Health Care Compliance Brief

New, Stronger Evaluation and Management Upcoding Enforcement

YouCompli

OCTOBER 17, 2023

Based on the complexity of that work, they select a code from a category known as evaluation and management, or E&M. Evaluation and management upcoding have consistently been a compliance risk for over 20 years, and it continues today – especially with newer, tougher, and more complex guidelines to follow. CJ Wolf, MD, M.Ed.

COVID-19

COVID-19 Compliance Fraud Doctors

CMS Finalizes Major Changes to Hospital Price Transparency Rule

Hall Render

DECEMBER 4, 2023

Hall Render attorneys will be hosting an informative webinar on December 12, 2023, to discuss the new requirements and actions providers should take now following updates to the Hospital Price Transparency regulation. The MRFs must also meet several new requirements, some being technical. Register for the webinar here.

Hospitals

Hospitals Compliance Patient Advocacy Medicare

Compliance is Everybody’s Business: Clinical, Revenue Cycle, IT, Sales and Marketing

YouCompli

DECEMBER 14, 2022

Sharon Parsley, JD, MBA, CHC, CHRC contributes a monthly post on compliance officer effectiveness for the YouCompli blog. Many people in our discipline love the slogan “compliance is everybody’s business.” In the process, they became compliance champions. Consider scheduling periodic weekend rounding on different units.

Compliance

Compliance Compliance Officers Nurses Overpayments

Single Member Experience Platform

Innovaare Compliance

JANUARY 16, 2022

In this blog, we’ll explore six key benefits which should help simplify the decision for leaders of healthcare Appeals and Grievances departments. The cost saving categories are listed below: Single platform price is less than the price of two case-tracking systems. 6) Higher Compliance Adherence. One is around domain knowledge.

Compliance

Compliance Medicaid Medicaid Medicare

Skilled Nursing Transactions Update: CMS Enhances Scrutiny of Changes of Ownership for Skilled Nursing Facilities

Hall Render

NOVEMBER 18, 2022

On November 10, 2022, CMS also released changes to Chapter 10 of its Medicare Program Integrity Manual that incorporated these recent provider enrollment regulatory changes (“Program Integrity Manual Memo”). Skilled Nursing Facility Change in Ownership Screening Category Change. The NSVC will perform the site visit.

Nurses

Nurses Nursing Homes Medicare Medicare

Bonus Features – November 20, 2022 – 90% of healthcare buyers prioritize virtual care but want a clear roadmap, wearable data helped predict COVID-19 infections 12 days before the CDC, and more

Healthcare IT Today

NOVEMBER 20, 2022

This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. ONC published a blog post highlighting how to meet the 2015 Edition Cures Update requirements for ONC certification. Specifically, certified health IT developers have a Dec.

COVID-19

COVID-19 Telemedicine Hospitals Nurses

FDA Guidance Provides Relief for MDR Reporting During a Pandemic

Exeed Regulatory Compliance

MARCH 22, 2020

Timely MDR reporting is a challenging regulatory requirement for the industry. A new FDA guidance provides much-needed relief during a pandemic. Compliance to MDR reporting requirements is a common area of deficiency for the industry. During a pandemic, this can be particularly challenging to maintain at normal operating levels.

FDA

FDA Nursing Homes Compliance COVID-19

A Whole New World for Laboratory Developed Tests – FDA Proposes End to Its Longstanding Policy of Enforcement Discretion

Hall Render

NOVEMBER 30, 2023

On September 29, 2023, the Food and Drug Administration (“FDA”) announced the issuance of a Notice of Proposed Rulemaking (the “Proposed Rule”) to expand the FDA’s regulatory scope over in vitro diagnostics products (“IVDs”) to specifically address Laboratory Developed Tests (“LDTs”). Specifically, the definition of IVD in 21 C.F.R.

FDA

FDA Public Health Compliance Hospitals

OIG Issues Information Blocking Penalties Final Rule: Health IT Developers and Health Information Exchanges/Networks Have a Million Reasons to Care

Health Law RX

JULY 18, 2023

Those subject to the CMP Final Rule should consider prioritizing their compliance efforts because the OIG will begin enforcing the Rule on September 1, 2023. 2] The information blocking provisions of the Cures Act apply to three categories of actors: healthcare providers, Developers, and HIN/HIEs.

Fraud

Fraud Compliance Medicaid Medicaid

Takeaways from OCR’s Right of Access Initiative: Additional Enforcement Actions Demonstrate Ongoing Risks of Noncompliance

Hall Render

AUGUST 12, 2022

As health care continues to become a more patient-centered system that puts individuals “in the driver’s seat” with respect to their health care and related PHI, covered entities and business associates must remain diligent in their commitment to compliance or face potentially costly consequences.

HIPAA

HIPAA Compliance Licensing Regulatory Compliance

CMS Promotes Competition, Transparency, Health Equity and More in the CY2025 Medicare Advantage and Part D Proposed Rule

Healthcare Law Blog

NOVEMBER 13, 2023

The Proposed Rule covers an array of regulatory topics including the Star Ratings program, marketing and communications, agent and broker compensation, health equity, dual eligible special needs plans (“D-SNPs”), utilization management, network adequacy, and access to biosimilars.

Medicare

Medicare Medicare Medicaid Medicaid

FDA Oversight of AI Software Developed by Health Care Providers

Health Law Advisor

AUGUST 10, 2023

In this blog post, we take on the question of when machine learning software developed by those involved in delivering health care is FDA regulated. FDA doesn’t like to leave a space where FDA thinks there is risk that falls between two regulatory bodies. But as with almost all regulators, what FDA really hates is a gap. 3] 21 U.S.C.

FDA

FDA Licensing Hospitals Medicaid

Logical Contradiction Doctrine: Buckman for Textualists

Drug & Device Law

JANUARY 30, 2023

For those of you accessing the Blog on mobile devices, this post may be hard to read. Plaintiffs Legal Committee , 531 U.S. 341 (2001), with the rejection of the so-called “purposes and objectives” prong of implied preemption by the most conservative justices (at least in terms of federalism) on the Court. Mensing , 564 U.S. Myrick , 514 U.S.

FDA

FDA Fraud Governance Medicare

Health Care Compliance Brief

New, Stronger Evaluation and Management Upcoding Enforcement

CMS Finalizes Major Changes to Hospital Price Transparency Rule

Trending Sources

Compliance is Everybody’s Business: Clinical, Revenue Cycle, IT, Sales and Marketing

Single Member Experience Platform

Skilled Nursing Transactions Update: CMS Enhances Scrutiny of Changes of Ownership for Skilled Nursing Facilities

Bonus Features – November 20, 2022 – 90% of healthcare buyers prioritize virtual care but want a clear roadmap, wearable data helped predict COVID-19 infections 12 days before the CDC, and more

FDA Guidance Provides Relief for MDR Reporting During a Pandemic

A Whole New World for Laboratory Developed Tests – FDA Proposes End to Its Longstanding Policy of Enforcement Discretion

OIG Issues Information Blocking Penalties Final Rule: Health IT Developers and Health Information Exchanges/Networks Have a Million Reasons to Care

Takeaways from OCR’s Right of Access Initiative: Additional Enforcement Actions Demonstrate Ongoing Risks of Noncompliance

CMS Promotes Competition, Transparency, Health Equity and More in the CY2025 Medicare Advantage and Part D Proposed Rule

FDA Oversight of AI Software Developed by Health Care Providers

Logical Contradiction Doctrine: Buckman for Textualists

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