Center for Health Insurance Reform

JULY 26, 2023

Last month, the Centers for Medicare & Medicaid Services (CMS) held the first ever CMS Health Equity Conference. CHIR members who attended the inaugural conference provide an overview of the meeting—including a presentation by CHIR’s Christine Monahan—and its implications for current and future health equity initiatives.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

The Health Law Firm

SEPTEMBER 24, 2013

Leider with The Health Law Firm will be giving a presentation on Thursday, September 26, 2013, to the members of the Medical Office Resources of Florida (MOROF) and attending health care providers. This presentation is called, “Medicare and Medicaid Audits: Ready or Not, Here They Come.” Brown and Lance O.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

Healthcare It News

OCTOBER 27, 2023

In previous years, the USDA has funded food equity programs through Medicare and Medicaid. She reported positive results for diabetes sufferers from a study involving Instacart delivery of curated boxes of produce prescriptions to Medicaid population diabetic or pre-diabetic individuals for six months.

Medicaid 233

Medicaid Medicaid World Health Health Outcomes 233

Compliance Now

MAY 5, 2022

The Centers for Medicare and Medicaid Services recently opened the much-anticipated federal Independent Dispute Resolution (IDR) Portal , a component of the No Surprises Act section of the Consolidated Appropriations Act of 2021 (the Act). By: Jessica Waltman, Principal, Forward Health Consulting.

Medicaid 189

Medicaid Medicaid Medicare Medicare 189

Jackson Lewis

DECEMBER 16, 2021

On December 15, 2021, the Fifth Circuit Court of Appeals granted, in part, the federal administration’s motion to stay the nationwide preliminary injunction enjoining the Centers for Medicare and Medicaid (“CMS”) from enforcing its COVID-19 vaccine mandate nationwide as to non-plaintiff states. Louisiana et al v. Becerra et al. ,

COVID-19 Vaccine 40

COVID-19 Vaccine COVID-19 Medicaid Medicaid 40

MedTrainer

SEPTEMBER 20, 2023

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. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Accreditation.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

Healthcare IT News - Telehealth

APRIL 10, 2020

The Centers for Medicare and Medicaid Services has temporarily suspended several regulations to enable hospitals, clinics and other providers to boost their front-line medical staff during the coronavirus pandemic.

Nurses 210

Nurses Medicare Medicare Licensing 210

Hall Render

OCTOBER 19, 2023

The Award of Merit is presented each year to an individual who has made noteworthy contributions to the health care field within Indiana. He has extensive experience in the development of Medicaid funding mechanisms and Medicaid disproportionate share payment programs.

Hospitals 40

Hospitals Medicaid Medicaid 40

Bill of Health

APRIL 11, 2022

However, COVID has presented a new and more formidable challenge. The highest scores on the Index tended to cluster in states in the South and West that have not accepted the Medicaid expansion under the Affordable Care Act. For patients in poorer rural areas, the risk of hospital closures presents an especially serious threat.

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Hospitals Medicaid Medicaid Public Health 226

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

Medisys Compliance

APRIL 25, 2024

MIPS focuses on four key performance categories: Quality: This measures the quality of care you provide to your patients based on specific metrics established by the Centers for Medicare & Medicaid Services (CMS). Reporting accurate data for cardiology-specific quality measures is crucial.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medicare Medicare 64

Bill of Health

MARCH 27, 2024

Looking at how the current system works, including presently available psychedelic therapies, can help to inform coverage policies moving forward. Luckily, many insurers do— Cigna , Aetna , Blue Cross Blue Shield , United Healthcare , Medicaid , and Medicare all provide coverage.

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FDA Medicare Medicare Health Insurance 201

HIT Consultant

MAY 2, 2023

For decades, the industry lacked a patient-centric approach focused on efficiency, reliability, and accessibility for all populations, especially those enrolled in Medicare Advantage and Medicaid plans. In a recent study , 21% of U.S. adults without access to a vehicle or public transportation skipped needed medical care last year.

Medicaid 96

Medicaid Medicaid Medicare Medicare 96

Symplr

SEPTEMBER 1, 2022

At the same time, medical staff leaders must frequently perform quality reviews to enable providers to keep or update their clinical privileges and to participate on Medicare/Medicaid panels. As a result, physician quality review is one process that can present hospitals with a prime opportunity for optimization and cost-cutting.

Hospitals 52

Hospitals Medicaid Medicaid Medicare 52

HIPAA Journal

OCTOBER 10, 2022

According to the breach notice, a presentation was emailed to the DHS Children’s Long-Term Support Council in April 2021 that contained protected health information. Steps were also taken to recover all distributed copies of the presentation.

Medicaid 55

Medicaid Medicaid Governance Fraud 55

Healthcare IT News - Telehealth

MARCH 2, 2023

"We found that patients covered by Medicaid and Medicare had the highest in-person follow-up rates," they said. High rates of in-person follow-up were present only in specialties that require hands-on care, such as obstetrics and surgery.

Doctors 148

Doctors Telemedicine Medicaid Medicaid 148

Medisys Compliance

APRIL 11, 2024

The Centers for Medicare & Medicaid Services (CMS) website offers a comprehensive guide, including FAQs, enrollment instructions, and billing manuals specifically tailored for MFTs and MHCs. Benefits and Potential Challenges Direct billing presents several advantages for MFTs and MHCs.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Healthcare IT News - Telehealth

JUNE 28, 2021

" VanLandingham, who is senior counselor, Medicaid Policy/Acting Health IT at the agency, will be presenting at HIMSS21 this summer, HHS-OIG colleague, Assistant Inspector General for Legal Affairs Lisa Re. Overall, she says she hopes attendees leave their presentation with a sense of what compliance requires.

