Medicare Medicare Compliance COVID-19 40

MedTrainer

JANUARY 30, 2024

Healthcare compliance is a critical part of any organization’s business model. The professionals who manage compliance are the front lines of preventing medical errors, deterring fraud, and staying in good standing with federal payers like the Centers for Medicare and Medicaid Services (CMS).

Compliance 52

Compliance Compliance Officers Fraud Medicaid 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 22, 2024

offers insight into healthcare policy changes on the horizon and the predicted impact on compliance. In The Impact of Health Policy on Your Compliance Strategy, Hira talks about the macro trends in healthcare that could lead to policy change — for example the focus on cost savings and outcome improvements.

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Compliance Medicare Medicare Medicaid 52