Healthcare Law Blog

APRIL 13, 2022

However, in all states, the NSA governs disputes relating to air ambulance services, not state law. Federal law governs disputes relating to out-of-network services provided by air ambulance providers. Background of the NSA. AB 72 also limits the enrollee’s cost-sharing amount to the enrollee’s in-network rate.

Governance 52

Governance Medical Billing Licensing Medicare 52

Healthcare IT News - Telehealth

JANUARY 31, 2022

senators and representatives urged congressional leadership to safeguard Medicare telehealth services this past Friday. "Without more definitive knowledge about the duration of the pandemic and Medicare’s long-term coverage of telehealth, many organizations have been hesitant to fully invest in telehealth," the letter read.

COVID-19 129

COVID-19 Medicare Medicare Public Health 129

McGuire Wood

JULY 5, 2022

Founded in 2001, the company solutions, designed for government-sponsored health plans, are designed to support member interactions, compliance and Medicare processes. Under the terms of the definitive merger agreement, the firm will acquire all outstanding shares of Convey common stock, representing an enterprise value of about $1.1

Medicare 52

Medicare Medicare Governance Compliance 52

Healthcare IT News - Telehealth

OCTOBER 27, 2020

The government has signaled its support for reimbursing some telehealth services, at least in the short term. "The government can play a very positive role in telehealth by establishing clear standards and clear reimbursement guidelines," said Selesnick. " Ultimately, "telehealth is here to stay," he said.

COVID-19 188

COVID-19 Governance Medicare Medicare 188

Healthcare Law Today

JANUARY 11, 2023

The government alleged that, between April 2014 and April 2019, Jet Medical introduced devices into interstate commerce that were misbranded under the Federal Food, Drug and Cosmetic Act (FDCA) because Jet Medical did not obtain approval or clearance from the U.S. Food and Drug Administration (FDA) prior to distribution.

FDA 59

FDA Governance Medicare Medicare 59

Healthcare IT News - Telehealth

SEPTEMBER 3, 2020

Centers for Medicare and Medicaid Services to extend administrative flexibility around greater portability of licensure for telehealth service providers. "States and the federal government should work to harmonize definitions and regulations (e.g., But the details of telehealth reimbursement are still unknown.

Licensing 158

Licensing Medicare Medicare Governance 158

Healthcare IT Today

JULY 23, 2023

News and Studies The 2024 Medicare Physician Fee Schedule Proposed Rule from CMS would continue many of the public health emergency telehealth flexibilities, such as an expanded definition of telehealth practitioners, continued payments to rural health centers and FQHCs, and the expansion of originating sites. 17 to 23.

Medicare 82

Medicare Medicare Telemedicine Public Health 82

American Medical Compliance

MARCH 15, 2024

Furthermore, it prohibits knowingly submitting false or false claims to Medicare, Medicaid, or other federally funded healthcare programs. HIPAA regulations govern the use, disclosure, and safeguarding of protected health information (PHI) by covered entities and their business associates.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

Bill of Health

FEBRUARY 10, 2023

This replacement, “neoliberalism,” has as its central tenet that markets are, in all ways and at all times, superior to government in allocating societal resources. The traditional definition of the Police Power is the responsibility of the state to protect “health, safety, morals and general welfare.” Emphasis added.)

Public Health 261

Public Health Health Care Reform ACA COVID-19 261

Healthcare IT Today

OCTOBER 20, 2023

Previous articles covered the definition, collection, sharing, and use of SDoH. Food Aid Federal government food programs expanded significantly during the COVID-19 crisis. Clara Lambert, director of financial navigation, points out that out-of-pocket costs keep rising, reaching $8,300 per year now for Medicare Advantage.

