Verisys

NOVEMBER 8, 2023

The NPI improves the Medicare and Medicaid programs, other federal and private health programs, and the overall effectiveness and efficiency of the healthcare industry by simplifying administration and enabling the efficient electronic transmission of health information. Providers also need an NPI to enroll in Medicare.

Fraud 97

Fraud HIPAA Medicare Medicare 97

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.

Medicaid 52

Medicaid Medicaid Nurses Medicare 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. Your primary Hall Render contact. Allow CAHs that are part of a system to meet CoPs at the system level.

Hospitals 70

Hospitals Payment Systems Medicare Medicare 70

Healthcare IT Today

OCTOBER 20, 2023

Previous articles covered the definition, collection, sharing, and use of SDoH. A patient who signs up to be a member of Wellframe provides SDoH information, which the Wellframe platform then shares information with care managers who can contact the members to address the problems.

Medicaid 121

Medicaid Medicaid COVID-19 Doctors 121

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

JUNE 28, 2022

Medicare Coverage for Continuous Glucose Monitors (CGMs). On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) published a final rule in the Federal Register that addressed the classification and payment of continuous glucose monitors (CGMs) under the Medicare Part B benefit for durable medical equipment (DME).

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Medicare Medicare 52

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.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Public Health ADA Medical Billing 59

Hall Render

JANUARY 12, 2023

On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. Your primary Hall Render contact.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Compliancy Group

JANUARY 3, 2024

Contact Compliancy Group today to learn how they empower providers and administrators to meet their billing compliance obligations, improve their work processes, and find solutions to common medical billing issues. Another benefit is getting compliance program guidance for third-party medical billing companies.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

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

Healthcare Law Blog

FEBRUARY 28, 2023

On February 13, 2023, the Centers for Medicare and Medicaid Services (CMS) published the revised List of Telehealth Services for Calendar Year (CY) 2023 (List). The List includes the services that are payable under the Medicare Physician Fee Schedule when furnished via telehealth.

Medicare 52

Medicare Medicare Nurses Licensing 52

Hall Render

NOVEMBER 20, 2023

On November 17, 2023, CMS published its final rule requiring Medicare and Medicaid nursing facilities to provide more detailed ownership and managerial information. The final rule includes new definitions of “private equity company” and “real estate investment trust” for Medicare enrollment purposes.

Nurses 40

Nurses Medicare Medicare Medicaid 40

Health Law Advisor

APRIL 10, 2023

This distinction is relevant for applying the Preventive Care Exception to the Beneficiary Inducements CMP and may allow for a greater variety of incentives to be given to Medicare and Medicaid beneficiaries when the other requirements of that exception are met.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

MARCH 28, 2024

The answer has as many layers as the definition of compliance itself. Regardless of the size of a healthcare organization, the Office of the Inspector General (OIG) recommends identifying a compliance contact who is responsible for ensuring that compliance activities are completed.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

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

Medisys Compliance

MAY 27, 2024

Contact Medisys today at 888-720-8884 / info@medisysdata.com to learn more about our GI billing services. References: American Gastroenterological Association: Coding Top 15 gastroenterology CPT codes: Definitive Healthcare CPT® is a registered trademark of the American Medical Association (AMA).

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Hospitals 59

Medisys Compliance

JANUARY 4, 2024

However, specific definitions might differ depending on payers and specialties. Consult payer policies and the Current Procedural Terminology (CPT ® ) manual for definitive guidance. Choosing the Right CPT ® Code CPT ® codes paint a precise picture of the services rendered during a new patient visit.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Compliance Medical Billing Services 59

Hall Render

MAY 9, 2022

In connection with the COVID-19 public health emergency (the “PHE”), and the expanded coverage of telehealth services by Medicare and state Medicaid programs in response thereto, the FQHC received grant funding from the Federal Communications Commission and a local charity to purchase approximately 3,000 smartphones.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Medisys Compliance

JULY 10, 2023

This article aims to provide a comprehensive guide to modifiers for mental health billing, exploring their definitions, purposes, and relevant keywords. It is similar to the 95 modifier and is used to ensure proper billing and reimbursement for telehealth services under Medicare. What are Modifiers?

Medical Billing Outsourcing 52

Medical Billing Outsourcing Licensing Doctors Medicare 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

Healthcare IT News - Telehealth

APRIL 24, 2020

The Alliance for Integrated Care of New York (AICNY) oversees the healthcare needs of roughly 6,200 dually eligible Medicare and Medicaid beneficiaries with intellectual and developmental disabilities (IDD). Many AICNY beneficiaries reside in group homes and use Federally Qualified Community Health Centers. THE PROBLEM. MARKETPLACE.

