Healthcare Law Blog

JANUARY 9, 2024

At the first day of the J.P. Morgan Healthcare Conference, “[T]he answer to the ultimate question of life, the universe and everything is 42.” Recognize that famous line? No, it’s not something from ChatGPT, it’s Douglas Adams’ “The Hitchhiker’s Guide to the Galaxy of Healthcare.” But, AI was not mentioned only by NVIDIA.

Medicare 59

Medicare Medicare Hospitals Doctors 59

HIT Consultant

NOVEMBER 28, 2022

On July 1, 2021, the Centers for Medicare and Medicaid (CMS) issued its “Interim Final Rule on Requirements Related to Surprise Billing; Part I,” aka the No Surprises Act implementing regulations. The same applies to an out-of-network pathologist who was involved in planned surgery performed at an in-network hospital.

Doctors 97

Doctors Medicaid Medicaid Medicare 97

Healthcare IT News - Telehealth

JULY 17, 2023

Commonwealth Care Alliance is a healthcare services organization that offers health plans and care delivery programs designed for individuals with significant needs. CCA specializes in managing complex care for individuals dually eligible for Medicare and Medicaid, as well as those who narrowly miss the threshold for Medicaid.

Telemedicine 107

Telemedicine Medicaid Medicaid COVID-19 107

Innovaare Compliance

JANUARY 19, 2021

It has become evident by changes to the Centers for Medicare & Medicaid Services (CMS) Star Rating formulas over the past several years—and especially with changes implemented for the 2021 Plan Year—that member experience and medication adherence is of utmost importance to the CMS. Medicare Star Ratings 2021 Changes.

Medicare 52

Medicare Medicare COVID-19 Compliance 52

Medisys Compliance

JULY 27, 2023

By addressing these concerns, we aim to showcase our expertise and demonstrate how our services can help healthcare providers streamline their billing processes, ensure compliance, and optimize reimbursement. If you have more specific or detailed questions, feel free to ask, and we’ll do our best to assist you.

Medical Billing 52

Medical Billing Medicaid Medicaid Telemedicine 52

Healthcare IT Today

FEBRUARY 15, 2024

Sarah Carroll, Senior Vice President, Center for Care Transformation at AVIA Health Medicaid and Medicare have become one of the biggest quiet crises in health systems today. US hospitals regularly lose $100B annually on Medicaid and Medicare patients but continue to chase higher-margin commercial patients to drive toward profitability.

Medical Device Industry 119

Medical Device Industry Medicaid Medicaid Nurses 119

Healthcare IT Today

OCTOBER 23, 2023

For example, as outpatient services such as infusions outpace projections , and as the Centers for Medicare & Medicaid Services open the door to more outpatient procedures by moving 11 procedures off its “inpatient only” list, ambulatory providers must have the financial strength to make the investments needed to support growth.

Medical Billing 106

Medical Billing Medicaid Medicaid Medicare 106

Innovaare Compliance

JUNE 7, 2021

As a Medicare Advantage health plan, one of the main objectives should be to improve CMS Star Ratings. Because the higher the ratings, the larger the bonus payments health plans receive from the government. Percent of the best possible score the plan earned, based on how quickly members get appointments and care.

Medicare 40

Medicare Medicare Governance 40

YouCompli

APRIL 5, 2023

How Compliance Can Leverage the OIG’s 7 Elements and HHS Roadmap With the end of the COVID-19 Public Health Emergency (PHE) coming in May, many healthcare compliance leaders are in the process of slowly returning their organizations to normal. Let’s revisit the seven elements and how they can help you shape the patient experience.

Compliance Officers 52

Compliance Officers COVID-19 Compliance COVID-19 Vaccine 52

HIT Consultant

AUGUST 28, 2023

Here is why AP processes are so critical to medical facility business success, how to tell when AP is stunting business growth and how to improve AP so that it becomes an enabler, rather than an inhibitor, of business effectiveness. At first glance, the answer to that question may seem to be a resounding “no.”

Payment Systems 103

Payment Systems Compliance Medicaid Medicaid 103

Healthcare IT Today

APRIL 10, 2023

Why don’t we do what we’re “supposed to do” when it comes to our health? Written by Matt Loper, Co-Founder and CEO at Wellth and originally posted on Wellth’s website. I’ve seen so much unnecessary pain caused simply because we often don’t do the things we know we “should”.

