Governance, Hospitals, Medicaid and Medicare - Health Care Compliance Brief

Countercyclical Aid Is Not Enough to Fix the Broken US Approach to Public Health Financing

Bill of Health

SEPTEMBER 9, 2022

Consider, for example, the Coronavirus State and Local Fiscal Recovery Funds Program (SLFRF) — enacted as part of the American Rescue Plan Act — which provided $350 billion in flexible aid to state, local, tribal, and territorial governments. This precludes rebuilding the decimated public health workforce.

Public Health

Public Health COVID-19 Public Health Professionals Governance

CMS Finalizes Major Changes to Hospital Price Transparency Rule

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

Hospitals Compliance Patient Advocacy Medicare

Why Data Analytics are Critical in a Value-Based Care (VBC) Environment

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

Medicare Medicare Medicaid Medicaid

Why Data Analytics are Critical in a Value-Based Care (VBC) Environment

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

Medicare Medicare Medicaid Medicaid

White House looks to CMMI to test new ways to lower drug prices

C&M Health Law

NOVEMBER 7, 2022

The EO comes two months after the president signed the Inflation Reduction Act (IRA) which promises to lower the cost of prescription drugs for many Medicare beneficiaries. This is not the first time that the White House will try to leverage CMMI’s testing authority to create models that would lower drug costs in Medicare.

Medicare

Medicare Medicare Medicaid Medicaid

How CMS is boosting telehealth and RPM with new CPT codes

Healthcare IT News - Telehealth

SEPTEMBER 28, 2021

In the latest Medicare Physician Fee Schedule, the U.S. Centers for Medicare and Medicaid Services proposed for the first time a set of CPT codes for remote therapeutic monitoring. Nevertheless, new categories of digital health reimbursement have become increasingly clear. In the U.S.,

COVID-19

COVID-19 Medicare Medicare Hospitals

2020 Medicaid Managed Care Rule Summary

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Actuarial Soundness.

Medicaid

Medicaid Medicaid Medicare Medicare

You Play a Vital Role in Protecting the Integrity of the U.S. Healthcare System

AIHC

MAY 31, 2022

To combat fraud and abuse, all levels within a medical practice, hospital or health care organization must know how to protect the organization from engaging in abusive practices and violations of civil or criminal laws. billion reduction of Medicare Fee-for-Service (FFS) improper payments over seven years.

Fraud

Fraud Compliance Officers Compliance Medicare

Americans Across Political Party Worry About Prescription Drug Prices – Especially to Deal with COVID-19

Health Populi

JUNE 18, 2020

By demographics, more women than men are concerned about rising costs for the three health care spending categories the survey studied: drug prices, insurance premiums, and healthcare costs (medical care services spending). Across-the-board, nonwhites are more concerned than whites on the three spending categories, as well. bn to $9.9

Prescription Drug Pricing

Prescription Drug Pricing COVID-19 Medicaid Medicaid

HHS Issues Proposed Rule to Provide Clarity on Rights of Conscience in Healthcare

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

ACA Medicaid Medicaid Compliance

Part 2: Understanding How Payers Deny Claims

AIHC

MARCH 28, 2022

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?

Medicare

Medicare Medicare Compliance Governance

‘Free’ Screening? Know Your Rights to Get No-Cost Care

Kaiser Health News

JULY 6, 2022

And, if you get a bill from a physician, clinic, or hospital that you think might qualify for no cost sharing, call your insurer to inquire or dispute the charge. The federal government currently lists 22 broad categories of coverage for adults, an additional 27 specifically for women, and 29 for children.

ACA

ACA Medicare Medicare Medicaid

Part 3: Audit Documentation to Avoid Potential Appeal Consequences

AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud

Fraud Compliance Medicare Medicare

HIPAA Continuity of Care

HIPAA Journal

MAY 12, 2023

An example of this is a patient’s journey from a physician’s office to a hospital, then to a care home, then to a home health service. One of the permissible disclosures of PHI in this category is for “case management and care coordination”. 42 CFR Part 2).

