Healthcare Law Blog

NOVEMBER 16, 2023

Department of Health and Human Services’ Centers for Medicare and Medicaid Services (“CMS”) will publish a final rule requiring Medicare skilled nursing facilities (“SNFs”) and Medicaid nursing facilities (“Facilities”) to provide more detailed ownership, managerial and other information on Form CMS-855A (the “Final Rule”). [1]

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Nurses Medicaid Medicaid Medicare 52

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. These changes become effective on January 1, 2024. CMS anticipates the changes will increase MSSP participation by 10% to 20%.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

HIT Consultant

APRIL 19, 2024

Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule.

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Nurses Medicare Medicare Medicaid 102

Healthcare Law Blog

FEBRUARY 27, 2023

On February 15, 2023, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would require nursing homes enrolled in Medicare and Medicaid to disclose new information about their ownership and management structures. Finally, CMS proposed a number of other definitions (e.g.,

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Nursing Homes Nurses Medicaid Medicaid 52

Jane Sarashon

MAY 6, 2022

That’s about 4.5 compared with people under 65 about one-half of whom have poor value perceptions about U.S. This study’s definition of poor perceived value is: The consumer saying they paid too much for the quality of care received, as well as. struggle to pay for their care. in 10 health citizens.

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Medicaid Medicaid Medicare Medicare 89

Verisys

FEBRUARY 1, 2022

All individuals and organizations that meet the definition of healthcare provider as described in 45 CFR 160.103 that conduct transactions or use health records that fall under HIPAA regulations are required to obtain an NPI. Providers also need an NPI prior to enrolling in Medicare. Who Needs an NPI? . When Did NPI Numbers Begin?

Fraud 52

Fraud Medicare Medicare HIPAA 52

Healthcare IT News - Telehealth

APRIL 30, 2021

The act would expand coverage of Medicare telehealth services and make some COVID-19 telehealth flexibilities permanent, among other provisions. Access for Medicare beneficiaries. Questions about the future of telehealth regulations have endured ever since the federal government opted to relax some of them during the COVID-19 pandemic.

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COVID-19 Medicare Medicare Public Health 216

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.

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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”). Health Equity in Medicare Advantage.

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Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

OCTOBER 6, 2022

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. However, such allowance is not extended beyond March 31, 2023.

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Medicare Medicare Compliance Public Health 52

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Actuarial Soundness. Actuarial Soundness.

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Medicaid Medicaid Medicare Medicare 40

NY Health Law

FEBRUARY 13, 2024

On January 9, 2024, the federal Centers for Medicare and Medicaid Services (CMS) finally approved New York State’s 1115 waiver amendment to establish the New York Health Equity Reform (NYHER) Program. Workforce: Workforce investments with a goal of equitable and sustainable access to care in Medicaid.

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Medicaid Medicaid Nurses Medicare 52

Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of LTSS spending. [5]

Nursing Homes 52

Nursing Homes Medicaid Medicaid Medicare 52

Bill of Health

MAY 12, 2023

Fifteen states require insurers to cover some infertility care, though these mandates are riddled with holes: caps on total benefits, lack of express inclusion of IVF, marriage requirements, definitions of infertility that exclude same-sex couples, and other lurking exceptions. No state Medicaid program covers IVF.

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ACA Medicaid Medicaid Health Insurance 241

Healthcare Law Blog

DECEMBER 27, 2022

The Centers for Medicare and Medicaid Services (“CMS”) has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the “Proposed Rule”). CMS appealed but did not challenge the court’s findings about the negligence standard.

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Overpayments Overpayment Medicare Medicare 98

Bill of Health

FEBRUARY 10, 2023

That is why the ACA’s Medicaid expansion doesn’t exist in 11 states , why the penalties for failing to have insurance under the “individual mandate” has been set to $0.00. Do we have people thinking about how to sue Fox News, pundits, and political candidates for their lies? What are we doing on that front? Emphasis added.)

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Public Health Health Care Reform ACA COVID-19 261

C&M Health Law

OCTOBER 18, 2023

Section 504 covers all health care and human services programs and activities funded by HHS, from providers, like hospitals and doctors that accept Medicare or Medicare, to state child welfare programs, as well as Medicare Advantage Plans, and Medicaid Managed Care Plans. Value assessment methods.

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ADA COVID-19 Medicare Medicare 98

Healthcare IT Today

OCTOBER 20, 2023

This is the final article in a series about social determinants of health (SDoH). Previous articles covered the definition, collection, sharing, and use of SDoH. President Cheryl Dalton-Norman says they’ve found that they prevented a patient from going to the ER about 25% of the time when the patient considered doing so.

Medicaid 123

Medicaid Medicaid COVID-19 Doctors 123

Medisys Compliance

MAY 30, 2024

09 – Other abnormal glucose: This code can be used in situations where a definitive diagnosis of prediabetes cannot be made, but blood sugar levels are nonetheless abnormal. when diagnostic criteria for prediabetes are definitively met based on blood sugar levels. Stay Updated: ICD-10 codes are periodically revised.

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Medical Billing Outsourcing Public Health ADA Medical Billing 59

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

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Medicare Medicare Nurses Medicaid 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”). If you have any questions about the SRDP process or recent changes to the SRDP’s required forms, please contact any member of our Health Care Team for assistance.

