Hall Render

JUNE 16, 2023

The Court’s opinion settles two outstanding questions about the authority of the Government to dismiss FCA actions in which it first declines to intervene but that whistleblowers continue to pursue on the Government’s behalf. The Government and Defendants favored the broadest authority permitted in the D.C.

Governance 40

Governance Medicare Medicare Hospitals 40

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

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

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

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. What Is Considered a Primary Source? And the list goes on.…

Governance 52

Governance Licensing Malpractice Medicaid 52

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 170

Telemedicine COVID-19 Nurses Medicare 170

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

Hall Render

JUNE 15, 2022

On June 15, in American Hospital Association v. Becerra , the Supreme Court ruled the payment cuts made by the Department of Health and Human Services’ (“HHS”) Centers for Medicare & Medicaid Services (“CMS”) for 340B eligible outpatient drugs were not permissible under the governing statute.

Medicare 45

Medicare Medicare Hospitals Governance 45

Healthcare Law Blog

APRIL 13, 2022

However, in all states, the NSA governs disputes relating to air ambulance services, not state law. Federal law governs disputes relating to out-of-network services provided by air ambulance providers. Background of the NSA. AB 72 also limits the enrollee’s cost-sharing amount to the enrollee’s in-network rate.

Governance 52

Governance Medical Billing Licensing Medicare 52

Medisys Compliance

MARCH 26, 2024

Understanding CPT Codes for Holter Monitoring The Current Procedural Terminology (CPT) codes govern Holter monitor billing. Place of Service (POS) Codes POS 11: Outpatient office setting POS 21: Inpatient hospital setting Modifier Codes 51: Multiple procedures performed on the same day (e.g.,

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Governance Medical Billing Services 64

MedTrainer

MARCH 14, 2024

The specialist contacts other parties and primary sources to verify the provider’s information – prior employers, references, and educational institutions. Courtesy: This is when a hospital occasionally allows a provider to admit and treat a patient. However, not all providers need hospital privileges.

Malpractice 52

Malpractice Licensing Hospitals Compliance 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 1, 2022

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. Government and Non-Government Sources.

Governance 52

Governance Licensing Malpractice Medicaid 52

Healthcare IT Today

OCTOBER 19, 2023

In this article, I’ll show how many hospitals, payers, and other institutions are acting on that data. Of course, the staff of a clinic or hospital don’t go around looking for apartments the way they actively look for a long-term care facility. The company employs visits, phone calls, and online contacts to get the data.

Department of Veterans Affairs 100

Department of Veterans Affairs Nursing Homes Health Outcomes Hospitals 100

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 52

Fraud Compliance Officers Compliance Medicare 52

Hall Render

JULY 25, 2023

On December 14, 2022, the Office of Inspector General (“OIG”) issued an advisory opinion which approved a hospital program (“Arrangement”) to provide advanced practice provider (“APP”) support for inpatients being cared for by primary care physicians (“Participating Physicians”).

Compliance 40

Compliance Hospitals Governance Doctors 40

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. This standard was interpreted and applied differently by various Medicare contractors and was difficult to review/audit.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Medisys Compliance

MAY 30, 2022

The regulations governing PCS requirements are specified in the Code of Federal Regulations at 42 CFR 410.40(d). These regulations are the basis for Medicare guidelines. There is no specific Medicare-approved form for PCS. Regardless of the form you choose to use, the information on the form must comply with Medicare guidelines.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Medicare Medicare 52

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. For example, hospitals and home health agencies may be subject to additional state and federal regulations, while individual practitioners may have fewer requirements to meet.

Medicaid 52

Medicaid Medicaid Licensing Medical Billing Outsourcing 52

HIT Consultant

JANUARY 23, 2023

Nate Maslak, the co-founder/CEO of Ribbon Health Price Transparency: In 2022, we saw CMS’s Transparency in Coverage rule go into effect, requiring non-hospital entities like health plans and providers to publish publicly available rates for care. The loss of government health emergency funding will only make this worse.

Medicare 98

Medicare Medicare Governance Compliance 98

Hall Render

DECEMBER 5, 2022

This API will be the focus of future rulemaking and will hopefully provide hospitals and other providers with a more workable solution for complying with the GFE co-provider requirement. The FAQ does note that some states chose to be the primary enforcers of the GFE requirements, rather than the federal government.

Medicaid 72

Medicaid Medicaid Medicare Medicare 72

Medisys Compliance

JULY 18, 2022

In the Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare covered SNF stay be included in a bundled prospective payment made through the Part A Medicare Administrative Contractor (MAC) to the SNF. This practice created several problems. To summarize.