HIPAA

HIPAA Compliance Health Services Administration Medicare

Clarifying the HIPAA Retention Requirements

HIPAA Journal

MARCH 31, 2023

These generally fall into two categories – HIPAA medical records retention and HIPAA records retention requirements. The distinction between the two categories is that there are no HIPAA medical records retention requirements, but requirements exist for other documentation.

HIPAA

HIPAA Medicare Medicare Compliance

Prescription Drugs in the Pandemic, Year 2: Pricing Rx and Going Direct-to-Consumer

Health Populi

AUGUST 16, 2021

adults favor increased government funding allocated to lowering the out-of-pocket costs for patients. adults favor increased government funding allocated to lowering the out-of-pocket costs for patients. health care system from which other nations and governments are not burdened. Given our political chasms in the U.S.

COVID-19

COVID-19 Nurses Doctors Medicaid

Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?

Kaiser Health News

MAY 31, 2022

So when her primary care doctor suggested she be screened for colorectal cancer in September, Melville dutifully prepped for her colonoscopy and went to New London Hospital’s outpatient department for the zero-cost procedure. Service Provider: New London Hospital , a 25-bed facility in New London, New Hampshire.

ACA

ACA Doctors Medical Billing Hospitals

The 2022 Health Populi TrendCast for Consumers and Health Citizens

Jane Sarashon

DECEMBER 13, 2021

This big number is comprised by personal care and beauty (which had various shifts within the category in the pandemic – less color cosmetics and more skin health and hygiene), health eating and nutrition and weight loss, physical activity, and wellness tourism, among other categories.

COVID-19

COVID-19 Public Health Governance Medicaid

The Cobra Effect & Enforcing Compliance Standards

AIHC

FEBRUARY 16, 2024

The GCPG standardized the seven Elements of a Successful Compliance Program, which differs slightly from the individual compliance guidance documents (CPGs) directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers. The result?

Compliance

Compliance US Department of Health and Human Services COVID-19 Hospitals

The Cobra Effect & Enforcing Compliance Standards

AIHC

FEBRUARY 16, 2024

The GCPG standardized the seven Elements of a Successful Compliance Program, which differs slightly from the individual compliance guidance documents (CPGs) directed at various segments of the health care industry, such as hospitals, nursing homes, third-party billers, and durable medical equipment suppliers. The result?

Compliance

Compliance US Department of Health and Human Services COVID-19 Hospitals

Home Health PPS Proposed Rule for CY 2024: Broad Rule Has Something for Everyone

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

Medicare Medicare Payment Systems Governance

Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast

Health Populi

DECEMBER 25, 2018

This bill would create a government-run drug company to produce and distribute generic medicines. In 2018, we also saw a response to high drug costs in the form of CivicaRx, a consortium of hospitals coming together to manufacture drugs in short supply at hospitals.

Health Insurance

Health Insurance Hospitals Doctors Medicaid

FDA Oversight of AI Software Developed by Health Care Providers

Health Law Advisor

AUGUST 10, 2023

5] But that Interstate Commerce Clause needs to be viewed also in balance with the 10th Amendment of the Constitution, which reserves to the states any powers not delegated to the federal government. 13] Hospital Reprocessing of Single Use Medical Devices Medical devices can be quite expensive.

FDA

FDA Licensing Hospitals Medicaid

A Health-Heavy State of the Union

Kaiser Health News

FEBRUARY 9, 2023

He took a victory lap on recent accomplishments like capping prescription drug costs for seniors on Medicare. And he sparred with Republicans in the audience — who jeered and called him a liar — over GOP proposals that would cut Medicare and Social Security. Here is the tape. We got unanimity!

US Department of Health and Human Services

US Department of Health and Human Services Medicare Medicare FDA

GOP House Opens With Abortion Agenda

Kaiser Health News

JANUARY 12, 2023

But Medicare is likely to be on the agenda, which will require the input of the chairs of both committees. Still to be determined is whether Medicare — which provides insurance to most people with Alzheimer’s — will cover the drug. And of course, the Ways and Means Committee has jurisdiction over most of Medicare in the House.