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Overpayments Overpayment Medicare Medicare 52

Healthcare IT News - Telehealth

OCTOBER 27, 2020

The Centers for Medicare and Medicaid Services announced earlier this month , for example, that it would add 11 virtual services to its reimbursement list during the COVID-19 public health emergency – following in the footsteps of its earlier flexibilities for virtual care. Twitter: @kjercich. Email: kjercich@himss.org.

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COVID-19 Governance Medicare Medicare 191

Healthcare Law Blog

JANUARY 6, 2023

In addition to funding, the Act modifies certain telehealth provisions, expands and extends components of the Medicare and Medicaid programs, and supports initiatives within the behavioral health and substance use treatment spaces. Definition of “Originating Site”. Definition of “Practitioner”. Extension of Key Programs.

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COVID-19 Medicaid Medicaid Medicare 52

HIT Consultant

OCTOBER 7, 2021

Here are five things to know about the acquisition: 1. The merger is expected to close later this month, subject to completion of all necessary regulatory approvals and satisfaction of all closing conditions under the definitive agreement. Financial details of the transaction have not been disclosed.

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Medicaid Medicaid Medicare Medicare 52

Jane Sarashon

MARCH 29, 2023

” Start with the definition set forth in the report: that techquity is the “intentional design and deployment of technology both to advance health equity and to avoid depending existing systemic inequities and health disparities.”

Health Outcomes 101

Health Outcomes Medicaid Medicaid Medicare 101

Healthcare IT News - Telehealth

SEPTEMBER 3, 2020

Department of Health and Human Services "engage in an active dialogue" with health boards and associations about adjusting accreditations to include professionals specializing in mobile care delivery, among other policy changes. "States and the federal government should work to harmonize definitions and regulations (e.g.,

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Licensing Medicare Medicare Governance 161

Healthcare IT Today

FEBRUARY 15, 2024

While everyone seems to be excited about it, you might be left with questions and concerns about what its impact will be. What can be done about it and what’s the impact if we do nothing? Properly educating the market so that healthcare stakeholders can be more discerning about the 2. Who owns the data?”

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Medical Device Industry Medicaid Medicaid Nurses 119

Healthcare Law Blog

DECEMBER 12, 2022

The Centers for Medicare & Medicaid Services (CMS) Innovation Center continues to move forward with its “strategic refresh” initiative. Through this shift, CMS aims to examine and enhance payments for specialty care provided to Medicare beneficiaries. Value-Based Care and ACOs.

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Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

JUNE 7, 2023

While the EHR Association has long supported the goals of the proposed rule, called Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing Proposed Rule (HTI-1), we have a number of real concerns about the impact it would have on the industry if finalized as proposed.

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FDA Compliance Regulatory Compliance Medicaid 96

HIT Consultant

MARCH 28, 2023

With digital feedback tools and automated listening across channels like social media and online reviews, there is a massive opportunity to hear what caregivers are saying about their experiences. Information about respite care is often lacking, leaving caregivers to feel like they have to do everything themselves.

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Medicaid Medicaid Medical Billing Medicare 98

HIT Consultant

SEPTEMBER 18, 2023

Michael Pattwell, Principal Business Advisor, Value-Based Care, Edifecs While the need to address social determinants of health (SDOH) is definitely not new, 2023 marks the first year SDOH is codified into national and statewide value-based payment program mandates. million in 2019, according to the CMS report.

Health Outcomes 114

Health Outcomes Electronic Medical Records Medicaid Medicaid 114

HIT Consultant

JULY 24, 2022

About 40% of people with PAD have no symptoms, while the rest may experience pain and cramping while walking. The ARC Act would reduce amputations by requiring Medicare, Medicaid, and group health plans to cover preventive screenings for high-risk individuals without a copay. About Elizabeth Hogan Hamacher. Officially, 6.5

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Medicaid Medicaid Medicare Medicare 98

Healthcare IT Today

MARCH 1, 2023

The salary offer will not be based on a candidate’s salary history at other jobs, and by law, NYeC will not seek information about salary history, and candidates should not share such information with NYeC. NYeC is an Equal Opportunity Employer. You may be just the right candidate for this or other roles.

Healthcare information Technology 140

Healthcare information Technology Health Outcomes Medicaid Medicaid 140

HIPAA Journal

MAY 12, 2023

The term “continuity of care” has various definitions. Some definitions imply care is continuous within the same healthcare organization (or Organized Health Care Arrangement), while others extend the definition to multiple healthcare settings.

HIPAA 67

HIPAA Compliance Health Services Administration Medicare 67

Innovaare Compliance

FEBRUARY 14, 2022

This includes CMS regulations for Medicare Plans, regulations for Commercial Plans and Medicaid regulations for state plans. With this in mind, much as possible, find a way to standardize grievance categories so that they can equally apply to CMS reporting, Medicaid reporting and Commercial reporting.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Hall Render

JULY 7, 2022

The Consolidated Appropriations Act, 2021 (the “Act”) signed into law on December 27, 2020, created a new Medicare provider type called a Rural Emergency Hospital (“REH”). The Act created the new REH Medicare provider type. An REH must provide 24/7 emergency services and certain other outpatient health services. Proposed REH CoPs.

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Hospitals Payment Systems Medicare Medicare 70

Health Care Law Brief

AUGUST 26, 2022

The Centers for Medicare & Medicaid Services (“ CMS ”) recently published the proposed 2023 Physician Fee Schedule (“ PFS ”), which contains several important changes affecting Accountable Care Organizations (“ ACOs ”) that participate in the Medicare Shared Savings Program (“ MSSP ”), including a new Advanced Incentive Program.

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