Health Outcomes 103

Health Outcomes Hospitals ACA Doctors 103

American Medical Compliance

FEBRUARY 23, 2023

The HIPAA Regulations and Cybersecurity Training for Dental Healthcare Personnel course educates employees and management on how to be compliant with the Health Insurance Portability and Accountability Act (HIPAA). Covered entities include healthcare providers, health plans, and others.

HIPAA 52

HIPAA Compliance Governance Health Insurance 52

YouCompli

OCTOBER 26, 2022

They’re busy seeing patients and doing the best they can to deliver care the best way they know how. The review found providers often did not meet the Medicare billing requirements – a whopping 83 of 200 were in error. Helping our clinical colleagues feel the urgency of compliance monitoring can be a huge challenge.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

HIPAA Journal

JANUARY 31, 2024

Little did we know how bad the situation would get in such a short space of time. Little did we know how bad the situation would get in such a short space of time. As the chart shows, healthcare security breaches are occurring twice as often as in 2017/2018, with two large healthcare data breaches reported each day on average in 2023.

Ransomware 122

Ransomware HIPAA Hospitals Compliance 122

Health Populi

OCTOBER 15, 2019

56% of people also want payment plan options. 56% of people also want payment plan options. Patients’ experiences with the health care industry fall short of their interactions with other industries — namely online retail, online banking and online travel, a new survey from Cedar, a payments company, learned.

Medical Billing 94

Medical Billing Doctors Medicare Medicare 94

AIHC

NOVEMBER 6, 2023

Combining the requirements of both Acts and implementing best practices will help mitigate risk suffering non-compliance consequences for violating the rules. Combining the requirements of both Acts and implementing best practices will help mitigate risk suffering non-compliance consequences for violating the rules. What is “HITECH”?

HIPAA 59

HIPAA Compliance Governance Health Insurance 59

Healthcare IT News - Telehealth

DECEMBER 16, 2020

” For this report, PwC’s Health Research Institute surveyed 2,511 American consumers, 128 health plan executives, 153 healthcare provider organization executives, and 124 pharmaceutical and life sciences executives in August and September 2020.

COVID-19 213

COVID-19 Hospitals Doctors Health Insurance 213

Provider Trust

APRIL 14, 2023

In this post, we’ll explore current challenges for credentialing teams and provide best practices to increase efficiency and protect time and revenue. After all, having the necessary credentials and licenses ensures provider network integrity and compliance, all while helping members receive safe, equitable, high-quality care.

Licensing 52

Licensing Compliance Malpractice Medicaid 52

AIHC

NOVEMBER 6, 2023

Combining the requirements of both Acts and implementing best practices will help mitigate risk suffering non-compliance consequences for violating the rules. Combining the requirements of both Acts and implementing best practices will help mitigate risk suffering non-compliance consequences for violating the rules. What is “HITECH”?

HIPAA 52

HIPAA Compliance Governance Health Insurance 52

HIT Consultant

FEBRUARY 7, 2022

Medicare and Medicaid have an obligation to taxpayers who are paying into the system to help as many people as possible. Medicare and Medicaid have an obligation to taxpayers who are paying into the system to help as many people as possible. John Sargent | Founding Partner, BroadReach Group.

Doctors 98

Doctors Health Outcomes COVID-19 Health Insurance 98

Healthcare Law Blog

MARCH 8, 2023

For example, ChatGPT may help patients with chronic diseases by providing reminders of the need to schedule routine screenings, fill prescriptions, assist with other wellness matters such as monitoring steps taken, heart rates and sleep schedules, and customizing nutrition plans. 24/7 Medical Assistance According to the U.S.

HIPAA 52

HIPAA Licensing Compliance Health Insurance 52

Healthcare Law Blog

NOVEMBER 21, 2022

22-19 (the “Advisory Opinion”), which declared that a charitable organization funded by manufacturers would violate the AKS if it offered certain cost-sharing subsidies under Medicare Part D (“Part D”), even if the organization was independently run and patients had equal access to discounts for 90% of drugs on the market. Background.

Medicare 52

Medicare Medicare Governance Medicaid 52

Bill of Health

FEBRUARY 8, 2024

The article here explores how the complexities of the tax code are intertwined with American health care. The primary reason someone might choose to utilize an FSA is that FSA contributions don’t have employment or federal income taxes deducted. Tax-Advantaged Accounts FSAs What are FSAs and HSAs?

