Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. The federal government has been haranguing vendors and clinicians to make interoperable systems since the HITECH act was passed in 2009. The release of FHIR in the mid-2010 decade changed everything.

Electronic Medical Records 122

Electronic Medical Records Doctors Governance Medicaid 122

Health Populi

OCTOBER 8, 2018

As the only health economist in the family of the 2018 HIMSS Social Media Ambassadors, this is a voice through which I can uniquely speak. At the time of the signing of HITECH, Medicare and healthcare costs were seen as a key driver of America’s long-term deficit spending at this low point in the national economy. GDP, in 2018.

Hospitals 61

Hospitals Health Insurance Health Outcomes Telemedicine 61

CMS.gov

OCTOBER 2, 2018

Modernizing Medicare to Take Advantage of the Latest Technologies. Tue, 10/02/2018 - 13:57. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. Together we can ensure that Medicare beneficiaries see the impact of advances in 21 st century biomedicine.

Medicare 44

Medicare Medicare Payment Systems FDA 44

Healthcare Compliance Blog

JANUARY 14, 2022

million to settle allegations that the company sold custom fabricated shoe inserts to Medicare recipients that did not meet Medicare standards. Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. A Florida based diabetic shoe company has agreed to pay over $5.5

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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.

Fraud 59

Fraud Doctors Medicare Medicare 59

Health Populi

NOVEMBER 1, 2018

And maintaining good mental health and staying on-track with health goals come close to managing uncovered costs, Oliver Wyman’s 2018 consumer survey learned. But this time around, polling health-insured consumers in July 2018, Oliver Wyman perceives a change in consumers’ “willingness to try new kinds of health services.”

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Health Insurance Doctors Medicaid Medicaid 73

Health Populi

OCTOBER 17, 2019

points in 2018 to 57.9 Alegeus found that people are making progress in saving more for healthcare — up 13% between 2018 and 2019, which is a significant rise relative to other savings categories in U.S. That’s in addition to what Americans had already saved into Medicare. households. Traditionally the U.S.

Health Insurance 61

Health Insurance Medicare Medicare Governance 61

HIT Consultant

AUGUST 5, 2022

CMS Proposed Changes to the Physician Fee Schedule 2023 : On July 7, 2022, the CMS announced that it is soliciting public comment on proposed policy changes for Medicare payments under the Physician Fee Schedule (“PFS”) effective on or after January 1, 2023. – Overall, the number of transactions closed in the quarter dropped 41% to 264.

Telemedicine 98

Telemedicine Medicaid Medicaid Malpractice 98

Hall Render

JUNE 15, 2022

Becerra , the Supreme Court ruled the payment cuts made by the Department of Health and Human Services’ (“HHS”) Centers for Medicare & Medicaid Services (“CMS”) for 340B eligible outpatient drugs were not permissible under the governing statute. Background. for 340B eligible hospitals.

Medicare 45

Medicare Medicare Hospitals Governance 45

Kaiser Health News

MAY 27, 2022

In 2018, one of the nation’s largest independent gastroenterology practices, Texas Digestive Disease Consultants, announced a deal with the Chicago-based private equity firm Waud Capital to expand by offering management services to other physicians. For those 65 and older, Medicare picks up the tab.

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Doctors Nursing Homes Nurses Medicare 120

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024. million (net) and $4.7

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Overpayments Overpayment Medicare Medicare 52

Pharmacy Law Blog

MARCH 13, 2018

The federal judge refused the dismissal on the grounds that the government had sufficiently backed its allegations against both the company and its owner. The government had also adequately backed its allegations that RS knew it had been overpaid but had made no attempt to refund the difference to Tricare, according to the judge.

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Fraud Governance Licensing FDA 52

Healthcare Law Blog

JUNE 30, 2022

The FCA allows the federal government to recover fraudulently-obtained federal funds, plus significant additional monetary damages and penalties. These types of dismissals of qui tam suits have become increasingly popular in recent years, with the DOJ outlining seven standards for seeking dismissals in a 2018 memorandum by Michael D.