US Department of Health and Human Services

US Department of Health and Human Services FDA Medicare Medicare

HIPAA Updates and HIPAA Changes in 2023

HIPAA Journal

JANUARY 9, 2023

The Government Accountability Office (GAO) has shared a methodology for sharing funds, but OCR is seeking comment on any alternative methodologies. The coronavirus pandemic has seen social distancing measures introduced, and with hospitals dealing with huge numbers of cases, Americans are being encouraged to remain indoors.

HIPAA

HIPAA COVID-19 COVID-19 Vaccine Compliance

The Most Common HIPAA Violations You Should Avoid

HIPAA Journal

JANUARY 2, 2023

Lahey Hospital and Medical Center – $850,000 settlement for the failure to conduct an organization-wide risk assessment and other HIPAA violations. Joseph’s Hospital and Medical Center – $160,000 penalty for a delayed response to a patient’s request for a copy of their medical records. Cardionet – $2.5

HIPAA

HIPAA Compliance Hospitals Medicare

Health Provider News – March 25, 2022

Hall Render

MARCH 25, 2022

Hospital stays for nursing home residents down nearly 9%, federal data shows. What’s holding up hospital at home? Alabama COVID hospitalizations drop to lowest point since pandemic started. New rural hospital model could preserve communities, jobs. Alabama lawmaker’s push to extend postpartum Medicaid coverage. $12

COVID-19

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

Guest Post – CMS Health Care Staff Vaccination Rule Enforceable as Challenges Continue

Drug & Device Law

JANUARY 16, 2022

It concern’s the Supreme Court’s 6-3 decision to permit the government to continue enforcement of its requirement that healthcare workers (at least those in facilities that accept Medicare/Medicaid, which is most of them) be vaccinated to avoid infecting themselves and their patients with COVID-19.

Compliance

Compliance COVID-19 Medicaid Medicaid

Health Care Compliance Brief

Countercyclical Aid Is Not Enough to Fix the Broken US Approach to Public Health Financing

CMS Finalizes Major Changes to Hospital Price Transparency Rule

Trending Sources

Why Data Analytics are Critical in a Value-Based Care (VBC) Environment

Why Data Analytics are Critical in a Value-Based Care (VBC) Environment

White House looks to CMMI to test new ways to lower drug prices

How CMS is boosting telehealth and RPM with new CPT codes

2020 Medicaid Managed Care Rule Summary

You Play a Vital Role in Protecting the Integrity of the U.S. Healthcare System

Americans Across Political Party Worry About Prescription Drug Prices – Especially to Deal with COVID-19

HHS Issues Proposed Rule to Provide Clarity on Rights of Conscience in Healthcare

Part 2: Understanding How Payers Deny Claims

‘Free’ Screening? Know Your Rights to Get No-Cost Care

Part 3: Audit Documentation to Avoid Potential Appeal Consequences

HIPAA Continuity of Care

Clarifying the HIPAA Retention Requirements

Prescription Drugs in the Pandemic, Year 2: Pricing Rx and Going Direct-to-Consumer

Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?

The 2022 Health Populi TrendCast for Consumers and Health Citizens

The Cobra Effect & Enforcing Compliance Standards

The Cobra Effect & Enforcing Compliance Standards

Home Health PPS Proposed Rule for CY 2024: Broad Rule Has Something for Everyone

Costs, Consumerism, Cyber and Care, Everywhere – The 2019 Health Populi TrendCast

FDA Oversight of AI Software Developed by Health Care Providers

A Health-Heavy State of the Union

GOP House Opens With Abortion Agenda

HIPAA Updates and HIPAA Changes in 2023

The Most Common HIPAA Violations You Should Avoid

Health Provider News – March 25, 2022

Guest Post – CMS Health Care Staff Vaccination Rule Enforceable as Challenges Continue

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