HIPAA Journal

APRIL 29, 2024

A Portland, ME-based accounting and consulting firm has recently reported a data breach to the Maine Attorney General that involved the personal information of 1,107,354 individuals. A vendor was engaged to conduct a review of the affected files, and that process was completed on April 2, 2024.

Health Insurance 91

Health Insurance Health Analytics HIPAA Medicaid 91

Bill of Health

DECEMBER 6, 2023

By Hannah Rahim Many mental health provider directories for private and public insurance plans contain inaccurate or outdated provider information , which creates a misleading illusion of accessible care. These ghost networks result in many patients being unable to access essential mental health care.

Governance 144

Governance Medicaid Medicaid Medicare 144

Kaiser Health News

APRIL 16, 2024

District Court for the Southern District of Florida, two such call centers paid tens of thousands of dollars a day to buy names of people who responded to misleading advertisements touting free government “subsidies” and other rewards. Some consumers were switched multiple times or had duplicative policies.

ACA 138

ACA Health Insurance Governance Medical Billing 138

Bill of Health

JANUARY 23, 2024

Medicaid pays for more than 40% of births in the U.S., Examining efforts at the federal and state level, I highlight three options, leveraging Medicaid as a policy lever. In the past, when individuals were Medicaid-eligible due to pregnancy, federal law required states to provide coverage for at least 60 days postpartum.

Medicaid 111

Medicaid Medicaid Patient Satisfaction Health Insurance 111

HIT Consultant

MARCH 8, 2022

The steep incline in unemployment and fears that millions of people would lose their health coverage drove the declaration of the national public health emergency (PHE) on January 31, 2020. Under the PHE, states must keep Medicaid enrollees continuously covered, irrespective of their circumstances. .

Public Health 98

Public Health Medicaid Medicaid Health Insurance 98

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. Educating patients on how to reduce their overall risk helps protect their health information.

Fraud 52

Fraud Medicare Medicare Compliance 52

HIT Consultant

JULY 17, 2023

Cessation of PHE telehealth, prescribing, and mental health access exceptions could impact the Medicaid population the most. Twenty-one percent of Medicaid enrollees have mild, moderate, or severe SUD, compared to 16% of commercially insured individuals. And as of the latest data, 7.3% And as of the latest data, 7.3%

Public Health 98

Public Health Medicaid Medicaid Electronic Medical Records 98

Verisys

JANUARY 8, 2024

This includes adherence to standards set by the Health Insurance Portability and Accountability Act (HIPAA) , the Centers for Medicare & Medicaid Services (CMS), and other regulatory bodies. for more information. Critical for protecting sensitive patient health information.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

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

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

HIPAA Journal

FEBRUARY 23, 2022

HIPAA is an acronym for the Health Insurance Portability and Accountability Act. When the Health Insurance Portability and Accountability Act was passed by Congress in 1996, the establishment of federal standards for safeguarding PHI was not one of the primary objectives. What is HIPAA? What is HIPAA Title II?

HIPAA 88

HIPAA Fraud Health Insurance Medicaid 88

Health Care Law Brief

JUNE 5, 2023

In 2013, Jelly Bean contracted with the Florida Health Kids Corporation (“ FHKC ”)—a state-created entity that offers health and dental insurance for Florida children—to create, host, and maintain HealthyKids.org, where, in part, parents and others could apply for state Medicaid insurance coverage for eligible children.

Fraud 52

Fraud Due Diligence Medicaid Medicaid 52

Health Populi

DECEMBER 9, 2021

being covered by health insurance is one of the social determinants of health. Without a health plan, an uninsured person in America is far more likely to file for bankruptcy due to medical costs, and lack access to needed health care (and especially primary care). In the U.S.,

Medical Billing 73

Medical Billing Health Insurance Medicaid Medicaid 73

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. Compliance efforts shifted toward protecting patient information.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

MedTrainer

NOVEMBER 14, 2023

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Exclusion from Government Programs: Entities found non-compliant may be barred from participating in government healthcare programs like Medicare and Medicaid. What Is Healthcare Compliance?

Compliance 52

Compliance HIPAA Governance Medicare 52

Medisys Compliance

JANUARY 30, 2023

The medical billing industry is a complex and ever-changing field, and it is crucial for healthcare providers and billing companies to stay compliant with government regulations. Violations of the False Claims Act can result in significant financial penalties, including fines and exclusion from government healthcare programs.

Compliance 52

Compliance Medical Billing Medical Billing Outsourcing HIPAA 52

MedTrainer

JANUARY 12, 2024

Healthcare facilities, from hospitals and clinics to insurance providers, are deeply affected by the regulations set forth by the Health Insurance Portability and Accountability Act (HIPAA). Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry.