US Department of Health and Human Services 187

US Department of Health and Human Services Fraud Compliance Medicaid 187

Bill of Health

FEBRUARY 10, 2023

That is why the ACA’s Medicaid expansion doesn’t exist in 11 states , why the penalties for failing to have insurance under the “individual mandate” has been set to $0.00. After initial disputes and over time, they will gain followers if such requirements are presented as morally required.

Public Health 261

Public Health Health Care Reform ACA COVID-19 261

HIT Consultant

JUNE 30, 2022

It presents the latest research, policies, and funding opportunities to help strengthen social determinants of health initiatives and offers educational events, such as discussions on using Medicaid benefits to address beneficiaries’ housing needs. The center will encourage and empower other stakeholders to support SDOH initiatives.

Medicaid 98

Medicaid Medicaid Health Outcomes 98

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 With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

AIHC

APRIL 18, 2022

Written by: Thomas "Trent" Jackson, BS, CCRS Medicare bad debts present Medicare Part A providers an opportunity to recover reimbursement dollars they otherwise would have missed. The account can be added to the Medicare bad debt log upon receipt of the Medicaid program’s remittance advice.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Healthcare IT News - Telehealth

AUGUST 12, 2021

But what they do have in common, said two legislators who co-presented at a HIMSS21 session on Thursday, is a telehealth strategy that proved to be wildly popular among residents during the COVID-19 pandemic. Florida and Rhode Island aren't all that similar when it comes to population size or state politics.

Telemedicine 151

Telemedicine COVID-19 Medicaid Medicaid 151

Healthcare IT Today

JANUARY 5, 2024

The proceeds from the financing will support PursueCare’s ongoing collaborative care initiatives with health systems across 11 states, as well as expansion into value-based care with Medicaid managed care and other health plans. The app-based digital therapeutics are the only FDA-authorized app-based treatments for SUD and OUD, respectively.

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FDA Medicaid Medicaid Hospitals 94

Medval Compliance Blog

FEBRUARY 8, 2022

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that it will be hosting a Workers’ Compensation Medicare Set-Aside (WCMSA) webinar next Thursday, February 17, 2022 at 1:00 pm ET. The presentation will be followed by a live question and answer session with representatives from CMS.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare It News

JANUARY 18, 2022

Social determinants of health are major contributors to health inequity and rising healthcare costs in vulnerable populations such as Medicaid beneficiaries. For example, training a predictive model on the general population may be inaccurate when used in a Medicare or Medicaid population. Twitter: @SiwickiHealthIT.

Health Outcomes 344

Health Outcomes Medicaid Medicaid Patient Satisfaction 344

Provider Trust

SEPTEMBER 12, 2022

In 2006, New York’s Office of the Medicaid Inspector General (OMIG) was established as an independent office within New York State’s Department of Health to combat fraud and abuse in New York State’s Medicaid program. No payments will be for medical care, services and supplies furnished, prescribed, or ordered by an excluded party.

Medicaid 52

Medicaid Medicaid Fraud Licensing 52

Med-Net Compliance

JULY 20, 2022

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Specifically, between January 2014 and February 2018, the doctor billed Medicare and Medicaid approximately $585,000 and was paid approximately $191,000.

Fraud 59

Fraud Doctors Medicare Medicare 59

HIT Consultant

APRIL 17, 2024

The Centers for Medicare & Medicaid Services (CMS) estimates a staggering $4.7 Improved Workflow: Bypassing manual processes, the module automates tasks, presenting auditors with all relevant data points linked directly to the corresponding medical records.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

MAY 7, 2024

After receiving a completed application, the company performs primary source verification before presenting the request for participation to the credentialing committee. Here is a list of the information you’ll need to gather for UnitedHealthcare credentialing: Training and Education Practitioner degree (M.D.,

Malpractice 52

Malpractice Licensing Medicaid Medicaid 52

Health Populi

JUNE 18, 2021

Gallup and West Health presented their study in a webinar earlier this week; in today’s post, I feature a few key data points that particularly resonate as I celebrate/appreciate yesterday’s U.S. Compared with people enrolled in Medicaid, members of private insurance plans were more likely to have medical debt. households.

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ACA Health Insurance Medicaid Medicaid 133

Compliancy Group

FEBRUARY 28, 2024

Within the US Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing and administering various healthcare programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). These audits should occur once per year.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

C&M Health Law

FEBRUARY 6, 2023

But it refused to speculate on a situation that had not been presented. Finally, in a policy that became effective on January 1, 2023, Pennsylvania issued guidance that appears to eliminate Medicaid reimbursement for 340B covered drugs dispensed by contract pharmacies. That guidance can be found here: MAB2022122201.pdf pdf (pa.gov).

Medicaid 52

Medicaid Medicaid Governance 52

Healthcare IT News - Telehealth

MARCH 30, 2022

With the temporary flexibilities from HHS and the Centers for Medicare and Medicaid Services, as well as the impact of the pandemic on telehealth use, we really wanted to kind of do a deep dive and to see, "OK, how many beneficiaries are using telehealth? Was there anything that surprised you in the report?

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Medicare Medicare US Department of Health and Human Services COVID-19 133

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

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Fraud Compliance Medicaid Medicaid 98

Medval Compliance Blog

MARCH 18, 2022

The Centers for Medicare & Medicaid Services (CMS) will be hosting an overview of the new “Go Paperless” feature available in the Medicare Secondary Payer Recovery Portal (MSPRP) on Thursday, April 13 at 1:00 pm ET. The webinar will feature opening remarks and a presentation, followed by a question and answer session.

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Medicare Medicare Medicaid Medicaid 52