Telemedicine 156

Telemedicine COVID-19 Medicaid Medicaid 156

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”). and 422.107).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

AIHC

JANUARY 5, 2022

These don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. The provisions of EMTALA apply to all individuals (not just Medicare beneficiaries) who attempt to gain access to a hospital for emergency care.

Medical Billing 52

Medical Billing Health Insurance Hospitals Medicare 52

MedTrainer

OCTOBER 29, 2023

Before looking specifically at provider credentialing in California, let’s start with a definition. Ensure the provider’s CAQH profile is up to date and if the provider will be enrolling with Medicare and the state’s Medicaid program, called Medi-Cal , set up those portals as well. Primary Source Verification.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Hall Render

AUGUST 1, 2022

The OPPS Proposed Rule also discusses quality-reporting requirements for REHs, an expedited Medicare enrollment process and REH-specific Stark Law updates. Hospitals may only convert to REHs if they were a CAH or rural hospital with not more than 50 beds participating in Medicare as of December 27, 2020. 340B Eligibility.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Healthcare Law Blog

MAY 2, 2023

On April 12, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released a final rule updating key regulations pertaining to Programs of All-Inclusive Care for the Elderly (“PACE”) (the “ Final Rule ”). Overall, these changes, summarized below, will offer significant administrative and operational flexibilities.

Due Diligence 52

Due Diligence Medicaid Medicaid Compliance 52

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. Because of the time required to process SDoH, Eye says, institutions need to prioritize which patients to contact. The percentage is much higher in some areas.

Doctors 121

Doctors Public Health Medicare Medicare 121

New Jersey Healthcare Blog

JANUARY 12, 2022

Exhibits can be reviewed by contacting the New Jersey Individual Health Coverage Program. Exhibits can be reviewed by contacting the New Jersey Small Employer Health Benefits Program. This includes agency name updates, contact information, and addresses. 10:69, AFDC-Related Medicaid, or 10:71, Medicaid Only.

Licensing 40

Licensing Medicaid Medicaid Nurses 40

Healthcare Law Blog

MARCH 7, 2023

The Centers for Medicare & Medicaid Services (“CMS”), on behalf of the U.S. This definition encompasses most digital signatures accepted by commonly used platforms. If you have any questions about the Proposed Rule or its impact on your organization, please contact a member of the Sheppard Mullin Healthcare Team.

US Department of Health and Human Services 52

US Department of Health and Human Services HIPAA Medicaid Medicaid 52

Hall Render

JULY 12, 2023

If a deemed hospice fails to meet the Medicare requirements or shows continued condition-level noncompliance, deemed status is generally removed and oversight is placed under the SA. Selected hospices either successfully complete the SFP program or are terminated from the Medicare program. of hospice providers reported data.

Medicare 40

Medicare Medicare Nursing Homes Fraud 40

HIT Consultant

OCTOBER 6, 2021

It doesn’t even take you to the Centers for Medicare & Medicaid Services (CMS) website. But there is rarely adequate time for discussion about possible barriers to carrying out these care recommendations or who to contact if there is confusion or a problem. Try Googling the word “caregiving.” How does that make sense?

COVID-19 98

COVID-19 Doctors Health Outcomes Licensing 98

Hall Render

JANUARY 11, 2023

Federal Food, Drug, and Cosmetic (“FD&C”) Act – If an app includes a software function that meets the definition of a medical device under section 201(h) of the FD&C Act, the app may be subject to regulatory oversight by the FDA. Your primary Hall Render contact.

Compliance 40

Compliance HIPAA FDA Due Diligence 40

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

Healthcare Law Blog

NOVEMBER 21, 2022

22-19 (the “Advisory Opinion”), which declared that a charitable organization funded by manufacturers would violate the AKS if it offered certain cost-sharing subsidies under Medicare Part D (“Part D”), even if the organization was independently run and patients had equal access to discounts for 90% of drugs on the market. and $500.39. [4].

Medicare 52

Medicare Medicare Governance Medicaid 52

Hall Render

MARCH 1, 2023

Reminder: Reporting on Additional Covered Recipients and Nature of Payment Categories Began in 2022 Covered Recipients Prior to 2021, only physicians (excluding medical residents) and teaching hospitals were included in the definition of Covered Recipients.

Hospitals 40

Hospitals Payment Systems Nurses Medical Device Industry 40

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

Hall Render

FEBRUARY 21, 2023

For SNFs, the data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). For NFs, the data would be reported via means prescribed by the particular state Medicaid agency. Hall Render blog posts and articles are intended for informational purposes only.

Nurses 40

Nurses Medicaid Medicaid Medicare 40