Hall Render

DECEMBER 20, 2023

Finalized Revisions to Form CMS-855A For SNFs, the aforementioned 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 applicable state Medicaid agency.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

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

Healthcare Law Today

NOVEMBER 9, 2022

Starting January 1, 2023, Medicare will cover telehealth-based treatment services delivered by federally-accredited opioid treatment programs (OTPs), commonly referred to as “methadone clinics.” Background and History of Medicare Telehealth Coverage of SUD Treatment.

Medicare 52

Medicare Medicare COVID-19 Telemedicine 52

Medisys Compliance

APRIL 8, 2022

During pandemic, guidelines has been loosened for more acceptance of telehealth services as in-person care may not be available all the time. In this article, we briefly discussed these Medicare telehealth billing guidelines. Temporarily Added Telehealth Services. Definition of ‘Originating Sites’. Newly Added Modifiers.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Medisys Compliance

FEBRUARY 20, 2023

Healthcare providers often get confused about the appropriate use of modifiers GA, GX, GY, and GZ while billing Medicare. GA modifier indicates that an Advance Beneficiary Notice (ABN) is on file and allows the provider to bill the patient if not covered by Medicare. Medicare does not pay for all health care costs.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending.

Medicare 52

Medicare Medicare Fraud 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

Healthcare Law Blog

NOVEMBER 2, 2023

population size of those 65 years and older continues to increase, the demand for long-term services and supports (“LTSS”) is also expected to increase. [1] 1] LTSS represents the wide-ranging health and social services that individuals require over an extended period of time, including assistive services. [2]

Nursing Homes 52

Nursing Homes Medicaid Medicaid Medicare 52

Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

Healthcare IT News - Telehealth

OCTOBER 14, 2021

A group of healthcare organizations announced this week the launch of the Advanced Care at Home Coalition, an advocacy effort aimed at creating a pathway toward safeguarding access to hospital-level services. The coalition's perspective, he said, is that regulators should "put guardrails on, but let us continue the good work."

Hospitals 147

Hospitals Public Health Patient Satisfaction COVID-19 147

Hall Render

DECEMBER 30, 2022

Medicare payment policy changes established under the CMS CY 2023 Medicare Physician Fee Schedule (“MPFS”) Final Rule , issued on November 1, 2022, become effective January 1, 2023. These services will be reported with three separate Medicare-specific G codes. Telehealth Services. Split/Shared E/M Visits.

Medicare 40

Medicare Medicare Licensing Health Services Administration 40

Health Law Advisor

AUGUST 14, 2023

During the COVID-19 PHE, CMS issued temporary waivers, including a waiver of the “location requirement” of the In-Office Ancillary Services (“IOAS”) exception. 1] With the end of the PHE having occurred over three months ago, that temporary waiver of sanctions ended and can no longer be relied upon for legal compliance with the Stark Law. [2]

COVID-19 52

COVID-19 Medicare Medicare Public Health 52

MedTrainer

OCTOBER 29, 2023

California is known for being “extra,” and that’s what you can expect when it comes to medical credentialing services in California. Before looking specifically at provider credentialing in California, let’s start with a definition. The post Medical Credentialing Services in California appeared first on MedTrainer.

Licensing 52

Licensing Malpractice Medicaid Medicaid 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2

Medicare 52

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.

Medicare 52

Medicare Medicare Compliance Public Health 52

YouCompli

NOVEMBER 9, 2022

Compliant Billing for Critical Care Evaluation and Management Services. This month’s article looks at critical care services. These codes are reimbursed at a higher rate than the typical evaluation and management, (E/M) codes reported for less-intensive professional medical services. CJ Wolf, MD ?provides

Compliance 52

Compliance Medicare Medicare Hospitals 52

YouCompli

MARCH 22, 2023

The second type is typically called quantitative or definitive drug testing. Department of Health and Human Services Office of Inspector General (OIG) has expressed concerns about UDT billing. According to the OIG, prior error rate testing has suggested an improper payment rate of almost 30% for Medicare.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

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.

Medicare 52

Medicare Medicare Overpayments Overpayment 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. The CONNECT Act would aim to answer at least some of those questions, at least where Medicare is concerned.

COVID-19 214

COVID-19 Medicare Medicare Public Health 214

Healthcare IT News - Telehealth

JANUARY 31, 2022

senators and representatives urged congressional leadership to safeguard Medicare telehealth services this past Friday. "In the meantime, it is crucial that an extension not include unnecessary statutory barriers in accessing telehealth services during this data collection and analysis period," they added. Led by Sens.