Doctors 111

Doctors Medicare Medicare Public Health 111

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Enrollee Participation in Plan Governance (§ 422.107).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

HIT Consultant

AUGUST 26, 2022

What You Should Know: – Digital senior care navigator Fair Square Medicare raises 15M in series A funding led by Define Ventures. Launched in 2020 out of YC, Fair Square Medicare is a digital health platform company that’s revolutionizing how seniors navigate their healthcare. Care Navigator for Seniors.

Medicare 97

Medicare Medicare Health Insurance 97

MedTrainer

AUGUST 30, 2023

What Are Types of Managed Care Plans? Depending on the structure of a managed care organization, it might offer any number of managed care plans. Some of the most common types of managed care plans include. POS plans combine features of HMOs and PPOs. Medicare Advantage (Part C). Point of Service (POS).

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Healthcare It News

JUNE 9, 2022

While investment dollars may be flowing into the sector, the overall focus of dollars toward primary care remains mediocre, at best. Others are choosing not to enter it in the first place. Primary care in the U.S. is at a unique inflection point. On one hand, the value of primary care physicians has never been higher.

US Department of Health and Human Services 252

US Department of Health and Human Services Nurses Health Outcomes Doctors 252

Hall Render

JANUARY 5, 2024

Wade; expected to remain big issue in 2024 races Most nursing home residents in Arizona still haven’t gotten their COVID-19 booster COVID-19 hospitalizations are up in Arizona and around the U.S.

COVID-19 40

COVID-19 Nursing Homes Nurses Hospitals 40

Verisys

MAY 9, 2023

But how do you achieve compliance goals when the healthcare industry and its regulations are ever-changing? This three-part compliance series aims to show how technology can help you achieve your compliance goals. There is no question that healthcare organizations should have an effective healthcare compliance program.

Compliance 52

Compliance Fraud Governance Licensing 52

YouCompli

AUGUST 16, 2023

We just need to work at it – which means focusing on how we communicate a compliance message of “do this” or “don’t do that.” So how do we do that? As compliance officers, we are continually placed in a position to influence the actions of others. That said, this perception can be overcome. Here are five strategies that may help: 1.

Compliance 52

Compliance HIPAA Medicare Medicare 52

Healthcare IT News - Telehealth

JUNE 4, 2021

When the COVID-19 pandemic struck the U.S. early last year, life slowed down, even ground to a halt in many circumstances. But for health IT, things sped up. When new technologies were needed to solve fast-moving healthcare challenges, hospitals and health systems could not afford to wait the time it normally took to stand up IT.

US Department of Health and Human Services 148

US Department of Health and Human Services COVID-19 Doctors Nurses 148

Hall Render

NOVEMBER 28, 2023

On November 1, 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 Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. 0.97110 1.0124 1.0012 0.9998 1.030 $2,038.13

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Provider Trust

NOVEMBER 8, 2022

In this Q&A, Clay discusses the urgent need for healthcare compliance monitoring, how he first began working with ProviderTrust, and what it means to lead yourself first. Q: What was your first introduction to ProviderTrust? I want to work with them.”. Q: What in particular made you want to work with them? That goes a long way.

Compliance 52

Compliance Medicaid Medicaid Medicare 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. Standard Contract Requirements/Coordination of Benefits.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Hall Render

OCTOBER 27, 2023

Ransomware attacks against hospitals put patients’ lives at risk, researchers say States, FTC continue to target noncompetes: 3 updates The best hospital in each state, per Newsweek What to know about Stark law’s $9.2M

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

Hall Render

OCTOBER 6, 2023

The CDC has stopped printing them Telehealth Visits Decline 46%, But Telebehavioral Healthcare Still High URAC to offer health equity accreditation Walgreens CIO is latest to leave in company’s C-suite shakeup AI is creating a complex landscape for healthcare executives ALABAMA Alabama hospital to remain on Cerner after sale Alabama gets $3.6M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

OCTOBER 6, 2023

The CDC has stopped printing them Telehealth Visits Decline 46%, But Telebehavioral Healthcare Still High URAC to offer health equity accreditation Walgreens CIO is latest to leave in company’s C-suite shakeup AI is creating a complex landscape for healthcare executives ALABAMA Alabama hospital to remain on Cerner after sale Alabama gets $3.6M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40