AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. Can the investigators “get it wrong”?

Fraud 52

Fraud Medicare Medicare Compliance 52

Hall Render

NOVEMBER 18, 2022

On November 2, 2022, CMS announced revisions to the Calendar Year 2023 Payment Policies that impact Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare and Medicaid Provider Enrollment Policies (“CY 2023 PFS Final Rule”).

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Nurses Nursing Homes Medicare Medicare 40

Healthcare Law Blog

MARCH 20, 2023

In light of the behavioral health shortage, and now that these crucial digital health resources have been established, the most looming priority for private and government payors is to address workforce limitations, which directly lead to accessibility limitations for mental health patients. 6] Increase provider reimbursement strategies.

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Medicaid Medicaid Licensing ACA 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. Below are additional details about the updates, including effective dates and implementation timelines. Register for the webinar here.

Hospitals 52

Hospitals Compliance Patient Advocacy Medicare 52

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. Information Security and Privacy Policies.

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HIPAA Medicare Medicare Compliance 129

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

Kaiser Health News

MAY 31, 2022

And often the doctors and hospitals are the ones who decide when those categories shift and a patient can be charged — but those decisions often are debatable. Remind your provider that the government’s interpretation of the ACA requires that colonoscopies be regarded as a screening even if a polyp is removed.

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ACA Doctors Medical Billing Hospitals 103

Healthcare Law Blog

NOVEMBER 16, 2023

Department of Health and Human Services’ Centers for Medicare and Medicaid Services (“CMS”) will publish a final rule requiring Medicare skilled nursing facilities (“SNFs”) and Medicaid nursing facilities (“Facilities”) to provide more detailed ownership, managerial and other information on Form CMS-855A (the “Final Rule”). [1]

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Nurses Medicaid Medicaid Medicare 52

Health Law RX

JULY 18, 2023

On June 27, 2023, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued its long-anticipated final rule amending the OIG’s civil monetary penalty (CMP) regulations as they relate to information blocking (CMP Final Rule or Rule). The CMP Final Rule was published in the Federal Register on July 3, 2023.

Fraud 52

Fraud Compliance Medicaid Medicaid 52

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. Information Accessibility Requirements.

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Medicaid Medicaid Medicare Medicare 40

AIHC

MARCH 28, 2022

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. This information is not all-inclusive and the article is a truncated version of Lesson 3 from our Certified Outpatient Clinical Appeals Specialist (COCAS SM ) training program.

Medicare 52

Medicare Medicare Compliance Governance 52

Kaiser Health News

JULY 6, 2022

The law covers most types of health insurance, such as qualified health plans under the ACA that consumers have purchased for themselves, job-based insurance, Medicare, and Medicaid. The federal government currently lists 22 broad categories of coverage for adults, an additional 27 specifically for women, and 29 for children.

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ACA Medicare Medicare Medicaid 76

AIHC

FEBRUARY 16, 2024

The GCPG is a reference guide for the health care compliance community and other health care stakeholders and provides information about relevant Federal laws, compliance program infrastructure, OIG resources, and other information useful to understanding health care compliance. The result? a day for orphans, but $2.75

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

The GCPG is a reference guide for the health care compliance community and other health care stakeholders and provides information about relevant Federal laws, compliance program infrastructure, OIG resources, and other information useful to understanding health care compliance. The result? a day for orphans, but $2.75

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Healthcare Law Blog

JANUARY 11, 2023

Morgan Healthcare Conference, you would know that all three are waiting to see what the upcoming final rule on Medicare Advantage risk adjustment data validation (known as RADV) audits will mean for the industry when it drops in February. (Trying really hard not to start off with a “three health plans walk into a bar” joke…). to perhaps a 2.3

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

MAY 12, 2023

With regards to HIPAA and continuity of care in a single healthcare setting – or within an Organized Health Care Arrangement – the Privacy Rule allows disclosures of Protected Health Information (PHI) for healthcare operations without patient consent or authorization. 42 CFR Part 2).

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HIPAA Compliance Health Services Administration Medicare 67

Redox

DECEMBER 4, 2020

Those challenges can be broken down into two general categories: How do we get it to everyone? Lisa Bari (she/her/hers) @lisabariMore accurate information about the number of distinct IIS in the US: Kate Ricker-Kiefert @k8kiefert@lisabari 64 IIS is for 50 states, 1 district, 8 territories, and 5 city local IIdNovember 17th 2020 2 Likes.

Public Health 52

Public Health Governance Doctors Medicare 52

Hall Render

MARCH 25, 2022

Alabama lawmaker’s push to extend postpartum Medicaid coverage. $12 Florida Medicaid hits Sunshine Health with $9M sanction for not paying providers’ claims. increase for 2023 Medicaid budget. At MS strike, Medicare call center workers demand paid sick leave, better health care. MISSISSIPPI.

COVID-19 40

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

HIPAA Journal

JANUARY 2, 2023

Texas Department of Aging and Disability Services – $1,600,000 penalty for risk analysis failures, access control failures, and information system monitoring failures. Impermissible Disclosures of Protected Health Information. Removing protected health information from a healthcare facility places that information at risk of exposure.

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HIPAA Compliance Hospitals Medicare 109

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Health Equity in Medicare Advantage.

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Medicare Medicare Medicaid Medicaid 52

Health Law Advisor

AUGUST 10, 2023

2] Implementing the 21st Century Cures Act from 2016, regulated CDS software includes that intended to “analyze” “medical information about a patient or other medical information” “for the purpose of supporting or providing recommendations to a healthcare professional about prevention, diagnosis, or treatment of a disease or condition.”

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FDA Licensing Hospitals Medicaid 98

HIPAA Journal

JANUARY 9, 2023

The HIPAA Privacy and Security Rules were introduced which limited uses and disclosures of protected health information, gave patients new rights over their healthcare data, and introduced a set of minimum security standards. Encouragement of information sharing for treatment and care coordination.

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HIPAA COVID-19 COVID-19 Vaccine Compliance 111

Health Law Advisor

JULY 21, 2023

On June 22, 2023, the Centers for Medicare & Medicaid Services (CMS) announced its proposed “Transitional Coverage for Technologies” (TCET) pathway—the Biden administration’s highly anticipated take on a mechanism to expedite coverage for certain devices designated by the U.S.

FDA 52

FDA Medicare Medicare Patient Advocacy 52

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

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Prescription Drug Pricing COVID-19 Medicaid Medicaid 78

Health Populi

AUGUST 16, 2021

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. In person, on the phone or online, quality health care is wherever you are,” their website informs us. for 2-day delivery).

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COVID-19 Nurses Doctors Medicaid 132

Health Populi

DECEMBER 25, 2018

This bill would create a government-run drug company to produce and distribute generic medicines. More people have come to realize that personal information shared online isn’t seen by “just” friends and family, and can be scraped and re-purposed by third parties.

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Health Insurance Hospitals Doctors Medicaid 106

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 52

US Department of Health and Human Services FDA Medicare Medicare 52

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!

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US Department of Health and Human Services Medicare Medicare FDA 52