Hall Render

FEBRUARY 14, 2023

Annually, MAOs participate in a risk adjustment process that allows MAOs to report diagnosis codes that result in additional payment based on the complexity of the enrollee’s care needs. CMS RADV audits review documentation in the medical record to ensure the medical records support the diagnoses reported by the MAO for risk adjustments.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Bill of Health

JANUARY 18, 2024

While summarizing the entire content of the 13 blogs comprising this symposium in any depth is not possible here, this concluding post will attempt to synthesize some of the major inputs from the contributions. In addition, Parliament, unable to enact new laws at the beginning of the pandemic, “abdicated” its duties to the executive.

Public Health 270

Public Health US Department of Health and Human Services COVID-19 COVID-19 Vaccine 270

Hall Render

FEBRUARY 16, 2024

A new term is included in the Proposed Rule which would mandate that a preliminary assessment occurs within a 30-day window. Institutional Record: A New Requirement for Research Conduct Oversight ORI also proposes a more defined framework for institutional responsibilities, ranging from assessment to record-keeping.

Public Health 40

Public Health 40

YouCompli

OCTOBER 17, 2023

For example, during a patient consultation, a physician might take a medical history from a patient, perform a physical exam, and then document their medical decision and disease management. Based on the complexity of that work, they select a code from a category known as evaluation and management, or E&M.

COVID-19 52

COVID-19 Compliance Fraud Doctors 52

Hall Render

NOVEMBER 18, 2022

Skilled Nursing Facility Change in Ownership Screening Category Change. SNFs are currently in the “limited-risk” screening category under 42 CFR § 424.518. SNFs that are initially enrolling or undergoing a change in ownership fall within the “high” screening category under 42 CFR § 424.518. New Definitions.

Nurses 40

Nurses Nursing Homes Medicare Medicare 40

Health Law Advisor

JUNE 1, 2023

That’s all the math you need to know to make sense of the risk of bias in a sepsis prediction algorithm. 11] Healthcare lawyers, on the other hand, must start by figuring out who the categories of people are that need to be statistically evaluated. The law doesn’t designate any protected categories or classes of people.

FDA 98

FDA Hospitals COVID-19 Malpractice 98

Exeed Regulatory Compliance

FEBRUARY 24, 2020

These terms are foundational to risk analysis, yet they are poorly understood and often incorrectly applied. If your organization has implemented ISO 14971, the International Standard for Risk Management , there is a good chance you are already familiar with these terms. This difference is subtle, but important.

FDA 52

FDA 52

Healthcare IT Today

NOVEMBER 14, 2023

“Wellness” has become a new mantra for healthcare organizations. Particularly pertinent to the Healthcare IT Today blog, wellness is a goal promised by many digital apps. Categories of Measures Clinicians, payers, and regulators tend to look at two different types of measures: outcomes and process indicators.

Medicare 104

Medicare Medicare Doctors COVID-19 104

Health Populi

JANUARY 31, 2018

Knowing your blood pressure is an important step for managing the risks of heart disease. These patients must be mindful of their risk for stroke: people with AFib have a 5x greater risk of stroke than others. Here is Omron’s blog written for #CES2018 on Going for Zero.

FDA 81

FDA Doctors Public Health Medicare 81

YouCompli

DECEMBER 14, 2022

Sharon Parsley, JD, MBA, CHC, CHRC contributes a monthly post on compliance officer effectiveness for the YouCompli blog. We are trained professionals tasked with protecting the organization from risk and supporting the mission of providing excellent patient care. Risk assessment processes vary greatly from one organization to another.

Compliance 52

Compliance Compliance Officers Nurses Overpayments 52

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 52

COVID-19 Telemedicine Hospitals Nurses 52

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. Below is a summary of some of the Proposed Rule’s key changes.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Health Populi

MARCH 12, 2020

economy: 54% of people are not financially prepared to manage a contagious disease outbreak that requires quantities and limits ability to work for several weeks. Eight days later, the World Health Organization did indeed name this new virus challenge a “pandemic.”. Thinking beyond the bug at other categories of consumer purchases.

