HIT Consultant

NOVEMBER 7, 2022

Frequent virtual medical triage significantly reduces the likelihood that patients will be sent to the hospital, which is often costly for insurance providers. It provides a mark of distinction for healthcare and demonstrates the company’s commitment to quality, which means improved patient health outcomes.

Health Insurance 98

Health Insurance Compliance Officers Health Outcomes Compliance 98

HIPAA Journal

FEBRUARY 15, 2022

Chicago’s South Shore Hospital has started notifying 115,670 current and former patients about a December 2021 cyberattack on its network. South Shore Hospital engaged a team of third-party computer forensics experts to investigate the security breach and determine whether patient information was accessed or stolen.

Hospitals 112

Hospitals Health Insurance HIPAA Medicaid 112

HIPAA Journal

JUNE 28, 2023

Good Samaritan Hospital in San Jose, CA, has agreed to settle a class action lawsuit that was filed in response to a data breach that exposed the protected health information of up to 233,835 individuals. The post Good Samaritan Hospital Settles Class Action Data Breach Lawsuit appeared first on HIPAA Journal.

Hospitals 75

Hospitals Fraud Licensing HIPAA 75

Health Law RX

FEBRUARY 21, 2024

The Centers for Medicare & Medicaid Services (CMS) has revised certain payment policies under the Medicare physician fee schedule, and updated provider and supplier enrollment regulations. CMS recently published a final rule (the Final Rule ) effective January 1, 2024. The stay ends on or before the 60th day of the stay period. “A

Medicare 52

Medicare Medicare Licensing Compliance 52

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. privately-insured people.

COVID-19 145

COVID-19 Hospitals Health Insurance Medicare 145

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report.

Medicare 52

Medicare Medicare Licensing Health Insurance 52

Bill of Health

JANUARY 26, 2022

In other words, both convicted individuals and those still presumed innocent are stripped of their access to the federal health insurance program for low-income individuals. Gamble (1976), affirmed that incarcerated individuals have the constitutional right to health care. The Supreme Court’s ruling in Estelle v.

Medicaid 293

Medicaid Medicaid COVID-19 Public Health 293

Jane Sarashon

FEBRUARY 27, 2024

NABIP, whose members represent professionals in the health insurance benefits industry, drafted and adopted a new American Healthcare Consumer Bill of Rights launched at the meeting. Health Populi’s Hot Points: Is there an American Civil Right for health care?

ACA 113

ACA Prescription Drug Pricing Health Insurance Hospitals 113

Center for Health Insurance Reform

SEPTEMBER 15, 2023

As summer was winding down, CHIR was reading up on the latest health policy research. In August, we read about differences between Medicare Advantage and commercial plans’ negotiated hospital prices, the affordability of employer-sponsored insurance for older adults, and the expected growth of 2024 Affordable Care Act Marketplace premiums.

Medicare 97

Medicare Medicare Hospitals Health Insurance 97

Center for Health Insurance Reform

FEBRUARY 10, 2022

Continue reading → The post January Research Roundup: What We’re Reading appeared first on Center on Health Insurance Reforms.

Health Insurance 98

Health Insurance Medicare Medicare ACA 98

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 143

Medicare Medicare Doctors Fraud 143

Healthcare IT Today

DECEMBER 17, 2023

News In a blog post, ONC highlighted trends in patient access to electronic health information. Nearly all (97%) hospitals and roughly almost two-thirds (65%) of physician practices are now capable of enabling patient access. Missouri-based Phelps Health chose KeyCare to support virtual care delivery through MyChart.

Hospitals 92

Hospitals Nurses Compliance Regulatory Compliance 92

MRO Compliance

NOVEMBER 13, 2023

Morrell brings with her more than 25 years of government affairs experience covering both state and federal rulemaking tied to Medicare, Medicaid, commercial insurance and health IT. Morrell spent over a decade at Health Net, Inc. . – November 13 , 2023 – MRO Corp., as the vice president for government relations.

Governance 124

Governance Health Insurance Medicaid Medicaid 124

Health Populi

JUNE 18, 2021

with employer-sponsored health insurance worry that a major health event in their household could lead to bankruptcy, according to research gathered by West Health and Gallup in Business Speaks: The Future of Employer-Sponsored Insurance. Health Populi’s Hot Points: U.S. One-half of U.S.

ACA 133

ACA Health Insurance Medicaid Medicaid 133

Bill of Health

OCTOBER 26, 2022

In the post- Dobbs fight to safeguard reproductive healthcare, a new spotlight has been placed on two existing federal laws: the Health Insurance Portability and Accountability Act (HIPAA) and the Emergency Medical Treatment and Active Labor Act (EMTALA). . By Katie Gu. The Guidances. In June 2022, the U.S. CMS EMTALA Guidance .

HIPAA 184

HIPAA Medicare Medicare Medicaid 184

Verisys

JANUARY 19, 2022

By outsourcing medical credentialing, hospitals can significantly reduce their costs. According to recent surveys of major metropolitan hospitals , departments that typically share the responsibility for credentialing include: The Compliance Office. million dollars for an average-sized hospital. Human Resources.