HIPAA 52

HIPAA Compliance Health Insurance Hospitals 52

Healthcare IT Today

MAY 15, 2023

The Company takes a local approach – with local brands and local teams – to provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Originally announced May 3rd, 2023

Medicare 80

Medicare Medicare Governance Health Insurance 80

MedTrainer

OCTOBER 4, 2023

Federal healthcare compliance requirements encompass a set of regulations and laws established by various government agencies to ensure certain standards for the healthcare industry at the national level. CMS plays a crucial role in overseeing federal healthcare programs, including Medicare and Medicaid. Office for Civil Rights (OCR).

Compliance 52

Compliance Fraud HIPAA Governance 52

Healthcare IT Today

AUGUST 20, 2023

Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job. In addition, FQHC Connecticut Institute for Communities deployed eClinicalWorks Population Health.

Health Insurance 92

Health Insurance Medicaid Medicaid FDA 92

Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare It News

FEBRUARY 28, 2023

The payer mix of health insurance is typical, with 35% of patients representing government insurance such as Medicare or Medicaid, 60% commercial insurance, and 6% self-pay patients. "UPMC is only one of eight health systems for the highest tier of recognition.

Electronic Medical Records 235

Electronic Medical Records Telemedicine Health Insurance Health Outcomes 235

HIPAA Journal

MARCH 6, 2023

Cedar Park, TX-based Dental Health Management Solutions (DHMS), a provider of dental services to the government/military and private patients has recently announced – via its legal counsel – that the protected health information of certain patients was exposed in a 2021 hacking incident.

Electronic Medical Records 74

Electronic Medical Records HIPAA Licensing Nurses 74

Medisys Compliance

JULY 11, 2022

The Centers for Medicare & Medicaid Services (CMS) has released Frequently Asked Questions (FAQs) on the No Surprises Act implementation, providing details about balance billing and notice and consent prohibitions. These requirements are collectively referred to as “No Surprises” rules. Patient Protection against Balance Billing.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Health Insurance Medicaid 52

Verisys

FEBRUARY 23, 2022

As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Facilities increasingly rely on healthcare compliance officers (HCOs) to bridge the gap between government regulation and daily operations.

Compliance Officers 52

Compliance Officers Compliance US Department of Health and Human Services Governance 52

MedTrainer

SEPTEMBER 8, 2023

The breach occurred in 2013 when four unencrypted laptops containing the electronic protected health information (ePHI) of over 4 million patients were stolen from an Advocate Health administrative building. Details of the settlement indicate the submission of false claims to Medicare, Medicaid, TRICARE, and FECA programs.

Compliance 52

Compliance HIPAA Medicaid Medicaid 52

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

MedTrainer

MAY 6, 2024

We’ll walk you through the steps to enroll providers with Aetna (a CVS Health company), the information and documents you’ll need, and best practices to follow. Payer enrollment is a crucial step that allows healthcare providers to participate in the network of a specific insurance payer.

Licensing 52

Licensing Malpractice Health Insurance Medicaid 52

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. The new broker provision aims to deter fraudulent sign-ups by clarifying that applicants must attest that the income projections listed are correct.

ACA 72

ACA Health Insurance Licensing Governance 72

Kaiser Health News

NOVEMBER 11, 2021

Yet federal officials say complaints are rising from seniors tricked into buying policies — without their consent or lured by questionable information — that may not cover their drugs or include their doctors. To use the new option, beneficiaries should contact their state’s health insurance assistance program at www.shiphelp.org/.

Medicare 144

Medicare Medicare Doctors Fraud 144

AIHC

NOVEMBER 6, 2023

The focus of this article is to “connect the dots” between Health Insurance Portability & Accountability Act (HIPAA) and HITECH regarding privacy and security of electronically protected health information (ePHI). It has to do with the every-evolving advancement in healthcare information technology. Why HITECH?

HIPAA 59

HIPAA Compliance Governance Health Insurance 59

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 99

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

MedTrainer

JANUARY 26, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. It jeopardizes patient health, and can seriously harm the legal standing and reputation of healthcare institutions. What is Healthcare Compliance?

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

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. The Act equates virtual care’s standard to in-person care, emphasizing sufficient provider-patient relationships and informed consent.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

HIT Consultant

APRIL 24, 2023

Continuing staff shortages, endemic COVID-19, high inflation rates, and supply chain disruptions continue to drive medical costs higher, worsening what is already a persistent challenge for health insurers. Government through CMS. Medicaid and Medicare account for 36.5% health insurance market. of the U.S.

Health Insurance 52

Health Insurance COVID-19 Medicare Medicare 52

Healthcare IT Today

JANUARY 2, 2024

The following is a guest article by Marlena Herrera, Director at Protegrity Healthcare organizations are becoming more lucrative targets for hackers, as their data is rich with extremely sensitive information and is often susceptible to vulnerabilities.

Compliance 69

Compliance US Department of Health and Human Services HIPAA Health Insurance 69

MedTrainer

DECEMBER 4, 2023

Regulations in the district encompass diverse healthcare areas, including patient privacy and data security, Medicaid and Medicare compliance, health insurance marketplaces, and scope of practice for healthcare professionals. This centralized repository ensures all employees have easy access to essential information.

Compliance 52

Compliance Health Insurance Health Outcomes Medicaid 52