Healthcare Law Blog

JANUARY 17, 2024

workflow and performance assessment, data analytics, and certain Medicare eligibility and performance assistance). On December 28, 2023, the Office of Inspector General (the “OIG”) issued a favorable Advisory Opinion (No. The OIG explained that the Requestor provides consulting services for practice optimization to physician practices (i.e.,

Medicare 52

Medicare Medicare Payment Systems Compliance 52

Medisys Compliance

FEBRUARY 9, 2024

Staying informed about new and revised CPT codes is essential for accurate coding and billing of wound care services. Hospital Outpatient Prospective Payment System (OPPS) Updates OPPS is a payment system used by Medicare to reimburse hospitals for outpatient services, including some wound care procedures.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Payment Systems Medical Billing Medicare 59

Medisys Compliance

APRIL 11, 2024

Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can now directly bill Medicare for services they furnish and diagnose. This milestone represents a major victory for the mental health professions, expanding access to much-needed care for Medicare beneficiaries and offering exciting new possibilities for MFTs and MHCs.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Medisys Compliance

NOVEMBER 21, 2023

With Medicare Part A serving as a primary payer for many residents, understanding the intricate landscape of SNF billing is crucial to ensure proper reimbursement and compliance. Know the SNF Billing Requirements SNFs bill Medicare Part A using Form CMS-1450 (UB-04) or its electronic equivalent.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medicare Medicare Medical Billing 59

MRO Compliance

OCTOBER 23, 2023

This transformation aims to enhance patient care quality and better align ACO reporting with the Quality Payment Program (QPP) Merit-Based Incentive Payment System (MIPS). These organizations received concessions from CMS to serve as early adopters and test the system. But other ACOs are only just getting started.

Payment Systems 130

Payment Systems Medicare Medicare 130

Hall Render

APRIL 12, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Background Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Medisys Compliance

AUGUST 4, 2022

Proposed ESRD Payment System. This rule also proposes an update to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year (CY) 2023. We can assist you in receiving accurate and timely Medicare reimbursement for delivered services.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Payment Systems Medicare 59

Hall Render

APRIL 4, 2024

The Requestor’s services further include offering physician practices training related to the Medicare Merit-Based Incentive Payment System (“MIPS”), which could result in higher Medicare reimbursement to the Requestor’s clients. Hall Render blog posts and articles are intended for informational purposes only.

Payment Systems 40

Payment Systems Medicare Medicare Fraud 40

Compliancy Group

OCTOBER 5, 2023

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law to improve patient healthcare outcomes. Under MACRA, the Centers for Medicare and Medicaid Services (CMS) created regulations to encourage healthcare providers to use secure health information technology. What Are the MIPS Rules for 2023?

HIPAA 52

HIPAA Medicare Medicare Compliance 52

Healthcare IT Today

OCTOBER 4, 2022

Effective Health Information Exchange (HIE) requires a secure and reliable Health Information Service Provider (HISP) infrastructure to provide HIPAA-compliant delivery of healthcare information. She shares several popular and impactful use cases, including how they’re looking at provider and payer collaboration.

Payment Systems 97

Payment Systems HIPAA Medicare Medicare 97

HIT Consultant

NOVEMBER 2, 2021

In 2010, the Affordable Care Act ushered in a new era for Medicaid Modularity, an approach anchored by breaking down large, monolith systems into smaller, more nimble and self-contained modules that can de-risk healthcare delivery and unlock innovation. Prior to SAS, he was the Chief Information Officer of Arkansas Medicaid.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

AUGUST 1, 2022

The proposed payment policies include an initial monthly facility fee of approximately $268,000 per month, which will adjust in future years based on a market-basket update. REHs would also get a 5 percent add-on to most outpatient payments. More information on the proposed CoPs is included in our prior alert available here.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Healthcare IT Today

NOVEMBER 15, 2023

The technique involves finding data from public sources such as Centers for Medicare & Medicaid Services (CMS). Jackleen Samuel, president and CEO, says that they analyze patient demographics, clinical information, and process indicators such as medication compliance and service utilization. offering in-home treatment.

Medicare 112

Medicare Medicare Hospitals Compliance 112

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

CMS.gov

OCTOBER 2, 2018

Modernizing Medicare to Take Advantage of the Latest Technologies. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. However, while medical technology is developing at a rapid pace, Medicare’s payment systems haven’t always been as quick to change.

Medicare 44

Medicare Medicare Payment Systems FDA 44

Healthcare IT Today

JUNE 29, 2023

Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid. ASCs must also meet Medicare’s Conditions for Coverage. Medicare Payment Resources CMS implemented an Ambulatory Payment Classification-based payment methodology in 2008.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

MedTrainer

JANUARY 12, 2024

Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance efforts shifted toward protecting patient information. Compliance now involves reporting quality data and participating in payment models that incentivize better care.

