The Health Law Firm

AUGUST 20, 2012

Lower Medicare reimbursement rates are coming in October of 2012, to 2,211 hospitals around the country, including 131 in Florida. This is allegedly due to excessive readmission rates in these hospitals between July 2008 and June 2011, according to the Centers for Medicare and Medicaid Services (CMS). Indest III, J.D.,

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Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. MAOs will be required to remit improper payments identified during RADV audits in a manner specified by CMS.

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The Health Law Firm

JUNE 11, 2012

Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means.

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The Health Law Firm

MAY 4, 2012

Over 100 doctors, nurses and other health professionals were arrested on charges relating to Medicare fraud by federal agents on May 2, 2012. Indest III, J.D., Board Certified by The Florida Bar in Health Law. The arrests were made in seven cities nationwide, but more than half took place in South Florida.

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Healthcare IT News - Telehealth

JULY 18, 2022

"In addition, in 2012, UVA Health launched a remote patient monitoring program to improve patient compliance and clinical outcomes, and to reduce hospital readmissions, hospital length of stay and emergency department visits.

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COVID-19 Telemedicine Electronic Medical Records Hospitals 173

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

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The Health Law Firm

OCTOBER 3, 2012

On September 19, 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices (PMDs) Demonstration at a Senate Special Committee on Aging. To see the Power Mobility Devices (PMDs) Demonstration operational guide from the Centers for Medicare and Medicaid Services (CMS), click here.

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Healthcare IT Today

JUNE 21, 2023

Inflation will push Payers back into the Public Marketplace whether Statewide and Federal Health Exchanges, Medicaid and Medicare Before the pandemic, many payers left statewide health exchanges as they found more ways to become profitable outside of the public market.

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Medicare Medicare COVID-19 Medicaid 72

HIPAA Journal

OCTOBER 21, 2022

However, in 2015, Congress partially relented its stance by passing the Medicare Access and CHIP Reauthorization Act which requires the Centers for Medicare and Medicaid to remove Social Security Numbers from Medicare cards and replace them with Medicare Beneficiary Numbers.

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Healthcare Law Blog

NOVEMBER 1, 2022

CMS announced today a further extension until February 1, 2023, of the deadline for its publication of the long-awaited final rule on the use of extrapolation and the application of a fee-for-service adjuster (FFS Adjuster) in risk adjustment data validation (RADV) audits of Medicare Advantage organizations (MAOs). See 42 U.S.C.

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The Health Law Firm

JUNE 15, 2012

The DOJ announced the settlement on April 20, 2012. Walgreens Allegedly Offered Inducements to Medicare and Medicaid Beneficiaries. The settlement resolves allegations that Walgreens violated the False Claims Act. To view the DOJ's press release concerning the settlement with Walgreens, click here.

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Healthcare IT Today

DECEMBER 17, 2023

Though this is a significant increase from 2012, numbers haven’t budged much since 2015. Pair Team expanded into seven more California counties ; the company provides virtual primary care for Medicaid beneficiaries. Pennsylvania-based WellSpan Health selected Arcadia data analytics to supports its Medicare Shared Savings Program.

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Hospitals Nurses Compliance Regulatory Compliance 95

The Health Law Firm

OCTOBER 9, 2012

In September 2012, the Centers for Medicare and Medicaid Services (CMS) made the decision to allow Recovery Audit Contractors (RACs) to begin reviewing the billing codes for office visits for healthcare providers. By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law.

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HIT Consultant

OCTOBER 6, 2021

It doesn’t even take you to the Centers for Medicare & Medicaid Services (CMS) website. Thanks to the pandemic, for example, Medicare and most private insurance payers now cover telemedicine services, making it easier for patients and their caregivers to consult with their providers. Try Googling the word “caregiving.”

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COVID-19 Doctors Health Outcomes Licensing 98

Innovaare Compliance

FEBRUARY 9, 2021

Annually, the Centers for Medicare & Medicaid Services (CMS) releases star ratings, which measure the quality of care health plans deliver for its members. Medicare Advantage and Part D) for a comprehensive assessment of a health plan’s performance. Read More – Medicare Star Ratings Changes 2021 .

