Health Populi

MAY 14, 2019

The mainstreaming of SDoH speaks to the awareness that health is made where we live, work, play, pray, learn and shop… beyond the health”care” system of hospitals, doctors’ offices, and prescription drug dispensaries. adults between 18 and 64 years of age in December 2018.

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Health Populi

SEPTEMBER 5, 2018

The largest patient experience workflows included shopping for health insurance, preparing to see a healthcare provider, connecting with that provider, managing a diagnosis, shopping for services, receiving treatment, and finally, paying for the services. At this moment in U.S.

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Health Insurance Medical Billing Medicaid Medicaid 63

Health Populi

DECEMBER 4, 2019

With new rules emanating from the White House this month focusing on health care price transparency, health care costs are in the spotlight at the Centers for Medicare and Medicaid Services.

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Health Populi

FEBRUARY 14, 2018

of health spending per person. Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers. That equates to 18.4% of the Gross Domestic Product (GDP) and $12,230.40

Health Insurance 79

Health Insurance Medicare Medicare Medicaid 79

Healthcare Law Blog

JANUARY 25, 2023

Introduction: Defining Interprofessional Consultation In a January 5, 2023, letter to state health officials, the Centers for Medicare & Medicaid Services (“CMS”) clarified a Medicaid and Children’s Health Insurance Program (“CHIP”) policy on the coverage and payment of interprofessional consultations (the “Guidance”).

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Medicaid Medicaid Medicare Medicare 52

Health Populi

MARCH 1, 2018

To more effectively help patients manage diabetes , CentraForce Health used geospatial mapping of SBDoH data to develop deeper insights into peoples’ health needs and behaviors — such as eating fast food in the past 30 days, sufficient time to eat healthy food, and tendency to follow a doctor’s recommendations.

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Health Insurance Medicaid Medicaid Public Health 82

Health Populi

JUNE 13, 2018

The 6% trend is equal to that of 2018, illustrating a flat scenario, roughly the same trend seen in 2016 at 6.2%. Even with moderating medical trend growth, the Centers for Medicare and Medicaid Services (CMS) expect that healthcare spending will account for 20% of the U.S. That’s one-half the high point at nearly 12% in 2007.

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Medicaid Medicaid Health Insurance Medicare 63

Healthcare Compliance Blog

MARCH 31, 2022

The agencies received millions of dollars in funding from Medicaid, which is funded in part by the federal government, and much of that money was meant to pay the wages and benefits of their aides. Under the Wage Parity Law, which is funded by Medicaid, aides are to be paid a minimum amount in total compensation.

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Medicaid Medicaid Governance Fraud 59

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.

COVID-19 216

COVID-19 Hospitals Doctors Health Insurance 216

Jane Sarashon

FEBRUARY 4, 2024

Furthermore, health plan members now see themselves as medical bill payers, seeking value and consumer-level services for their health insurance premium investment. According to the online Merriam-Webster dictionary , the first use of the phrase “health insurance” occurred in 1901. Consulting Noah Webster….and

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US Department of Health and Human Services Health Insurance Medicare Medicare 75

Healthcare Law Blog

MARCH 25, 2022

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger insurers. New Mexico Health Connections v. United States Dep’t of Health & Human Servs. ,

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ACA US Department of Health and Human Services Health Insurance Medicaid 52

C&M Health Law

DECEMBER 21, 2022

If the proposed rule is finalized, covered entities would have to comply within 24 months after the effective date of the final rule, and small health plans would have 36 months to comply. HHS also adopted the NCPDP Batch Standard Medicaid Subrogation Implementation Guide, Version 3, Release 0 (Version 3.0)

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HIPAA Medicaid Medicaid Health Insurance 52

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts.

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Medicare Medicare COVID-19 Medicaid 98

Health Populi

AUGUST 5, 2019

Power,” your mind probably imagines reviews of automotive performance, retail shopping experiences, or perhaps even health insurance plan customer service. Expanding its report-card role in the health ecosystem. In 2019, 28 states have payment parity policies for Medicaid. When you think “J.D.

