Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. To become a provider for Ohio Medicaid, you must first enroll in the Ohio Medicaid program. Here are the steps of provider enrollment for Ohio Medicaid: Provider Enrollment for Ohio Medicaid 1.

Medicaid 52

Medicaid Medicaid Licensing Medical Billing Outsourcing 52

Healthcare Blog

APRIL 13, 2023

As hospitals have become increasingly complex organizations, effective governance, risk, and compliance (GRC) strategies have become essential for ensuring patient safety and regulatory compliance. What are the Key Components of a Successful Governance, Risk, and Compliance (GRC) Strategy?

Governance 40

Governance Compliance Hospitals Regulatory Compliance 40

Medisys Compliance

MAY 19, 2022

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located.

COVID-19 52

COVID-19 Medicare Medicare Medical Billing 52

Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. The Final Rule went into effect on June 5, 2023, and can be found here.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

HIT Consultant

APRIL 21, 2022

What You Should Know: – Centers for Medicare & Medicaid Services’ (CMS) payment adjustments did not adequately address hospitals increased costs for FY 2021, according to new data from Premier. – The data reveals this discrepancy has resulted in hospitals receiving only a 2.4 PINC AI™ Data Analysis.

Hospitals 52

Hospitals COVID-19 Payment Systems Medicaid 52

Healthcare IT News - Telehealth

MAY 30, 2023

This change is yet another signal that the country is working to move past the pandemic, which falls in line with recent moves by the federal government to move the pandemic to a more controlled phase. Further, what should CIOs and other health IT leaders at hospitals and health systems be doing to address new telemedicine challenges?

Telemedicine 184

Telemedicine COVID-19 Governance Medicare 184

Medisys Compliance

JULY 13, 2023

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

Medicare 52

Medicare Medicare Medical Billing Outsourcing Health Outcomes 52

Verisys

FEBRUARY 9, 2024

Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Here is a round up of bad actors: Physician Fraud Glastonbury Psychologist Admits Defrauding Medicaid of More Than $1.6 Million Civil Judgment and Drug Treatment Center Enters Settlement to Pay $2.2

Fraud 52

Fraud Medicaid Medicaid Medicare 52

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

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Medicare Advantage (M.A.): and cybersecurity threats. Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

MedTrainer

JUNE 15, 2022

When changes are made to government regulations, they have far-reaching effects. This is the case for proposed changes to the Medicare Shared Savings Program, as they’ll impact ACOs in more ways than one if they’re enacted. ACO stands for accountable care organization and is made up of care providers, doctors, and hospitals.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

DECEMBER 4, 2023

The Centers for Medicare & Medicaid Services (“CMS”) finalized significant updates to the Hospital Price Transparency regulation for the first time since the rule took effect on January 1, 2021. All hospital MRFs must now comply with a CMS template, a markedly more prescriptive approach than previously allowed.

Hospitals 52

Hospitals Compliance Patient Advocacy Medicare 52

Healthcare It News

OCTOBER 31, 2022

Through the secure collection, documentation, reporting, access and use of data across provider types, ONC aims to address health inequities that have their root causes in poverty and racism. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org.

Licensing 257

Licensing Health Outcomes Medicaid Medicaid 257

MRO Compliance

JUNE 1, 2022

HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. HEDIS works as a government rating tool. Depending on the score of a health plan, payers may receive considerable Medicare financial incentives if a score exceeds a certain level.

Medicare 130

Medicare Medicare Compliance Medicaid 130

Health Populi

JULY 16, 2020

The median charge for hospitalizing a patient with COVID-19 ranged from $34,662 for people 23 to 30, and $45,683 for people between 51 and 60 years of age, according to FAIR Health’s research brief, Key Characteristics of COVID-19 Patients published July 14th, 2020. They used two ICD-10-CM diagnostic codes for this research: U07.1,

COVID-19 145

COVID-19 Hospitals Health Insurance Medicare 145

HIT Consultant

AUGUST 17, 2023

The declining birth rate is especially a problem for rural hospitals, many of which aren’t meeting the required number of deliveries per year to meet safety standards. Hospitals in under-resourced areas have less to offer new doctors in terms of equipment, support, and quality of life. Incentivizing Medicaid capture.

Medicaid 97

Medicaid Medicaid Doctors Telemedicine 97

Health Law Advisor

AUGUST 14, 2023

2] This means, in most cases, that Medicare beneficiaries must now come to a physician practice’s office location to pick up their DME – including IUCs – when the DME items are furnished and billed by physicians or their practices. The IOAS exception does NOT apply.

COVID-19 52

COVID-19 Medicare Medicare Public Health 52

Healthcare IT News - Telehealth

JUNE 30, 2020

Signers pointed out that the authorities granted to the Department of Health and Human Services and the Centers for Medicare and Medicaid Services are restricted to the public health emergency period triggered by COVID-19. introduced legislation earlier this month to codify Medicare reimbursement of virtual care at FQHCs and RHCs.

US Department of Health and Human Services 193

US Department of Health and Human Services COVID-19 Telemedicine Medicare 193

Kaiser Health News

NOVEMBER 11, 2021

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. “You’re not from Medicare,” Heimer told her.

