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. First and foremost, collection efforts for Medicare beneficiaries must be similar to efforts to collect comparable amounts from non-Medicare patients.

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Medicare Medicare Medicaid Medicaid 98

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

The Health Law Firm

JUNE 5, 2023

Board Certified by The Florida Bar in Health Law When a healthcare provider receives notice of an audit or site visit from Medicare, the Medicare Administrative Carrier (MAC), or the Integrity Contractor, they must act quickly. By George F. Indest III, J.D.,

Medicare 40

Medicare Medicare 40

Medisys Compliance

APRIL 8, 2022

In this article, we briefly discussed these Medicare telehealth billing guidelines. Due to the provisions of the Consolidated Appropriations Act of 2021, the CMS continues to evaluate the inclusion of telehealth services that were temporarily added to the Medicare telehealth services list during the COVID-19 PHE (Public Health Emergency).

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Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Medisys Compliance

FEBRUARY 20, 2023

Healthcare providers often get confused about the appropriate use of modifiers GA, GX, GY, and GZ while billing Medicare. GA modifier indicates that an Advance Beneficiary Notice (ABN) is on file and allows the provider to bill the patient if not covered by Medicare. Medicare does not pay for all health care costs.

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Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Healthcare Law Blog

JANUARY 17, 2024

workflow and performance assessment, data analytics, and certain Medicare eligibility and performance assistance). As always, the Opinion stipulated that it may only be relied on by the Requestor on the specific facts presented to OIG, and that certain state and federal laws may continue to limit similar arrangements.

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Medicare Medicare Payment Systems Compliance 52

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. additional test results).

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Medicare Medicare Licensing Health Insurance 52

Healthcare It News

DECEMBER 26, 2023

First, the program offers an initial access point for patients who present to the Convenient Care clinics or emergency rooms and who do not have a primary care provider, said Stephen Kapa, administrative director of telehealth services at FirstHealth of the Carolinas.

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Medicare Medicare Telemedicine Nurses 257

Health Law Advisor

MARCH 7, 2023

To advance these efforts, CMS established a Medicare Drug Rebate and Negotiations Group dedicated to the IRA and set forth the agency’s intended overarching timeline to implement the various IRA provisions, such as the Medicare Drug Price Negotiation Program and the Part D redesign.

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Medicare Medicare Prescription Drug Pricing Medicaid 52

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

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

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Medicare Medicare Overpayments Overpayment 52

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

Health Law Advisor

AUGUST 22, 2022

The company that requested this advisory opinion contracts with Medicare Advantage Organizations (“MAOs”) to offer the educational program to MA plan enrollees and charges the MAOs a per-member, per-month fee for the program.

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Medicare Medicare Fraud 52

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. Spravato is covered by Medicare Part B , which pays 80% of expenses. As such, depending on coverage , Spravato can fall under either (or both) medical or pharmacy benefits.

FDA 201

FDA Medicare Medicare Health Insurance 201

Medisys Compliance

APRIL 25, 2024

Introduction The ever-evolving world of healthcare billing can feel complex, and with the introduction of MACRA (Medicare Access and CHIP Reauthorization Act) in 2015, cardiology practices have faced some adjustments. MACRA replaced the previously used Sustainable Growth Rate (SGR) formula for Medicare physician payments.

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Medical Billing Outsourcing Medical Billing Medicare Medicare 64

Hall Render

DECEMBER 30, 2022

Medicare payment policy changes established under the CMS CY 2023 Medicare Physician Fee Schedule (“MPFS”) Final Rule , issued on November 1, 2022, become effective January 1, 2023. These services will be reported with three separate Medicare-specific G codes. Evaluation and Management (E/M) Visits. Split/Shared E/M Visits.

Medicare 40

Medicare Medicare Licensing Health Services Administration 40

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.

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Medicaid Medicaid Medicare Medicare 40

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 211

Nurses Medicare Medicare Licensing 211

Med Law Blog

JANUARY 24, 2022

This has been a particular hot point in groups, such as hospital employed groups, where a significant portion of the services have traditionally been performed by physician assistants but billed in the name of the physician because the physician was still present for some portion of those services.

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Medicare Medicare Hospitals 52

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.