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Telemedicine Doctors Medicaid Medicaid 82

Health Populi

FEBRUARY 11, 2019

That wand has begun to initiate its magic in the physician community, based on a wonderful essay in JAMA published 20 December 2018 titled, Social Determinants of Health in the Digital Age: Determining the Source Code for Nurture. Yet it’s older people who are more at-risk for SD0H challenges.

Medicare 95

Medicare Medicare Doctors Health Insurance 95

Jane Sarashon

JULY 18, 2024

Following the BLS report on the CPI for June 2024, PwC published their new annual report from PwC titled Behind the Numbers 2025 tells us that commercial health care spending is expected to grow some 8.0% for Individual health plans — increasing from 7.5% for Group plans and 7.5% and 7.0%, respectively.

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Doctors Prescription Drug Pricing Hospitals Health Insurance 59

Health Populi

JANUARY 18, 2019

Research published in JAMA Internal Medicine in December 2018 found that as out-of-pocket costs for insulin have increased over the past few years, many patients use less insulin than needed. As patients continue to morph into consumers who pay for health care services, they are seeking price transparency — but not finding it so easy.

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Prescription Drug Pricing Health Insurance Doctors Medicare 66

CMS.gov

NOVEMBER 16, 2018

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Fri, 11/16/2018 - 18:46. Administrator, Centers for Medicare & Medicaid Services. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 percent in 2018. Home health corrective actions resulted in a significant $6.92

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Medicare Medicare Overpayments Overpayment 20

Healthcare Law Blog

APRIL 24, 2023

On April 17, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the U.S. Department of Health and Human Services (“HHS”) Notice of Benefit and Payment Parameters for 2024 Final Rule (the “Notice”) that includes standards for issuers and Marketplaces, and requirements for agents, brokers, web-brokers and others.

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Medicaid Medicaid Compliance Health Insurance 52

Health Populi

JULY 16, 2018

HealthyCapital develop a Health Management Retirement Index to calculate an individual’s percentage of retirement healthcare costs that can be funded by savings from improved health. Health Populi’s Hot Points: In the U.S.,

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Health Insurance Medicaid Medicaid Doctors 54

Health Law RX

DECEMBER 21, 2023

Department of Health and Human Services (HHS) Office for Civil Rights (OCR) is signaling that it is cracking down on healthcare organizations that fail to identify and address cybersecurity vulnerabilities as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA Rules).

HIPAA 52

HIPAA Ransomware Compliance Medicaid 52

Healthcare Law Today

FEBRUARY 6, 2023

As of 2019 almost 95% of such persons had Medicare coverage and about half of those also had some sort of supplemental health insurance coverage. 2 See Trust for America’s Health: The State of Obesity: Policies for a Healthier America, 2022 (September 2022). 4 PYA, Compensation Study: Spotlight on Cardiology (2018).

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US Department of Health and Human Services Electronic Medical Records Medicare Medicare 52

Physician Credentialing Company

DECEMBER 20, 2024

Health insurance companies also allow credentialed providers to submit claims for healthcare services. 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

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 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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Hospitals Medicare Medicare Medicaid 40

Florida Health Care Law Firm

DECEMBER 9, 2021

On January 1, 2022, a new federal law, “ Requirements Related to Surprise Billing, Part I ” (“The Rule”), goes into effect for health care providers and facilities and for providers of air ambulance services. The Rule will restrict excessive out-of-pocket costs to consumers which resulting from surprise billing and balance billing.

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Medical Billing Medicare Medicare Compliance 40

HIPAA Journal

JULY 24, 2023

HHS was one of the first Departments to have an Office of Inspector General in 1976 due to billions of dollars being lost each year to Medicaid fraud. Subsequent Acts of Congress increased the OIG’s regulatory authority to prevent crimes against the Department. HCFAC gave HHS’ OIG the resources to enforce §1128 of the Social Security Act.