Medicare 144

Medicare Medicare Doctors Fraud 144

AIHC

NOVEMBER 29, 2023

Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. Hospital reimbursement also changed. As the cost of providing care grew, payers started instituting methods to curb expenses and how claims were paid.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Medisys Compliance

MARCH 14, 2023

Wound care is provided in various healthcare settings like inpatient hospital, outpatient clinics, long-term care facilities, home health settings, hospice and skilled nursing facilities. For example, patients who require ongoing wound care but do not need to be hospitalized can receive treatment in outpatient clinics.

Payment Systems 52

Payment Systems Medical Billing Medicare Medicare 52

Healthcare IT News - Telehealth

OCTOBER 2, 2020

Department of Health and Human Services to issue guidance to states about how to increase access to telehealth under Medicaid and the Children’s Health Insurance Program. Examples of states that have used waivers under the Medicaid program to test expanded access to telehealth. WHY IT MATTERS. healthcare system."

US Department of Health and Human Services 147

US Department of Health and Human Services COVID-19 Medicaid Medicaid 147

Health Law Attorney

DECEMBER 18, 2020

The Centers for Medicaid & Medicare Services ( CMS ) recently released the 2021 Outpatient Prospective Payment System ( OPPS ) and Ambulatory Surgical Center ( ASC ) Final Rule, which may be accessed here. CMS Administrator Seema Verma indicated there would be less micromanagement from the government regarding such decisions.

Medicare 40

Medicare Medicare COVID-19 Payment Systems 40

Verisys

DECEMBER 5, 2023

For the medical staff services team at a hospital to properly verify a healthcare practitioner’s credentials, dozens of primary sources must be contacted directly, and those primary source organizations must then verify the credentials of the practitioner in question. The policy issuer for malpractice insurance verifies insurance coverage.

Governance 52

Governance Licensing Malpractice Medicaid 52

Health Care Law Brief

FEBRUARY 8, 2024

billion to fund Medicaid, $4.8 In addition to those provisions that look to extend current government programs, the HMH Bill proposes the following new initiatives: Provider Specific Provisions : Transforming Safety Net Hospitals. The HSNT Program would authorize the issuance of grant funds to safety net hospitals.

Medicaid 52

Medicaid Medicaid Nurses Licensing 52

AIHC

NOVEMBER 29, 2023

Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. Hospital reimbursement also changed. As the cost of providing care grew, payers started instituting methods to curb expenses and how claims were paid.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Law Advisor

JULY 5, 2023

Entitled the Healthcare Accountability & Consumer Protection Act (the “Act”), this legislation includes Introduction 844, which establishes an Office of Healthcare Accountability, whose work would allow patients to see through a website what they would be charged for procedures at hospitals throughout New York City.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Verisys

MARCH 23, 2023

Abuse of government healthcare programs is a federal offense with severe penalties. government or a government contractor. The Most Common False Claims The FCA primarily combats healthcare fraud and abuse associated with Medicare and Medicaid.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare IT Today

NOVEMBER 15, 2023

The technique involves finding data from public sources such as Centers for Medicare & Medicaid Services (CMS). Resilient Healthcare Employs Extensive Data Analytics Resilient Healthcare provides in-home care for conditions that have traditionally required a hospital stay. offering in-home treatment.

Medicare 95

Medicare Medicare Hospitals Compliance 95

Bill of Health

MARCH 15, 2022

During the early months of the pandemic, disabled people became unemployed at disproportionate rates , likely related to substantial employment declines in certain industries, such as retail and hospitality, where disabled people are overrepresented. In July 2021, the U.S.

COVID-19 246

COVID-19 ADA Medicaid Medicaid 246

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

MedTrainer

APRIL 11, 2024

They are responsible for developing policies that govern the employment relationship between the organization and its employees. They develop and implement compliance programs that include policies, practices, and procedures to ensure all departmental operations align with federal and state laws.

Compliance Officers 52

Compliance Officers Compliance Medicaid Medicaid 52

HIT Consultant

NOVEMBER 30, 2022

Significant Growth Anticipated for Medicaid and Capitation Contracts: Most respondents report strategic plans to expand their VBC contracts over the next three years. Some hospitals are just starting out and have little to no revenue from VBC contracts. Key Themes and Ideas Regarding Value-Based Care Reimbursement 2022.

Medicaid 95

Medicaid Medicaid Medicare Medicare 95

Healthcare IT News - Telehealth

OCTOBER 27, 2020

The government has signaled its support for reimbursing some telehealth services, at least in the short term. "The government can play a very positive role in telehealth by establishing clear standards and clear reimbursement guidelines," said Selesnick.

COVID-19 187

COVID-19 Governance Medicare Medicare 187

Healthcare IT News - Telehealth

NOVEMBER 2, 2020

Located in the heart of North Philadelphia, Temple University Hospital serves one of the nation’s most economically challenged and diverse urban populations. More than 85% of the patients served by Temple are covered by government programs, including Medicare and Medicaid. ” USING FCC AWARD FUNDS.

Telemedicine 159

Telemedicine COVID-19 Nurses Medicare 159

MedTrainer

FEBRUARY 12, 2024

government collected $2.2B Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Healthcare IT News - Telehealth

JULY 16, 2020

Now, the question becomes : How many of those changes, particularly regarding temporary waivers issued by the Centers for Medicare and Medicaid Services, will become permanent? Among other provisions, the act would eliminate most geographic and originating site restrictions on the use of telehealth in Medicare.

COVID-19 135

COVID-19 Medicare Medicare Governance 135