Medical Billing 52

Medical Billing Medicare Medicare Medical Billing Outsourcing 52

HIPAA Journal

MARCH 29, 2024

billion has been provided to safety net hospitals and federally qualified health centers that serve high-risk patients and communities. They explained that the HHS has asked health plans to provide national contact information that the affected providers can use, and have shared resources to help affected providers get the answers they need.

Ransomware 95

Ransomware US Department of Health and Human Services HIPAA Hospitals 95

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 106

ACA Doctors Medical Billing Hospitals 106

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. ” Medicare Part C. ” Medicare Part C. Medicare Advantage Programs were another target in 2021.

Fraud 40

Fraud Governance Medicare Medicare 40

Compliancy Group

JANUARY 3, 2024

This mistake resulted in millions of dollars in lost revenue for hospitals. Contact Compliancy Group today to learn how they empower providers and administrators to meet their billing compliance obligations, improve their work processes, and find solutions to common medical billing issues.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

HIT Consultant

MARCH 8, 2022

Most government agencies have disparate legacy eligibility and enrollment systems that do not share data. Many people have moved during the pandemic due to job loss or an eviction, and states may not have up-to-date contact information as almost two years have passed since the last redetermination.

Public Health 98

Public Health Medicaid Medicaid Health Insurance 98

Healthcare IT Today

OCTOBER 20, 2023

A patient who signs up to be a member of Wellframe provides SDoH information, which the Wellframe platform then shares information with care managers who can contact the members to address the problems. Food Aid Federal government food programs expanded significantly during the COVID-19 crisis.

Medicaid 118

Medicaid Medicaid COVID-19 Doctors 118

Medisys Compliance

MARCH 27, 2023

These terminologies are briefly discussed below for better understanding: Provider enrollment: This refers to the process of enrolling a healthcare provider with an insurance plan or government program, such as Medicare or Medicaid. Hope this article has answered the question ‘what is provider credentialing in healthcare?’

Malpractice 52

Malpractice Medical Billing Outsourcing Governance Patient Satisfaction 52

Hall Render

JANUARY 21, 2022

In 2008, the plaintiff physician joined a Michigan-based health system (the “Hospital”) as a member of its medical staff. Plaintiff, and all members of the staff, were required to regularly reapply for medical staff privileges which could be granted for up to two years at a time by the Hospital. Your primary Hall Render contact.

Hospitals 40

Hospitals Medicare Medicare Governance 40

Hall Render

DECEMBER 28, 2023

Regulatory Challenges Are the New Normal – In 2023, we saw a renewed interest by government regulators in health care. In 2024, we expect a continued interest by government officials in regulating health care in nearly all of the areas that were highlighted in 2023. Regulatory oversight has taken multiple forms.

Hospitals 40

Hospitals Governance Medicaid Medicaid 40

Healthcare IT Today

OCTOBER 18, 2023

Data can be spotty, according to Eye, who says for instance that data from Centers for Medicare & Medicaid Services (CMS) often lacks racial identifications. Because of the time required to process SDoH, Eye says, institutions need to prioritize which patients to contact. The percentage is much higher in some areas.

Doctors 118

Doctors Public Health Medicare Medicare 118

Verisys

DECEMBER 23, 2021

Provider enrollment is the application process by which a practitioner is approved to seek reimbursement from government and/or third-party payers or seek admitting privileges at a hospital. It includes: The provider enrollment process for various government health plans. Steps to successful enrollment.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Populi

MARCH 12, 2020

For example, only health care providers that have an existing relationship with a Medicare patient would be eligible per the requirements in the legislation. But the private sector can only do as much with the obstacles of government regulations and other market barriers long preventing the spread of telehealth in the U.S.

COVID-19 116

COVID-19 Telemedicine Medicare Medicare 116

MedTrainer

APRIL 22, 2024

The Centers for Medicare and Medicaid imply that a compliance committee is in place and participates in reporting to the governing board. Demonstrate organizational transparency and accountability using regular updates and reports to employees and the governing board. Who Should Sit on a Compliance Committee?

Compliance 52

Compliance Compliance Officers Governance Medicaid 52

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 52

Medicare Medicare Payment Systems Governance 52

MedTrainer

JUNE 6, 2021

Accreditation is the method in which organizations such as hospitals, practices, and other healthcare-related institutions establish their ability to meet the requirements and standards of regulatory agencies that govern the various aspects of the healthcare industry. What is Accreditation?

Compliance 40

Compliance Governance Medicaid Medicaid 40