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Fraud Medicare Medicare Medicaid 52

Health Populi

MAY 20, 2024

In the past year, the growth of prescription drug utilization and spending has much to do with the use of GLP-1 agonists to treat diabetes and obesity, along with immunology therapy, and lipid meds, along with specialty medicines now accounting for over half of spending — up from 49% in 2018.

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FDA Medicaid Medicaid Medicare 71

Healthcare Law Blog

MAY 5, 2022

The Report is another example of the OIG fanning the fire of criticism of MAOs by ignoring the overwhelming evidence that MAOs provide access to medically necessary services and also minimized the program requirements and guidance from the Centers for Medicare and Medicaid Services (“CMS”), with which MAOs must comply. The OIG Report.

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Medicare Medicare Licensing Health Insurance 52

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. Over time, America’s approach to health care provision fragmented by plan sponsor, whether U.S.

Medicaid 54

Medicaid Medicaid Medicare Medicare 54

CMS.gov

JUNE 11, 2018

Mon, 06/11/2018 - 12:04. Medicaid & CHIP. However, it is important for our beneficiaries across the country to know that the Centers for Medicare & Medicaid Services (CMS) is exploring all of our options to address this national crisis. out of 1,000 Medicaid beneficiaries are impacted by OUD. CMS Opioids Roadmap.

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Medicaid Medicaid Medicare Medicare 20

Redox

FEBRUARY 7, 2019

According to Deloitte’s 2018 Survey of US Physicians , only 23% of patients have had video visits and just 14% of physicians have video visit capability. Oddly, even with its place in the general public’s lexicon, telemedicine utilization is still rather low. CMS expanding reimbursable telemedicine and remote patient monitoring services.

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Telemedicine Public Health Medicaid Medicaid 40

Health Populi

JULY 13, 2021

CVS has been tracking the growing trend of health care consumerism in the U.S. since first launching this consumer market research in 2018 in the Health Ambitions Study conducted in concert with Aetna — the pharmacy chain’s newly-acquired health insurance company. Stress levels among U.S.

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COVID-19 Health Insurance Medicaid Medicaid 71

Health Populi

JUNE 14, 2018

parents are sobering up to the risks of social mobility in America for their children: in 2018, 51% of U.S. This is unique compared with people living in other OECD countries, only 37% of whom agree with the education statement. In the U.S., social mobility is not evenly distributed across the generations.

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Medicaid Medicaid Health Insurance Public Health 76

Healthcare Law Blog

JANUARY 26, 2023

The PHS Act requires post-graduate physician training programs that do not perform induced abortions to be deemed accredited and protects governmental payments provided as reimbursement for carrying out health related activities. Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat.

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HIPAA Journal

MAY 29, 2023

It has been 27 years since President Clinton signed the Health Insurance Portability and Accountability Act (HIPAA) into law, but compliance is still proving a challenge for many HIPAA-regulated entities. reduction in total penalties compared to 2018, falling from $28.7 million in 2018 to just $1.6 million in 2022.

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HIPAA Compliance Due Diligence COVID-19 105

New Jersey Healthcare Blog

JANUARY 12, 2022

1791(c), the Department of Human Services, Division of Aging Services, Office of the State Health Insurance for the Aged and Disabled, readopted a rule regarding the Senior Gold Prescription Program Manual. 10:37 (Community Mental Health Services Act) with technical amendments. On October 18, 2021, at 53 N.J.R.

Licensing 40

Licensing Medicaid Medicaid Nurses 40

Hall Render

FEBRUARY 23, 2024

CT’s Medicaid reimbursement rates lower than peer states: report Better safety training, reporting, escorts for CT home health care workers focus of new legislation D.C. Acquisition of BCBSLA Paused a Second Time It was the biggest health care deal in Louisiana history. What they say sets them apart.

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Nursing Homes Nurses Hospitals Medicaid 40