US Department of Health and Human Services 52

US Department of Health and Human Services Hospitals Malpractice Compliance Officers 52

Jane Sarashon

FEBRUARY 4, 2024

Furthermore, health plan members now see themselves as medical bill payers, seeking value and consumer-level services for their health insurance premium investment. According to the online Merriam-Webster dictionary , the first use of the phrase “health insurance” occurred in 1901. Retail health-meets-Medicare.

US Department of Health and Human Services 70

US Department of Health and Human Services Health Insurance Medicare Medicare 70

Health Populi

AUGUST 21, 2019

There are over 60 million enrollees in Medicare in 2019, and fully one-third are in Medicare Advantage plans. Medicare is adding 10,000 new beneficiaries every day in the U.S. Medicare Advantage enrollment is fast-growing, shown in the first chart where over 22 million people were in MA plans in January 2019.

Medicare 81

Medicare Medicare Health Outcomes HIPAA 81

Health Populi

MAY 21, 2020

Patients’ concerns of COVID-19 risks have led them to self-ration care in the following ways: 41% have delayed health care services. 42% felt uncomfortable going to a hospital for any medical treatment. Nearly every respondent in the study reported having health insurance coverage. ACHP and AMCP polled 1,263 U.S.

COVID-19 159

COVID-19 Doctors Health Insurance Medicare 159

MedTrainer

JANUARY 30, 2024

Compliance is Mandatory for Federal Programs One constant is that organizations and facilities that participate in federal healthcare programs, such as Medicare and Medicaid, must have a compliance program. Laboratories: Clinical laboratories that perform tests covered by Medicare or Medicaid.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

Hall Render

MARCH 20, 2024

The Final Rule also imposes additional reporting requirements under the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals and for eligible clinicians reporting under the Promoting Interoperability performance category of the Merit-Based Incentive Payment System.

Medicare 40

Medicare Medicare Health Insurance Medicaid 40

Bill of Health

FEBRUARY 28, 2024

Medically tailored meals have been associated with lower hospital admissions. It will also be essential to develop strategies to minimize barriers, such as health insurance and access to the health care system. Patients can access medically tailored meals through a referral from a medical professional.

Health Insurance 230

Health Insurance Medicaid Medicaid Health Care Reform 230

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

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). Health plans: Insurance companies, HMOs, Medicare, Medicaid, and other health insurance providers.

HIPAA 52

HIPAA Compliance Health Insurance Hospitals 52

HIPAA Journal

JULY 28, 2023

The HHS’ Centers for Medicare and Medicaid Services (CMS) is being urged not to implement the proposed standards for prior authorization attachments, as detailed in its December 2022 Notice of Proposed Rulemaking (NPR).

HIPAA 83

HIPAA Health Insurance Medicaid Medicaid 83

Compliancy Group

MARCH 19, 2024

Hospitals and private practices aren’t the only enterprises with compliance obligations within this sector. Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations. No other industry in the U.S.

Regulatory Compliance 52

Regulatory Compliance Compliance US Department of Health and Human Services ACA 52

Hall Render

AUGUST 10, 2023

On August 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its Final Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) PPS rule for fiscal year (“FY”) 2024 (“Final Rule”). The Final Rule increases the rate for IPPS payments by 3.3%

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

HIPAA Journal

MARCH 3, 2022

Mon Health said the incident also affected its affiliated hospitals: Monongalia County General Hospital Company, Stonewall Jackson Memorial Hospital Company, and Preston Memorial Hospital Corporation.

Health Insurance 80

Health Insurance Hospitals HIPAA Medicare 80

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 Managed care now covers more than half of Medicare enrollees and over 80% of Medicaid enrollees.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

HIPAA Journal

OCTOBER 6, 2022

The information potentially accessed and stolen included names, addresses, birth dates, Social Security numbers, Medicare claim numbers, patient account numbers, health insurance information, medical record numbers, dates of service, provider names, claims information, and medical and clinical treatment information.

HIPAA 89

HIPAA Fraud Hospitals Health Insurance 89

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 Care Law Brief

FEBRUARY 2, 2024

The Waiver Amendment was approved on January 9, 2024, by the Centers for Medicare & Medicaid Services (“CMS”) under Section 1115(a) of the Social Security Act and will expire on March 31, 2027. billion in Medicaid investments over the next three years. CMS has authorized up to $2.2 CMS has authorized up to $2.2

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

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

HIPAA Journal

AUGUST 14, 2023

Last month, Johns Hopkins Health System announced it was investigating a cyberattack and data breach, which was reported to the HHS’ Office for Civil Rights by Johns Hopkins Health System and Howard County General Hospital as affecting more than 5,500 individuals.

Medicaid 75

Medicaid Medicaid HIPAA Health Insurance 75

HIT Consultant

JUNE 12, 2022

adults with private health insurance have received an unexpected medical bill, and of those, one in three were not able to pay the bill with money immediately available to them. For example, a patient could be treated by an anesthesiologist or radiologist that is not covered by their insurer in a hospital that is within their network.

Medical Billing 98

Medical Billing Medicare Medicare Health Insurance 98

MedTrainer

MAY 7, 2024

Benefits of Enrolling Your Providers With UnitedHealthcare Here are some key advantages of becoming an in-network provider with UnitedHealthcare: Expanded Revenue Opportunities: UnitedHealthcare is the 4th largest health insurer in the U.S.,

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52