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Jane Sarashon

JULY 18, 2024

growth for group health insurance plans is the highest rate of medical cost trend growth since 2012. Millions of seniors (8 million, the report quantifies) in Medicare were also part of this large contingent of health citizens concerned about their ability to access medicines. for Group plans and 7.5% and 7.0%, respectively.

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Doctors Prescription Drug Pricing Hospitals Health Insurance 59

CMS.gov

APRIL 30, 2018

CMS Encourages Eligible Suppliers to Participate in Expanded Medicare Diabetes Prevention Program Model. For the first time, both traditional healthcare providers and community-based organizations can enroll as Medicare suppliers of health behavior change services. keya.joy-bush@…. Mon, 04/30/2018 - 10:58. Seema Verma. Initiatives.

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Medicare Medicare US Department of Health and Human Services Medicaid 22

Healthcare Law Today

JANUARY 2, 2023

” The currently proposed provision has similar effect to the language CMS proposed in 2012 and, after consideration of comments, ultimately rejected in the 2014 Final Rule (Medicare Advantage and Part D) and 2016 Final Rule (Medicare Part A and Part B). 3729(b)(1)(A). The public has until 5 p.m.

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Overpayments Overpayment ACA Medicare 52

Hall Render

AUGUST 10, 2023

On August 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its Final Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) PPS rule for fiscal year (“FY”) 2024 (“Final Rule”). The Final Rule increases the rate for IPPS payments by 3.3% in FY 2024 but applies a 0.2%

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CMS.gov

MARCH 4, 2013

In January, we passed the 210,000 mark for the total number of providers, including nearly 200,000 eligible professionals, who received a Medicaid or Medicare incentive payment for successfully adopting, implementing, or upgrading or meeting meaningful use of EHR technology. Growing EHR Adoption and Meaningful Use.

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Medicare Medicare Medicaid Medicaid 26

Redox

DECEMBER 4, 2020

Perhaps more importantly, Meaningful Use spurred adoption on the provider side, requiring that providers use certified EHRs to receive Medicare and Medicaid funds. Meaningful Use Stage 2 in 2012, and made immunization reporting mandatory unless a state had no registry. It also converged on HL7 2.5.1

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Public Health Governance Doctors Medicare 52

Kaiser Health News

JUNE 16, 2022

Hospitals recorded their most profitable year on record in 2019, notching an aggregate profit margin of 7.6%, according to the federal Medicare Payment Advisory Committee. Insurance protections there are weaker, many of the states haven’t expanded Medicaid, and chronic illness is more widespread. “The No.

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US Department of Health and Human Services Medical Billing Hospitals Medicare 145

Health Populi

OCTOBER 8, 2019

The study reviewed reports and articles published between January 1, 2012 and May 15, 2019, dressing the topic of waste across six domains previously identified by the Institute of Medicine: Failure of care delivery, with waste ranging between $102 bn and $166 bn. Political debates in this 2020 U.S. patients).

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Prescription Drug Pricing Medicare Medicare ACA 108

Kaiser Health News

JUNE 16, 2022

Los hospitales registraron su año más rentable de la historia en 2019, anotando un margen de beneficio agregado del 7,6%, según el Comité Asesor de Pagos de Medicare federal. Incluso la cobertura de Medicare puede dejar a los pacientes pagos de miles de dólares por medicamentos y tratamientos, según estudios.

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Healthcare IT News - Telehealth

JUNE 3, 2021

Before that she served as director of the State Innovation Models Initiative at the Centers for Medicare and Medicaid Services. Before joining Geisinger, she served as Pennsylvania’s secretary of health, where she developed an innovative payment and delivery model for rural hospitals. Isaiah Nathaniel. Philadelphia.

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COVID-19 Department of Veterans Affairs COVID-19 Vaccine Nurses 103

New Jersey Healthcare Blog

JANUARY 12, 2022

1846(a), the Department of Human Services, Division of Medical Assistance and Health Services published a notice of readoption of New Jersey Care … Special Medicaid Programs Manual. The Manual extends Medicaid eligibility to certain persons not eligible under the provisions at N.J.A.C. On November 1, 2021, at 53 N.J.R.