Medicaid 118

Medicaid Medicaid COVID-19 Doctors 118

Healthcare Law Today

JANUARY 2, 2023

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question. Healthfirst, Inc. ,

Overpayments 52

Overpayments Overpayment ACA Medicare 52

Healthcare IT News - Telehealth

JUNE 8, 2020

It has broadened the definition of "vulnerable population" to include elderly people, those with chronic illnesses, people experiencing domestic violence, healthcare frontline workers and others. Since the pandemic began its spread across the U.S. this spring, Smith said, MTP has expanded its focus.

COVID-19 182

COVID-19 Medicaid Medicaid Telemedicine 182

HIT Consultant

NOVEMBER 15, 2022

The growing number of promising but expensive treatments present a challenge – to governments, caregivers, insurance companies, and ordinary citizens. Payers, including insurance companies and government agencies, cannot help but look at the bottom line. And for decades, no definitive answer or policy has been found.

Governance 98

Governance Medicare Medicare Hospitals 98

Healthcare Law Blog

JANUARY 26, 2023

BACKGROUND The Proposed Rule is the latest in a long line of federal legislation and rulemakings governing the conscience rights of healthcare providers and entities. The Church Amendments In the 1970s, the federal government enacted the Church Amendments, 42 U.S.C.

ACA 105

ACA Medicaid Medicaid Compliance 105

Healthcare Law Blog

FEBRUARY 28, 2024

Department of Health and Human Services, Office of the Inspector General (“OIG”) concerning pharmaceutical manufacturers’ offers of cost-sharing subsidies to Medicare Part D (“Part D”) beneficiaries. The government, through Medicare, would foot the rest of the over-$111,000 bill for the year. [3]

Medicare 52

Medicare Medicare Governance 52

Compliancy Group

JANUARY 3, 2024

When auditing claims, medical records, and financial documentation, it is essential to incorporate guidance based on the following questions: Are all codes for services and supplies correct?

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

HIPAA Journal

NOVEMBER 4, 2022

Warner suggests the only way to improve healthcare cybersecurity rapidly is through a collaborative effort involving the public and private sectors, with the federal government providing overall leadership. The program would standardize coverage elements and provide incentives for insurance companies to adopt them.

HIPAA 134

HIPAA Governance FDA Medicaid 134

Provider Trust

MAY 17, 2022

In this post, we’ll break down the definition of healthcare vendors and summarize the most important and impactful laws and regulations that apply to vendors and the healthcare organizations that contract with them. Which regulations govern vendor compliance? So what does that mean for your healthcare organization’s compliance program?

Compliance 52

Compliance Medicare Medicare Due Diligence 52

Hall Render

NOVEMBER 18, 2022

On November 2, 2022, CMS announced revisions to the Calendar Year 2023 Payment Policies that impact Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare and Medicaid Provider Enrollment Policies (“CY 2023 PFS Final Rule”). New Definitions.

Nurses 40

Nurses Nursing Homes Medicare Medicare 40

MedTrainer

MARCH 28, 2024

The answer has as many layers as the definition of compliance itself. Establishes a governance structure, reviews compliance reports, and ensures the organization operates ethically and within legal boundaries. But that’s only one aspect of this complex – and sometimes confusing – process.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Enrollee Participation in Plan Governance (§ 422.107). and 422.107).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Healthcare IT Today

OCTOBER 18, 2023

Data can be spotty, according to Eye, who says for instance that data from Centers for Medicare & Medicaid Services (CMS) often lacks racial identifications. The service pulls together the profiles maintained by facilities and local governments and combines relevant information to display to providers.

Doctors 118

Doctors Public Health Medicare Medicare 118

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. This standard was interpreted and applied differently by various Medicare contractors and was difficult to review/audit.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the Bureau of Facility Standards , provide oversight with certain standards, adding a layer of complexity to successfully managing healthcare compliance in Idaho. Similar to other states, Idaho has its own unique regulations and requirements that healthcare providers and organizations must adhere to.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

Healthcare IT Today

FEBRUARY 15, 2024

Sarah Carroll, Senior Vice President, Center for Care Transformation at AVIA Health Medicaid and Medicare have become one of the biggest quiet crises in health systems today. US hospitals regularly lose $100B annually on Medicaid and Medicare patients but continue to chase higher-margin commercial patients to drive toward profitability.

