HIT Consultant

AUGUST 3, 2022

Medicaid reimbursement, which comprises the largest share of nursing home reimbursement, has not kept pace, resulting in SNFs and medical providers assuming the burden of those costs. . A Regulatory compliance and survey process both distract and often assault a beaten-up staff and push people out of service to the facilities.

Nursing Homes 98

Nursing Homes Nurses Medicaid Medicaid 98

Innovaare Compliance

APRIL 29, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. Multiple Medicare Advantage Prescription Drug Plans (MAPDs) have already received notification of their selection. CMS anticipates a total of 25 plan organizations to be audited in this cycle.

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Compliance 52

Healthcare Blog

APRIL 13, 2023

As hospitals have become increasingly complex organizations, effective governance, risk, and compliance (GRC) strategies have become essential for ensuring patient safety and regulatory compliance. Improve GRC in Your Facility GRC strategies are essential for ensuring hospital patient safety and regulatory compliance.

Compliance 40

Compliance Hospitals Governance Regulatory Compliance 40

MedTrainer

APRIL 20, 2023

Providers need a strong compliance program to inform the creation of compliance checklists. The Seven Core Compliance Program Requirements The Centers for Medicare & Medicaid Services (CMS) criteria promote an effective compliance program in healthcare organizations.

Compliance 52

Compliance Compliance Officers Regulatory Compliance Regulations Compliance 52

Medisys Compliance

APRIL 25, 2023

Need of Choosing Oncology Billing Company As an oncology practice, selecting the right billing company is a crucial decision that can significantly impact your financial success and regulatory compliance. This article will discuss key factors in choosing oncology billing company.

Regulatory Compliance 52

Regulatory Compliance Compliance ACA Health Insurance 52

Verisys

DECEMBER 22, 2021

Should a group health plan, insurer, or state agency find that time is running out on achieving regulatory compliance with H.R. As a product manager at the healthcare technology and services company Verisys , he guides many of the solutions that support health plans, health systems, and state Medicare and Medicaid agencies.

Compliance 52

Compliance Health Insurance Regulatory Compliance Healthcare information Technology 52

Innovaare Compliance

FEBRUARY 14, 2022

Operational teams—such as the Member Services Department and the Appeals & Grievances Department—have significant compliance regulations, so they must know to maintain compliance. This includes CMS regulations for Medicare Plans, regulations for Commercial Plans and Medicaid regulations for state plans.

Medicaid 52

Medicaid Medicaid Compliance Regulatory Compliance 52

Medisys Compliance

MAY 4, 2023

Regulatory compliance: Oncology practices must comply with various regulatory requirements, including HIPAA, CMS, and payer-specific guidelines. Compliance failures can result in penalties and fines. Insurance denials can be common, requiring appeals and resubmissions.

Medical Billing 52

Medical Billing Compliance Regulatory Compliance HIPAA 52

Healthcare Law Today

JANUARY 20, 2022

The entity is also prohibited from billing Medicare or, possibly, Medicaid for such referrals. Given the multiples at which these practices will trade, vetting critical legal issues is crucial to ensure buyers of legal and regulatory compliance and maintaining value for the prices to be paid.

Medicare 52

Medicare Medicare Compliance Medicaid 52

HIT Consultant

OCTOBER 4, 2021

The Centers for Medicare and Medicaid Services (CMS) strive for innovations in healthcare technologies that drive down costs and improve the patient experience. Bernard Harguindeguy, Chief Technology Officer & General Manager Intelligence Ping Identity. About Bernard Harguindeguy.

Regulatory Compliance 52

Regulatory Compliance Medicaid Medicaid HIPAA 52

Innovaare Compliance

NOVEMBER 4, 2021

Armed with this regulatory compliance information, you should be in a better position to create accurate universes that comply with the latest Medicare and Medicaid protocols. Inovaare has been providing healthcare organizations with quality services that help them comply to Medicare/Medicaid regulations since 2008.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Florida Health Care Law Firm

DECEMBER 2, 2021

The OIG clarified that using the SDP may mitigate potential exposure under Medicare and Medicaid 60-day reporting and returning requirements for overpayments. Any overpayment retained after this period may create liability under the Civil Monetary Penalties Law and the False Claims Act.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Innovaare Compliance

MAY 13, 2021

If health plans aren’t continuously monitoring all CMS universes for compliance issues, not only can errors creep into regulatory compliance tables, it highlights how member care isn’t being positioned as a high priority. However, health plans need to continuously monitor its compliance activities.

Compliance 40

Compliance Medicare Medicare Regulatory Compliance 40

Health Care Law Brief

JANUARY 19, 2022

Medicare and Medicaid have had similar price transparency rules, but now those rules will apply across all lines of business in New York. Disclosure requirements.

Prescription Drug Pricing 52

Prescription Drug Pricing Medicaid Medicaid Compliance 52

Health Care Law Brief

FEBRUARY 6, 2023

The bill states that “physician practices are subject to far less oversight than [other facilities]” but that they “remain unregulated by the state outside of the licensure of the individual practitioners who practice at these sites and Medicaid enrollment.”

Patient Satisfaction 52

Patient Satisfaction Health Insurance Medicaid Medicaid 52

Florida Health Care Law Firm

FEBRUARY 22, 2022

That type of arrangement is equivalent to buying a referral, which is unlawful, violates antikickback statutes, and will result in false claims being filed with Medicare, Medicaid, Tricare, ChampVA, or others. DME companies that hire telemarketers cannot pay these telemarketers to pay telehealth providers. genetic testing).

Medicare 52

Medicare Medicare Telemedicine Medicaid 52

Health Care Law Brief

MARCH 8, 2022

On February 24, 2022, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), announced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, which will begin January 1, 2023, and replace the Global and Professional Direct Contracting (GPDC) Model.

Medicare 52

Medicare Medicare Fraud Compliance 52

Health Care Law Brief

JUNE 2, 2022

Does the state apply different standards, for example, to Medicaid encounters? Do these encounters comport with telehealth encounter requirements set forth by applicable state laws, or government or private payor requirements? Prescriptions & Controlled Substances.

Public Health 52

Public Health Compliance COVID-19 HIPAA 52

Health Care Law Brief

JUNE 26, 2022

With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Health Care Law Brief

NOVEMBER 17, 2021

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its final rules for the 2022 Medicare Physician Fee Schedule (PFS Final Rule) and 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS Final Rule). Both rules take effect January 1, 2022. at 1396b(s).

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIT Consultant

DECEMBER 6, 2022

Telemental health providers were not immune to this activity in 2022, and providers should prioritize regulatory compliance as the industry looks ahead to 2023. “As For example, some states’ Medicaid programs now provide coverage for certain services supplied through audio-only modalities.

Compliance 98

Compliance Medicaid Medicaid Telemedicine 98

Health Care Law Brief

NOVEMBER 9, 2021

1] See, e.g., Centers for Medicare & Medicaid Services Fact Sheet, “Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period (September 20, 2021) at [link]. As noted, the Part II Rule is set to take effect generally beginning on January 1, 2022. [1] 2] See 86 Fed.

Medical Billing 75

Medical Billing Compliance Due Diligence Patient Satisfaction 75