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Medicaid Medicaid Medicare Medicare 189

Hanys

JUNE 21, 2023

In partnership with HANYS, the American Hospital Association presented its 2023 New York state Grassroots Champion Award to Patrick O'Shaughnessy, DO, MBA, FACEP, CHCQM, in recognition of his effective and persistent advocacy for New York hospitals and health systems. The award is presented annually to one individual from each state.

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Hospitals Medicare Medicare 52

Healthcare Compliance Blog

JANUARY 26, 2022

On December 7, 2021, a San Diego private ambulance company entered into a plea agreement with the OIG to resolve allegations that it presented claims to Medicare Part B for ambulance transportation to and from SNFs where such transportation was already covered by the SNF’s consolidated billing payment under Medicare Part A.

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Medicare Medicare Compliance Nurses 59

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.

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Medicaid Medicaid Medicare Medicare 97

Medisys Compliance

JANUARY 21, 2024

Key aspects include: Expanded Coverage: Medicare will now cover marriage and family therapy, mental health counselors, and intensive outpatient programs, increasing access for seniors. Network Adequacy: The bill pushes for adequate provider networks in Medicare Advantage plans. Handle the complexities of new documentation requirements.

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Medical Billing Outsourcing Medical Billing Medicare Medicare 59

Healthcare Law Today

NOVEMBER 30, 2022

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released its final 2023 Medicare Physician Fee Schedule (PFS) rule. Telehealth and other digital health modalities continue to increase in importance for Medicare populations and corresponding health care providers.

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Medicare Medicare Telemedicine Nurses 132

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. ,

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COVID-19 Vaccine COVID-19 Medicaid Medicaid 40

MRO Compliance

OCTOBER 23, 2023

Multiple EHRs Present Unique Challenges First, it is important to understand the key changes that ACOs will face in 2025. This marks a departure from the previous requirement to report only 248 sample Medicare patients. Therefore, it is essential for ACOs to use their time wisely.

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Payment Systems Medicare Medicare 130

Healthcare IT News - Telehealth

JULY 22, 2022

Meanwhile, the Centers for Medicare and Medicaid Services' Center for Program Integrity also announced that it has taken administrative actions against more than 50 healthcare providers alleged to be involved in similar schemes. billion in alleged fraud. ON THE RECORD. healthcare system at the expense of patients."

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Fraud Telemedicine Medicare Medicare 129

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.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

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.

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Medicare Medicare Payment Systems FDA 44

Healthcare Law Blog

JANUARY 9, 2024

The most jam packed, standing room only session of the day was NVIDIA Corporation, presenting for its fifth year. Cleveland Clinic’s presentation today focused in part on the potential for developments in personalized and individualized cancer care in the next five to ten years. What did NVIDIA discuss?

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Medicare Medicare Hospitals Doctors 59

Healthcare IT Today

NOVEMBER 15, 2023

The technique involves finding data from public sources such as Centers for Medicare & Medicaid Services (CMS). Medicare launched a payment system for in-home treatment during the pandemic, and now more than 200 hospitals have been approved by Medicare for the service. offering in-home treatment.

Medicare 99

Medicare Medicare Hospitals Compliance 99

Medisys Compliance

MARCH 5, 2024

Introduction Cardiology billing presents unique challenges due to evolving regulatory landscapes, complex coding requirements, and the constant scrutiny of payer audits. This complexity is reflected in the coding and billing requirements set forth by government payers such as Medicare, as well as private insurance companies.

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Medical Billing Outsourcing Medical Billing Compliance Governance 105

Med-Net Compliance

SEPTEMBER 20, 2022

million scheme to defraud Medicare by billing for services under another doctor’s name after Medicare revoked his privileges to participate in the program. According to court documents and evidence presented at trial, the podiatrist was revoked from participating in the Medicare program in January 2015.

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Fraud US Department of Health and Human Services Medicare Medicare 59

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.

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Hospitals Medicaid Medicaid Medicare 52

Healthcare IT News - Telehealth

MARCH 27, 2020

CCS Healthcare provides telehealth services to any Medicare recipient for free. “It is important to also help reduce any potential surges that would overload hospitals and to assist our medical colleagues who may presently be unable to provide services to their patients.” ” No co-pays or fees for seniors.

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Nurses Medicare Medicare Hospitals 156

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.

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