Medical Device Industry 111

Medical Device Industry Medicaid Medicaid Nurses 111

Health Populi

OCTOBER 17, 2019

While two-thirds of consumers say they understand their insurance coverage, only one-half of them can correctly answer questions about the definition of premiums and deductibles. That’s in addition to what Americans had already saved into Medicare. Add patients to that definition. Given that the average savings in a U.S.

Health Insurance 58

Health Insurance Medicare Medicare Governance 58

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs. This requirement can sometimes apply to specific types of professionals when located in law or regulations governing their profession.

Telemedicine 59

Telemedicine COVID-19 Compliance Informed Consent 59

Healthcare Law Blog

NOVEMBER 21, 2022

Pharmaceutical manufacturers are challenging the breadth of the Federal Anti-Kickback Statute (“AKS”) in federal court, arguing that the government is harming the very vulnerable patients it aims to serve by prohibiting cost-sharing subsidies for life-saving oncology drugs. and $500.39. [4].

Medicare 52

Medicare Medicare Governance Medicaid 52

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment.

Medicare 52

Medicare Medicare Payment Systems Governance 52

Compliance Now

AUGUST 1, 2022

To this end, they indicate that the Medicare Part D Coverage Determination Request Form would be a good model for this purpose. Entities wishing to take advantage of these opportunities are permitted to self-certify or notify the government of their eligibility. Specific Required Benefits.

FDA 100

FDA Medicare Medicare Governance 100

Health Law Advisor

NOVEMBER 23, 2021

On November 12, 2021, the Centers for Medicare and Medicaid Services (“CMS”) released final guidance confirming that hospitals can be co-located with other hospitals or healthcare providers. The allowableness of shared-space arrangements in such circumstances may hinge on compliance with the provider-based regulation, 42 C.F.R.

Hospitals 40

Hospitals Compliance Medicare Medicare 40

Healthcare Law Today

JANUARY 20, 2022

The entity is also prohibited from billing Medicare or, possibly, Medicaid for such referrals. It is noteworthy that requirements of the IOAS, including compliance with the definition of “group practice” are well beyond the scope of this discussion, but should be reviewed, in depth, with counsel knowledgeable with them.

Compliance 52

Compliance Medicare Medicare COVID-19 52

AIHC

APRIL 10, 2024

HIPAA and HITECH is for all health care organizations falling under the definition as a Covered Entity, from solo practices to larger clinics and hospital medical networks to health plans and clearinghouses. There is a lot of information available.

Compliance 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

The Digital Health Corner

JUNE 14, 2017

One early definition of Artificial Intelligence (AI) in medicine (1984) was “…the construction of AI programs that perform diagnosis and make therapy recommendations. Today a broader definition may be applied: “the simulation of human intelligence processes by machines, especially computer systems. Artificial Intelligence (AI).

Patient Satisfaction 87

Patient Satisfaction Hospitals FDA Governance 87

HIT Consultant

NOVEMBER 22, 2021

July 1, 2021 was the enforcement date for the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule. John Kelly, Principal Business Advisor, Edifecs. The healthcare industry is now closer than ever to its quest for true interoperable data exchange. Compliance Challenges.

Compliance 52

Compliance Medicaid Medicaid Medicare 52

Health Populi

MAY 6, 2018

government (which offers several flavors of plans through the VA, Tricare for active military, Medicare for aging people and Medicaid for people with low-incomes) or private sector employers, unions, and other insurance-conveners. .” At the time, this was one of the world’s biggest public-sector financed health plan.

Medicaid 54

Medicaid Medicaid Medicare Medicare 54

AIHC

APRIL 10, 2024

HIPAA and HITECH is for all health care organizations falling under the definition as a Covered Entity, from solo practices to larger clinics and hospital medical networks to health plans and clearinghouses. There is a lot of information available.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52