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Governance Medicare Medicare 52

Health Populi

MARCH 1, 2018

To optimize communication strategies for attracting Medicare Advantage enrollment , a Mid-Atlantic health plan studied the media and social consumption patterns for older people, learning that the target population was more tech-savvy than presumed. This would break down a barrier for people living in food and/or pharmacy deserts.

Health Insurance 82

Health Insurance Medicaid Medicaid Public Health 82

Healthcare IT News - Telehealth

DECEMBER 16, 2020

The virtual trial, to be sure, is not a new concept: One team of researchers counted more than 1,100 trials listed on ClinicalTrials.gov employing connected digital products for remote data collection in both 2017 and 2018, the organization observed. " Healthcare organizations also need to convene regional collaborations, HRI said.

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COVID-19 Hospitals Doctors Health Insurance 216

Health Law Gurus

MAY 22, 2019

The Centers for Medicare and Medicaid Services (CMS) is launching new value-based programs with great fervor as a central strategy to bend the healthcare cost curve. Take Medicare Accountable Care Organizations (ACO) as an example. This is a tool available to Medicare beneficiaries, allowing them to access and share their claims data.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

McGuire Wood

OCTOBER 2, 2023

times the amount the government believed was due to improper billing, after a voluntary disclosure to the Department of Justice (DOJ). According to the DOJ press release, from January 2013 to July 2018, Oliver Street, doing business as U.S. This settlement includes more than $5.928 million in restitution, essentially a payment of 1.49

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Fraud Governance Compliance Medicare 52

HIT Consultant

AUGUST 15, 2022

Approximately 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans—a segment projected to reach 46% by 2025. Due to rapid growth of the 65-and-older portion of the population, Medicare expenditures are forecast to reach $1,559.4 – Continued increase in overall Medicare costs. Case in Point.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Physician Credentialing Company

DECEMBER 20, 2024

Medicare guidelines should be checked if you are billing this payer. Medicare and Medicaid allow non-credentialed providers to get reimbursement but under strict rules. It was reported in 2018 that a healthcare facility in New York paid about $6.6 Sixty days is a consecutive limit, including the days off.

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 52

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment. Physical Therapy 3.30

Medicare 52

Medicare Medicare Payment Systems COVID-19 52

AIHC

APRIL 5, 2022

Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back.

Fraud 52

Fraud Medicare Medicare Compliance 52

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. The CMS star ratings challenge. Why are CMS star ratings important?

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Medicare Medicare Medicaid Medicaid 40

Healthcare IT Today

AUGUST 24, 2023

Today’s announcement marks Waystar’s eighth acquisition since 2018, following the strategic additions of organizations like Recondo , eSolutions , and Patientco. Waystar is trusted by 1M+ providers, 1K+ hospitals, and health systems, and is connected to over 5K commercial and Medicaid/Medicare payers.

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Patient Satisfaction Medicaid Medicaid Medicare 52

Healthcare Law Blog

NOVEMBER 21, 2022

Pharmaceutical manufacturers are challenging the breadth of the Federal Anti-Kickback Statute (“AKS”) in federal court, arguing that the government is harming the very vulnerable patients it aims to serve by prohibiting cost-sharing subsidies for life-saving oncology drugs. and $500.39. [4].

Medicare 52

Medicare Medicare Governance Medicaid 52

HIPAA Journal

JULY 24, 2023

This section relates to the “Exclusion of Certain Individuals and Entities from Participation in Medicare and State Health Care Programs”, which – although effective since the passage of the Medicare-Medicaid Anti-Fraud and Abuse Amendments in 1977 – had never been properly enforced due to a lack of resources.

Fraud 52

Fraud Medicare Medicare Medicaid 52

CMS.gov

JULY 18, 2018

Thu, 07/19/2018 - 00:03. Administrator, Centers for Medicare & Medicaid Services. We see health IT systems that work seamlessly with each other, and a government that supports secure data sharing and emerging technologies so that healthcare in America is better and less expensive. CMS Doubling Down on Health IT; Patients.

