C&M Health Law

AUGUST 3, 2023

OIG confirmed that information blocking may also constitute an element of a fraud scheme, such as by forcing unnecessary tests or conditioning information exchange on referrals. Other than the information blocking penalties, the rest of the final rule’s provisions are effective August 2, 2023.

Fraud 52

Fraud HIPAA Governance Compliance 52

AIHC

NOVEMBER 29, 2023

In 1983 Medicare shifted to the inpatient Prospective Payment System (PPS) and DRGs (Diagnostic Related Groups) and only paying a limited number of days to the hospital regardless of the actual length of stay. Hospital reimbursement also changed.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIT Consultant

NOVEMBER 2, 2021

If states were happy with their Program Integrity (PI) systems, but not satisfied with the payment systems, states had no choice but to stay with the vendor. In each case and so many others, fraud activities can be missed unless data analytics looks across providers and analyzes similar data sets, not just by specialty.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

JUNE 29, 2023

Medicare Payment Resources CMS implemented an Ambulatory Payment Classification-based payment methodology in 2008. Visit the Medicare payment resources page on the ASCA website to learn about the changes that CMS has made to the payment system and ensure that your ASC is paid appropriately.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

Hall Render

NOVEMBER 25, 2024

Quality of Care and Quality of Life OIG identified that beyond the Requirements of Participation for Long Term Care Facilities in 42 CFR 483 , the failure to provide quality care and promote quality of life poses a risk of fraud and abuse for nursing facilities.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Health Blawg

JANUARY 16, 2019

As in the case of the RFI regarding Stark and AKS, this is prompted in large part by the move from volume to value, and the widespread belief that value-based payment systems will right the listing ship of the U.S. healthcare “system.” ” (Let’s just say here that the jury is still out.

HIPAA 60

HIPAA Fraud Governance Payment Systems 60

Health Blawg

JANUARY 16, 2019

As in the case of the RFI regarding Stark and AKS, this is prompted in large part by the move from volume to value, and the widespread belief that value-based payment systems will right the listing ship of the U.S. healthcare “system.” ” (Let’s just say here that the jury is still out.

HIPAA 60

HIPAA Fraud Governance Payment Systems 60

Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Hall Render

NOVEMBER 28, 2023

On November 1, 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 Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

HIPAA Journal

FEBRUARY 9, 2024

Card on file payments can accelerate collections from patients, reduce non-payments, and protect both patients and practices from credit card fraud. It is also claimed that card on file payments builds trust between practices and patients and contributes towards patient retention. #7

HIPAA 40

HIPAA Compliance Payment Systems Ransomware 40

Healthcare IT Today

JUNE 5, 2024

In the case of Change Healthcare, the organization saw an immediate disruption in operations, which restricted access to billing and payment systems as well as care authorization portals. And the impact of these types of incidents can be even more severe, from both a security and medical standpoint.

Payment Systems 75

Payment Systems Healthcare information Technology Fraud Hospitals 75

CMS.gov

DECEMBER 21, 2018

To this end, we are developing and testing new payment models to transform our payment system, and today’s changes to Medicare’s ACO program are a critical component of that transformation. ACOs are groups of healthcare providers that take responsibility for the total cost and quality of care for their patients.

Medicare 41

Medicare Medicare Payment Systems Fraud 41

Hall Render

JANUARY 26, 2024

NATIONAL 55% of rural hospitals don’t offer obstetric care: Report Academic health systems are scooping up hospitals AHA says Medicare payments to long-term care hospitals are inadequate AHA Warns Hospitals of IT Help Desk Social Engineering Scheme Amazon Pharmacy connects with One Medical Biden administration reinforces reproductive health obligations (..)

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

AUGUST 4, 2023

1 CMS final rule boosts Medicare hospice payments by 3.1% to settle Medicare fraud claims Maine in top 10 for health care, No. 1 for access in WalletHub ranking VA Maine Healthcare System receives 4 stars CMS quality ratings Maine’s tally of ‘high-performing’ hospitals falls sharply in latest U.S.

COVID-19 40

COVID-19 Nursing Homes Hospitals Nurses 40

Hall Render

MARCH 15, 2024

HSHS moves up 2nd hospital closure How Dr. Trinity: How the 3 largest nonprofit systems’ finances compare BAMF, Corewell Health partner on clinical trial for advanced cancer treatment Doctor files whistleblower lawsuit against DMC after patient becomes quadriplegic Lakeshore outpatient surgery center completes $9.3M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

JANUARY 31, 2025

Duke Health, UNC Health to partner on new $2 billion childrens hospital in the Triangle Greensboro substance abuse laboratory reaches Medicaid fraud settlement with U.S., is Americas loneliest city. Wayne Berberian as chief medical officer Pallone Secures $5.5 Now, a building boom is looming.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Medicaid 40

Hall Render

FEBRUARY 7, 2025

fraud scheme Banner names Seattle physician-scientist to C-suite role Bill would require Arizona hospitals to ask about immigration status Phoenix Children’s receives $2.25 Alaska Mental Health Trust Authority chooses new chief executive ARIZONA Arizona couple pleads guilty to $1.2B The university says no. area clinics, eyes more D.C.

Nurses 40

Nurses Nursing Homes Hospitals Medicaid 40

Hall Render

APRIL 21, 2023

health-tech startup MemoryWell pivots, eyes new funding to roll out software for insurers Department of Veterans Affairs health system kicks off multiyear Greater Washington expansion Georgetown to open Southeast D.C. health care fraud scheme SA cancer research company entering Dallas market as it eyes more U.S.,

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nursing Homes Nurses 40