COVID-19 128

COVID-19 Medicare Medicare Public Health 128

C&M Health Law

OCTOBER 18, 2023

Department of Health and Human Services (“HHS”) published a proposed rule updating Section 504 of the Rehabilitation Act of 1973 (“Section 504”). The Proposed Rule clarifies obligations to provide services in the most integrated setting appropriate to a person’s needs. On September 14, 2023, the U.S. Web and mobile accessibility.

ADA 98

ADA COVID-19 Medicare Medicare 98

Healthcare Law Blog

JANUARY 20, 2023

To address social determinants, providers may need to resourcefully rely on non-clinical services or provide medical services in alternative settings, which may present reimbursement difficulties.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

C&M Health Law

JANUARY 18, 2023

On January 4, in its most recent effort to expand federal support for addressing health-related social needs (HRSNs), the Centers for Medicare & Medicaid Services (CMS) issued guidance to clarify an existing option for states to address HRSNs through the use of “in lieu of” services and settings policies in Medicaid managed care.

Medicaid 52

Medicaid Medicaid Health Outcomes Federal Policy 52

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.

Medicare 52

Medicare Medicare Nurses Medicaid 52

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.

Medicare 79

Medicare Medicare Telemedicine Public Health 79

Healthcare IT News - Telehealth

SEPTEMBER 3, 2020

"Each of the four elements of distributed health services has progressed rapidly over the past decade, more or less independently of the others," Auerswald wrote. Centers for Medicare and Medicaid Services to extend administrative flexibility around greater portability of licensure for telehealth service providers.

Licensing 157

Licensing Medicare Medicare Governance 157

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.

Hospitals 70

Hospitals Payment Systems Medicare Medicare 70

McGuire Wood

JULY 5, 2022

is a specialized healthcare technology and services company. Founded in 2001, the company solutions, designed for government-sponsored health plans, are designed to support member interactions, compliance and Medicare processes. TPG Capital will take Convey Health Solutions Holdings (NYSE: CNVY) private, according to a news release.

Medicare 52

Medicare Medicare Governance Compliance 52

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

AIHC

FEBRUARY 7, 2024

This article provides a basic overview of Artificial Intelligence, Telehealth, Asynchronous Services and HIPAA privacy concerns. Telehealth refers to a collection of methods to enhance health care delivery and education — it’s not a specific service. It is a service rendered outside of a real-time or live interaction with a patient.

HIPAA 59

HIPAA Medicaid Medicaid Telemedicine 59

Healthcare IT News - Telehealth

OCTOBER 27, 2020

Virtual care may be popular among patients, but if providers can't get paid for their services, it's unlikely they'll be able to continue to provide them. The government has signaled its support for reimbursing some telehealth services, at least in the short term. " Kat Jercich is senior editor of Healthcare IT News.

COVID-19 193

COVID-19 Governance Medicare Medicare 193

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”). UnitedHealthcare challenged the current Overpayment Rule in litigation. [1]

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

Healthcare Law Blog

APRIL 13, 2022

The California Department of Managed Health Care (“DMHC”) issued a recent guidance interpreting the application of the No Surprises Act (“NSA”)—a new federal law prohibiting out-of-network healthcare providers from balance-billing patients for certain emergency and non-emergency services—in California. Background of the NSA.

Governance 52

Governance Medical Billing Licensing Medicare 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

AIHC

FEBRUARY 7, 2024

This article provides a basic overview of Artificial Intelligence, Telehealth, Asynchronous Services and HIPAA privacy concerns. Telehealth refers to a collection of methods to enhance health care delivery and education — it’s not a specific service. It is a service rendered outside of a real-time or live interaction with a patient.

HIPAA 52

HIPAA Medicaid Medicaid Telemedicine 52

Healthcare IT News - Telehealth

FEBRUARY 19, 2024

McKinsey estimates $265 billion worth of care services for Medicare patients could shift from traditional facilities to the home by 2025. Resources from specialties like cardiology and endocrinology to services like case management and social services are often siloed, making coordination even more difficult.

Hospitals 144

Hospitals Nurses Medicare Medicare 144

Medisys Compliance

JANUARY 4, 2024

Generally, patients haven’t received professional services (Evaluation and Management [E/M] or face-to-face encounters) from the same physician or group practice within the past three years. However, specific definitions might differ depending on payers and specialties.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Compliance Medical Billing Services 59