Licensing 40

Licensing Medicaid Medicaid Nurses 40

New Jersey Healthcare Blog

JULY 22, 2022

The chapter describes the policies and procedures of the New Jersey Medicaid/NJ FamilyCare program regarding transportation services. In 2012, N.J.S.A. On April 4, 2022, at 54 N.J.R. 620(b), the Department of Human Services, Division of Medical Assistance and Health Services adopted amendments to Transportation Services Rules.

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COVID-19 Vaccine Licensing COVID-19 Public Health 40

Bill of Health

JULY 8, 2022

Although Professor Levinson wrote this passage in 2012, it is surely just as true — if not more so — today. The outcome of the affirmative action case will have a critical effect on the future composition of the health care workforce.

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Governance Public Health Medicaid Medicaid 147

Bill of Health

JANUARY 3, 2023

Sebelius (2012) , which upheld the Affordable Care Act while declaring the individual mandate a violation of the Commerce Clause. Most such proposals rely on conditional spending, especially of Medicare funds. Oregon , and NFIB v. Almost all scholars see such measures as a legitimate exercise of constitutional power.

Licensing 130

Licensing Telemedicine Governance Federal Policy 130

HIPAA Journal

DECEMBER 14, 2022

The Centers for Medicare and Medicaid Services (CMS) also published an interoperability rule in March 2020 that applies to Medicare- and Medicaid-participating short-term acute care hospitals, long-term care hospitals, rehabilitation hospitals, psychiatric hospitals, children’s hospitals, cancer hospitals, and critical access hospitals (CAHs).

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HIPAA COVID-19 COVID-19 Vaccine Compliance 129

Kaiser Health News

DECEMBER 10, 2024

The Biden administration is likely to appeal, although a Centers for Medicare & Medicaid Services representative said in an email that the agency would not comment on the litigation. It does not appear to affect enrollment or coverage in other states, lawyers following the case said Tuesday. as children by their families.

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ACA Medicaid Medicaid Medicare 93

Kaiser Health News

DECEMBER 10, 2024

La administración Biden probablemente apelará, aunque un representante de los Centros de Servicios de Medicare y Medicaid (CMS,) la entidad federal que coordina estos mercados, dijo por correo electrónico que la agencia no comentará sobre el litigio.

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ACA Medicaid Medicaid Medicare 69

Kaiser Health News

JULY 11, 2023

Hospitals also claim as community benefits the difference between what it costs to provide a service and what Medicaid pays them, known as the Medicaid shortfall. ” Hospitals have long argued they need to charge private insurance plans higher rates to make up for the Medicaid shortfall.

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Hospitals Medicaid Medicaid Medical Billing 72

Kaiser Health News

JUNE 29, 2022

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Medicare Advantage plans accept a set fee from the government for covering a person’s health care.

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Medicare Medicare Governance Overpayments 107

Kaiser Health News

AUGUST 12, 2022

First, it would give the federal government the ability to negotiate prices of some drugs purchased by Medicare beneficiaries, a tool that has long been opposed by the drug industry. Department of Health and Human Services to identify Medicare’s 100 most expensive drugs and then pick 10 for price negotiations starting in 2023.

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Medicare Medicare Prescription Drug Pricing Governance 96

Health Populi

NOVEMBER 5, 2018

[As a sidebar, if you’re concerned about the state of civil verbal discourse in America, you may be comforted to know that an Arizona State Legislator Lori Klein (R-Anthem) introduced a law into the State House to prevent teachers from cussing in Arizona classrooms, as this article from back in 2012 discusses.

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Medicaid Medicaid ACA Health Insurance 78

Kaiser Health News

JANUARY 12, 2023

But Medicare is likely to be on the agenda, which will require the input of the chairs of both committees. Still to be determined is whether Medicare — which provides insurance to most people with Alzheimer’s — will cover the drug. And of course, the Ways and Means Committee has jurisdiction over most of Medicare in the House.

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US Department of Health and Human Services FDA Medicare Medicare 52