Medicare 35

Medicare Medicare Governance Medicaid 35

Jane Sarashon

JULY 29, 2022

” It turns out that if Medicare Part D paid for the 184 most common generic medications for enrollees based on Costco’s cash-prices for the same products, the U.S. government would have saved $2.6 billion in 2018. Costco isn’t only beloved for the $1.50

COVID-19 72

COVID-19 Health Insurance Telemedicine Doctors 72

Health Populi

MAY 6, 2018

Universal health care was covered in a section on 28 April 2018, and coverage on financial inclusion was bundled into the 5th May edition. Two weeks in a row, The Economist , the news magazine headquartered in London, included two special reports stapled into the middle of the magazines.

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Medicaid Medicaid Medicare Medicare 54

Med Law Blog

MAY 1, 2023

Tenet went through its own bankruptcy difficulties and, in 2018, sold its remaining Philadelphia assets, i.e. Hahnemann Hospital and St. Howell, Constantine Yannelis and Abhinav Gupta positing that their research shows that “PE ownership increases short term mortality of Medicare patients by 10%, in nursing homes”.

Nursing Homes 52

Nursing Homes Malpractice Hospitals Nurses 52

CMS.gov

OCTOBER 31, 2018

Wed, 10/31/2018 - 17:03. Administrator, Centers for Medicare & Medicaid Services`. Some believe that our sole purpose is to finance public benefits, even if that means lost opportunity and a life tethered to government dependence. CMS Approves Innovative Wisconsin Plan to Improve Health and Lift Individuals from Poverty.

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Medicaid Medicaid Medicare Medicare 51

Health Populi

OCTOBER 24, 2022

I had asked some years ago, “what is a pharmacy” anymore, when CVS Pharmacy dropped tobacco from its SKUs and aisles in February 2014, rebranding as CVS Health; and, when Amazon purchased PillPack in June 2018. ” Dr. Cosgrove based that sobering forecast due to changes in the U.S.

COVID-19 54

COVID-19 Prescription Drug Pricing Health Insurance Health Care Reform 54

Redox

DECEMBER 4, 2020

Immunization information systems (IIS) have received special focus as part of government health initiatives (Meaningful Use 1 and 2), so every state has one or more: More accurate information about the number of distinct IIS in the US: [link] — Lisa Bari (she/her/hers) (@lisabari) November 17, 2020. The government thought the same.

Public Health 52

Public Health Governance Doctors Medicare 52

Pharmacy Law Blog

MAY 7, 2018

This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment. Copyright © 2018 The Health Law Firm. You do not have to report a pending DOH investigation against you to anyone. a Florida professional service corporation, since 1999.Copyright

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Licensing Nurses Medicaid Medicaid 40

Pharmacy Law Blog

MAY 14, 2018

This will then result in your exclusion from the Medicare and Medicaid Programs, and you debarment/exclusion from all government contracting or employment. Copyright © 2018 The Health Law Firm. You do not have to report a pending DOH investigation against you to anyone. a Florida professional service corporation, since 1999.Copyright

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Licensing Nurses Medicaid Medicaid 40

YouCompli

AUGUST 16, 2023

For example, let’s say there was an audit that identified a billing error which resulted in a six-figure repayment to Medicare. For example, let’s assume you have been made aware that the organization inadvertently billed Medicare for a particular procedure in error (e.g., the wrong procedure code was billed).

Compliance 52

Compliance HIPAA Medicare Medicare 52

HIT Consultant

NOVEMBER 22, 2021

July 1, 2021 was the enforcement date for the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule. In some cases, even as the national conversation about data blocking started in Congress, payers started to build out an FHIR infrastructure as early as 2018.

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Compliance Medicaid Medicaid Medicare 52

Health Law Advisor

MARCH 7, 2023

In 2018, Congress passed requirements under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, requiring DEA to create a special registration for opioid addiction treatment via telehealth by October 2019.

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Telemedicine COVID-19 FDA Compliance 52