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

MRO Compliance

APRIL 11, 2024

That’s why providers need to understand which path is best for them when it comes to partnering with an eCQM / Medicare CQM for direct Electronic Health Record (EHR) connection or using QRDA-1 for data uploads. This limitation poses risks to the reliability of quality reporting outcomes.

Regulatory Compliance 141

Regulatory Compliance Medicare Medicare Compliance 141

MedTrainer

FEBRUARY 1, 2024

A corporate compliance program in healthcare is a comprehensive set of policies, procedures, and practices that healthcare organizations establish and maintain to ensure that they operate compliant with all applicable laws, regulations, and ethical standards. Why do healthcare facilities use corporate compliance programs?

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

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

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Findings from OIG audits can identify compliance areas needing improvement.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 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

HIT Consultant

FEBRUARY 16, 2023

Sean Eaton, Senior Compliance Solutions Specialist at GHX American health systems, hospitals and post-acute care providers are required to comply with hundreds of regulatory requirements. Facilitating this compliance comes with a high cost. million annually on administrative activities to support regulatory compliance.

Compliance 52

Compliance Hospitals Regulatory Compliance COVID-19 52

Healthcare IT Today

JUNE 29, 2023

Each ASC is responsible for ensuring that they are in compliance with the numerous statutes and regulations that are in place at both the state and federal levels. However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. Two other appendices apply to ASCs.

Compliance 52

Compliance Medicare Medicare Medical Billing 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

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

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

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 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

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

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

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

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. Increased use of data analytics: CMS will be using data analytics more extensively in its audits.

Medicaid 52

Medicaid Medicaid Medicare Medicare 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

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

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

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

Medisys Compliance

APRIL 28, 2024

Regulatory Compliance: It’s crucial to ensure any NLP system adheres to all relevant coding and billing regulations. Given these considerations, radiology practices should carefully evaluate their needs and resources before implementing NLP solutions.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Regulatory Compliance Compliance 64

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. How will data be used for marketing, in compliance with applicable laws, including HIPAA?

Public Health 52

Public Health Compliance COVID-19 Licensing 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 96

Hospitals Nurses Compliance Regulatory Compliance 96

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 ACA Medical Billing Outsourcing 52

Med Com Blog

DECEMBER 14, 2021

AUSTIN, Texas – December 14, 2021 – Med Claims Compliance Corporation (MCC), a healthcare platform as a service (PaaS) company, today announced that MCC completed a $5.7 From the payor’s perspective, every year, the Medicare Fee- for-Service program improperly pays $25B+ due to insufficient and/or incomplete documentation.

Compliance 40

Compliance Regulatory Compliance Medicare Medicare 40

YouCompli

MARCH 21, 2022

Its Compliance function was overwhelmed too, struggling to manage the volume, speed, and scope of regulatory changes coming in. Another challenge was the health system’s decentralized model for managing regulatory compliance. Managing healthcare regulatory changes is a balancing act for chief compliance officers (CCO).

Hospitals 52

Hospitals Compliance COVID-19 Regulatory Compliance 52

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

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 79

FDA Compliance Regulatory Compliance Medicaid 79

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

FEBRUARY 2, 2024

The Waiver Amendment was approved on January 9, 2024, by the Centers for Medicare & Medicaid Services (“CMS”) under Section 1115(a) of the Social Security Act and will expire on March 31, 2027. The rates must be at least 80% of Medicare rates. billion in Medicaid investments over the next three years.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Health Care Law Brief

DECEMBER 7, 2021

In a November 12, 2021 revision of its prior draft guidelines for hospital co-location compliance with Medicare conditions of participation (COP) for hospitals (QSO-19-13), CMS has apparently softened its approach to co-location.

Compliance 40

Compliance Hospitals Medicare Medicare 40

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