COVID-19 137

COVID-19 Telemedicine Hospitals Public Health 137

Hall Render

NOVEMBER 28, 2023

CMS dismissed the industry’s concerns because “there is always a level of concern that accompanies a payment rate decrease… ” CMS did not credit the widespread concern that the proposed cut risked creating an access to care problem. This could be what is driving the absolute numbers in each category down. Managing Employee.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Healthcare Law Blog

MARCH 20, 2023

The national shortage of mental health professionals, combined with the urgency required to secure treatment for an at-risk population, places a significant strain on practitioners, specifically, and the mental health industry, at large. Please refer to our blog for more information on the proposed rule. 21, 2023). [5] 5] Bellon, J.,

Medicaid 52

Medicaid Medicaid Licensing ACA 52

Healthcare Law Blog

JANUARY 10, 2024

So, unless you’re in one of the few delegated global risk arrangements in this country, there is no money for prevention of the catastrophe, only money to chase health once it has been lost or harmed. The CRP test also shows whether there is an increased risk of diabetes, hypertension and cardiovascular disease, and perhaps even cancer.

Medicare 52

Medicare Medicare Hospitals 52

C&M Health Law

FEBRUARY 16, 2021

On November 13, 2020, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule , demonstrating long-awaited efforts to streamline the regulatory framework governing the Medicaid and Children’s Health Insurance Program (“CHIP”) managed care programs. Risk-sharing Mechanisms. Actuarial Soundness.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

AIHC

AUGUST 8, 2023

Next you must evaluate the outcome from the initial response to your questions and develop new questions – but you must ask the right questions. If you don’t, every answer will be wrong, and the unknowns become high risk and increasingly dangerous. Why did the new programs go live without proper training?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Hall Render

AUGUST 12, 2022

Based on a review of the enforcement actions under OCR’s Right of Access Initiative, HIPAA covered entities are well-advised to consider the following observations and recommendations: All covered entities are at risk for noncompliance. Misplaced or forgotten requests pose a major compliance risk.

HIPAA 74

HIPAA Compliance Licensing Regulatory Compliance 74

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. It added incentives for its employees to sell more products and open more accounts to meet quotas. Was it you?

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. It added incentives for its employees to sell more products and open more accounts to meet quotas. Was it you?

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Healthcare Law Blog

JANUARY 5, 2023

The Proposed Rule includes changes on an array of topics including: Star Ratings, medication therapy management, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, behavioral health services, identification of overpayments , requirements for valid contract applications, and formulary changes.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

JULY 14, 2023

Managing Employees CMS proposes to expand the definition of managing employees for hospices and SNFs to include hospice administrators or hospice medical directors. With this change, hospices will now need to report both the administrator and medical director as managing employees for their Medicare enrollment.

Medicare 52

Medicare Medicare Payment Systems Governance 52

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 98

FDA Licensing Hospitals Medicaid 98

Health Populi

JULY 1, 2019

Get a cup of coffee and sit back, because this is a long one – not the usual short and sweet entry that each of us endeavors to craft on our respective blogs. We three don’t know what process ensued and what bidders came to the table, but in the end, it was UHG that stepped into iCarbonX’s shoes to become the new owner.

Health Insurance 86

Health Insurance Pharmaceutical Industry HIPAA Bioethics 86

Health Populi

JANUARY 10, 2019

Fast forward to 2018, and Fitbit’s blog posted about women’s health tracking, using the words “menstruation,” “period,” and “sexual health.” This new version replaces traditional basal temperature with pulse rate, skin temperature, and breathing to be more predictive about ovulation.

Licensing 96

Licensing HIPAA Doctors Hospitals 96

Jane Sarashon

DECEMBER 13, 2021

This year-end/New Year 2022 post on my Health Populi blog will weave together many of the key findings from these consumer health/care reports that are most resonating with me and the work I’m doing…. I cannot recall a season when so many health consumer studies have been launched into my email inbox.

COVID-19 60

COVID-19 Public Health Governance Medicaid 60

Drug & Device Law

JULY 31, 2023

We have blogged several times about the somewhat esoteric issue of whether intangible items – chiefly computer software, website algorithms, and other electronic information – is treated as a “product” for purposes of imposing strict liability on their creators. Farmers New World Life Insurance Co. did not create a risk of harm.”

Governance 52

Governance Payment Systems Hospitals Licensing 52