HIT Consultant

FEBRUARY 9, 2023

Czekai, MPH, VP of Strategic Partnerships at Cohere Health The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. LinkedIn – [link].

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

MedTrainer

AUGUST 30, 2023

Medicare Advantage (Part C). Medicare Advantage plans are managed care plans offered by private insurance companies as an alternative to traditional Medicare (Parts A and B). MCOs need to comply with various regulations and requirements to operate effectively — and ensure they meet the standards set forth by regulatory bodies.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. organizations that receive any funds from Medicare, Medicaid, TRICARE, or other federal programs cannot afford to employ individuals or entities excluded from even one program. Medicare opt out.

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Medicaid 52

Verisys

JANUARY 8, 2024

This type of audit is essential in the healthcare industry for several reasons: Regulatory Compliance It ensures that the healthcare organization complies with various federal and state laws and regulations. Compliance with state-specific healthcare laws and regulations is also assessed.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

Total Medical ComplianceHIPAA

JANUARY 11, 2024

These screenings search through various databases containing records of individuals or organizations barred from participating in Medicaid, Medicare, or other federal/state healthcare programs due to fraud, abuse, or other offenses. Why is Sanction Screening Vital Under HIPAA?

HIPAA 52

HIPAA Regulatory Compliance Malpractice Compliance 52

Compliancy Group

JANUARY 17, 2024

The OIG Work Plan, sometimes referred to as “the Work Plan” or “the Plan,” is an essential tool in securing and maintaining healthcare regulatory compliance for patient safety, privacy, and quality care.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Regulatory Compliance Regulations Compliance 52

Medisys Compliance

MARCH 7, 2024

Our team of experienced professionals utilizes cutting-edge technology and industry expertise to streamline processes, maximize reimbursements, and ensure regulatory compliance. MDS offers comprehensive billing solutions tailored to meet the unique needs of each client.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Regulatory Compliance Compliance 59

MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

Compliance Framework 52

Compliance Framework Governance Compliance Medicaid 52

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. Medicare Beneficiary Identifier (MBI) has been replaced with Enrollee ID.

Regulatory Compliance 52

Regulatory Compliance Compliance Medicare Medicare 52

Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes are significant and will have a major impact on Medicare and Medicaid plans. Increased use of data analytics: CMS will be using data analytics more extensively in its audits.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT Today

JUNE 29, 2023

However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. 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.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

MedTrainer

OCTOBER 5, 2023

As a key member of your facility’s healthcare compliance programming, you understand the significance of regulatory compliance and the critical role it plays in ensuring the privacy and security of patient information. Your organization’s ability to practice regulatory compliance is only as good as what’s been documented.

HIPAA 98

HIPAA Compliance Regulatory Compliance ADA 98

HIT Consultant

JANUARY 26, 2023

The Improving Seniors’ Timely Access to Care Act mandates the adoption of electronic PA for Medicare Advantage (MA) plans and requires plans to offer greater policy transparency, approval rates, and rationale for denials. It is time for intelligent utilization management, beginning with prior authorization. LinkedIn – [link].

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Medicaid 52

Medisys Compliance

MARCH 27, 2024

Expertise in Regulatory Compliance: The regulatory landscape for healthcare billing is constantly evolving. A specialized billing partner stays updated on the latest regulations and ensures your practice adheres to all coding and billing compliance standards.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Regulatory Compliance Compliance 64

Innovaare Compliance

JULY 20, 2023

Leveraging technology empowers health plans to strengthen their oversight capabilities, ensure regulatory compliance, and uphold high-quality care delivery through delegated entities.

Regulatory Compliance 40

Regulatory Compliance Compliance Medicaid Medicaid 40

Verisys

FEBRUARY 14, 2024

Healthcare compliance is a critical component in the operation of healthcare organizations, encompassing a broad range of activities designed to ensure adherence to applicable laws, regulations, and ethical standards. For instance, within the realm of healthcare compliance, HIPAA compliance plays a pivotal role.

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year.

Medicare 52

Medicare Medicare Compliance Medicaid 52

MedTrainer

FEBRUARY 1, 2024

Why Healthcare Corporate Compliance is Critical Healthcare facilities use corporate compliance programs for several important reasons: Reduce Risk-related Costs: Potential costs can arise from a variety of compliance risks including operational, legal, clinical, and financial.

Compliance 52

Compliance Fraud Regulatory Compliance Regulations Compliance 52

MedTrainer

NOVEMBER 2, 2023

Most compliance officers possess a bachelor’s degree, often in healthcare administration, law, or a related field. Additionally, hands-on experience in healthcare or regulatory compliance provides a foundation for this role.