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Hall Render

JULY 7, 2022

The Consolidated Appropriations Act, 2021 (the “Act”) signed into law on December 27, 2020, created a new Medicare provider type called a Rural Emergency Hospital (“REH”). The Proposed Rule did not contain the details of the payment policies for REHs, which CMS will develop in separate notice and comment rulemaking.

Hospitals 70

Hospitals Payment Systems Medicare Medicare 70

Hall Render

AUGUST 10, 2023

In doing so, CMS will finalize changes to its rural floor wage index policy that can drastically change payments for certain hospitals and its extension of the wage index add-on for low-wage hospitals. CMS also uses the hospital wage index for the Outpatient Prospective Payment System. percentage points.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

Healthcare IT Today

NOVEMBER 12, 2023

Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job. Houston’s Baylor College of Medicine chose Luna for in-home outpatient physical therapy.

Payment Systems 115

Payment Systems Public Health Medicare Medicare 115

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

Hall Render

AUGUST 11, 2023

On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year (“FY”) 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

Hall Render

MARCH 1, 2023

Following this reporting, impacted providers and teaching hospitals will have until May 15, 2023, to review reported payments and investments and to dispute any incorrect reports. During the Dispute Period, Covered Recipients may use CMS’ Open Payments system to formally dispute any information they believe is incorrect.

Hospitals 40

Hospitals Payment Systems Nurses Medical Device Industry 40

Verisys

JUNE 13, 2023

Centers for Medicare & Medicaid Services : The US Department of Health and Human Services has issued a final rule update concerning guidelines for COVID-19 vaccination requirements for Long-Term Care Facilities (LTC) and Intermediate Care for Individuals with Intellectual Disabilities (ICFs-IID). The information is fluid and evolving.

COVID-19 Vaccine 52

COVID-19 Vaccine US Department of Health and Human Services COVID-19 Licensing 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

C&M Health Law

DECEMBER 23, 2022

The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). ii) Prior authorization information would be included via the Patient Access API. Patient Access API.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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. healthcare system were exorbitant. These different Acts initiated the testing of alternate forms of delivering care and payment methodologies.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Compliancy Group

NOVEMBER 16, 2022

In 2015, legislation known as the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted. healthcare system since 2010’s Affordable Care Act. Under MACRA, the Centers for Medicare and Medicaid Services created regulations for healthcare providers’ use of health information technology.

Medicare 52

Medicare Medicare HIPAA Medicaid 52

Medisys Compliance

JUNE 16, 2022

Medicare’s 3-day (or 1-day) payment window applies to outpatient services that hospitals and hospital wholly owned or wholly operated Part B entities furnish to Medicare beneficiaries. If the admitting hospital is a Critical Access Hospitals (CAHs), the payment window policy doesn’t apply.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Hospitals Medicare 52

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. healthcare system were exorbitant. These different Acts initiated the testing of alternate forms of delivering care and payment methodologies.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

JULY 12, 2022

Under the voluntary EOM model, Physician Group Practices (“PGPs”) will be accountable for their patients’ health care quality and total spend during six-month episodes of care for Medicare patients with breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma and prostate cancer.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Health Populi

FEBRUARY 29, 2024

Privacy and scalability, where assuring the security of health citizens’ protected health information (PHI) must be designed into HaH programs. ” Thus the call for value-based payment which can, when well-designed, align the four stakeholders’ interests.

Hospitals 126

Hospitals COVID-19 Payment Systems HIPAA 126

Hall Render

SEPTEMBER 2, 2022

On July 26, 2022, the Centers for Medicaid and Medicare (“CMS”) published the 2023 Hospital Outpatient Prospective Payment System (OOPS) and Ambulatory Surgery Center Payment System Proposed Rule. One notable difference, however, is that the entity must enroll in Medicare as an REH. Background.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

Hall Render

APRIL 18, 2023

Background The Medicare Hospital Inpatient Prospective Payment System (“IPPS”) is designed to pay hospitals for services provided to Medicare beneficiaries based on a national standardized amount adjusted for the patient’s condition and related treatment.

Medicare 40

Medicare Medicare Hospitals Payment Systems 40

Hall Render

MAY 30, 2023

On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Medicare 40

CMS.gov

NOVEMBER 27, 2018

Administrator of the Centers for Medicare & Medicaid Services. We must do something about rising cost, and a key pillar is to empower patients with the information they need to drive cost and quality by making our health care system evolve to one that competes for patients. You Have the Right to Know the Price. Jeremy.Booth@c….

Medicare 48

Medicare Medicare Payment Systems Medicaid 48