Compliance Officers 52

Compliance Officers Compliance HIPAA Regulatory Compliance 52

MedTrainer

MARCH 28, 2024

Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations. Advises on compliance matters, reviews contracts, and handles regulatory and legal issues. Pros: Legal and regulatory compliance expertise, familiarity with laws and regulations, and trusted legal adviser.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

MedTrainer

JULY 12, 2023

Regulatory Compliance. Organizations like The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration (FDA), and Occupational Safety and Health Administration (OSHA) require incident reporting and response documentation as part of regulatory compliance.

Compliance 52

Compliance Regulatory Compliance FDA Medicaid 52

MedTrainer

JULY 12, 2023

Regulatory Compliance. Organizations like The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration (FDA), and Occupational Safety and Health Administration (OSHA) require incident reporting and response documentation as part of regulatory compliance.

Compliance 52

Compliance Regulatory Compliance FDA Medicaid 52

Healthcare IT Today

DECEMBER 17, 2023

Business process management company Sagility launched its Utilization Management as a Service offering , which aims to help providers with CMS regulatory compliance. Pennsylvania-based WellSpan Health selected Arcadia data analytics to supports its Medicare Shared Savings Program.

Hospitals 92

Hospitals Nurses Compliance Regulatory Compliance 92

Health Care Law Brief

FEBRUARY 2, 2024

The Waiver Amendment was approved on January 9, 2024, by the Centers for Medicare & Medicaid Services (“CMS”) under Section 1115(a) of the Social Security Act and will expire on March 31, 2027. The rates must be at least 80% of Medicare rates. billion in Medicaid investments over the next three years.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

FEBRUARY 16, 2023

Facilitating this compliance comes with a high cost. million annually on administrative activities to support regulatory compliance. Even with significant investments in administration to support compliance, overwhelmed providers can inadvertently leave gaps in security, access and credentialing systems.

Compliance 52

Compliance Hospitals Regulatory Compliance COVID-19 52

Health Care Law Brief

JUNE 26, 2022

Under the traditional, or fee-for-service (FFS), Medicare program, CMS directly pays providers a predetermined rate for the items and services furnished to patients under Medicare Parts A and B. CMS’s Payments to MA Plans. In turn, an MA plan pays providers a negotiated rate for the items and services they render to enrollees.

Overpayments 52

Overpayments Overpayment Medicare Medicare 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 Medical Billing Outsourcing ACA 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.

Governance 40

Governance Compliance Hospitals Regulatory Compliance 40

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

Healthcare Blog

AUGUST 23, 2023

Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization. Use the following strategies to promote ethical behavior in regulatory compliance. 2022, December 5).

Compliance 56

Compliance Nurses Regulatory Compliance Medicaid 56

YouCompli

MARCH 21, 2022

Another challenge was the health system’s decentralized model for managing regulatory compliance. By implementing YouCompli, the Compliance function delivered much greater value to the hospital system. Another challenge was the health system’s decentralized model for managing regulatory compliance.

Hospitals 52

Hospitals Compliance COVID-19 Regulatory Compliance 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 Regulatory Compliance Healthcare information Technology Health Insurance 52

Healthcare IT Today

JUNE 7, 2023

However, it seems that the protracted regulatory promulgation process that preceded the publication of HTI-1 was not used by ONC to push back various deadlines originally included in the proposed rule, resulting in suggested timelines that would be insufficient to complete sizable development work.

FDA 74

FDA Compliance Regulatory Compliance Medicaid 74

Med Com Blog

DECEMBER 14, 2021

From the payor’s perspective, every year, the Medicare Fee- for-Service program improperly pays $25B+ due to insufficient and/or incomplete documentation. Between a patient’s doctor’s office and their insurance company, over $60 is spent in administrative work to generate and process a claim that on average pays approximately $80.

Compliance 40

Compliance Regulatory Compliance Medicare Medicare 40

Florida Health Care Law Firm

FEBRUARY 22, 2022

In yet another take-down of an illicit scheme to defraud the Medicare Program and ChampVA, as well as other insurers, Patsy Truglia has been sentenced to 15 years in federal prison. million from Medicare, ChampVA, and insurance using a scheme of telemarketing, telemedicine, and multiple DME providers or “store fronts.”.

Medicare 52

Medicare Medicare Telemedicine Fraud 52

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

Health Care Law Brief

FEBRUARY 16, 2024

ERISA/self-insured plans are not expressly excluded from the scope of the draft rules, unlike the Medicare Advantage and Worker’s Compensation plans that are excluded. Existing contract terms that conflict with newly proposed network pharmacy contract restrictions would be voided and superseded by the draft regulations after January 1, 2027.

Licensing 52

Licensing Medicare Medicare Regulatory Compliance 52