Medisys Compliance

DECEMBER 23, 2022

The internet is ringing with the news of the CMS Updates Final rule for the 2023 Medicare Physician Fee Schedule. The finalized 2023 Medicare Physician Fee Schedule was announced by the Centers for Medicare & Medicaid Services (CMS) on November 1 2022. Medicare reimbursement for telehealth services.

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American Medical Compliance

MARCH 6, 2025

Fraud, Waste, and Abuse (FWA) remain critical challenges in the healthcare industry, impacting patient care, financial integrity, and regulatory compliance. Whether you’re a season professional or new to compliance training, this course will help you navigate FWA-related challenges with confidence and accountability.

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Fraud Medicare Medicare Compliance 52

Medisys Compliance

APRIL 8, 2022

Telehealth is witnessed high and low acceptance during COVID-19 pandemic last year, and it might play a key role in care delivery in 2022. CMS has updated the Telehealth Services List to show minor changes due to various activities, such as the CY 2022 MPFS Final Rule and legislative changes from the Consolidated Appropriations Act of 2021.

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HIT Consultant

FEBRUARY 6, 2025

What You Should Know: – Lynx , a leading fintech platform simplifying healthcare payments and administration, today announced the close of an oversubscribed $27 million Series A funding round, bringing its total funding to over $44 million since its inception in 2022. 406 Ventures , Obvious Ventures , and Frist Cressey Ventures.

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Healthcare IT Today

APRIL 9, 2025

The following is a guest article by Andrew Mahler, JD, CIPP/US, AIGP, CHC, CHPC, CHRC , Vice President of Privacy, Compliance Services at Clearwater When the healthcare information ecosystem operates as it should, it mirrors a healthy circulatory system. The cracks spread further. Reputations can tank. And the cost of inaction?

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Due Diligence Hospitals Compliance Ransomware 64

Compliance Now

MAY 5, 2022

The Centers for Medicare and Medicaid Services recently opened the much-anticipated federal Independent Dispute Resolution (IDR) Portal , a component of the No Surprises Act section of the Consolidated Appropriations Act of 2021 (the Act). By: Jessica Waltman, Principal, Forward Health Consulting.

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MRO Compliance

JUNE 1, 2022

Each year HEDIS rating criteria is updated, meaning your organization needs to stay up-to-date on the latest news and trends for HEDIS compliance audits. HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. Compliance with HEDIS specifications.

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Healthcare Law Today

JANUARY 20, 2022

As previously reported , on November 4, 2021 the Centers for Medicare and Medicaid (CMS) issued an Interim Final Rule (the CMS Rule) requiring most Medicare and Medicaid certified providers and suppliers to vaccinate staff members within 60 days. CMS has, however, modified the original compliance dates for the mandate.

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Healthcare IT Today

JANUARY 17, 2024

Patient volumes and surgical procedures showed signs of recovery from pandemic-era declines, increasing by 23% and 27% respectively over 2022. This underscores industry trends toward increased productivity and strategic implementation of technology, automation, and analytics in billing compliance and revenue cycle management operations.

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Overpayments Overpayment Compliance Medicare 122

AIHC

DECEMBER 27, 2024

Enforcing Accountability Oversight mechanisms should be strengthened to ensure compliance with consent standards. link] Copyright 2024 American Institute of Healthcare Compliance All Rights Reserved [1] CMS Revisions and Clarifications to Hospital Interpretive Guidelines for Informed Consent. 2022 Jan;52(1):28-31.

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Healthcare Blog

AUGUST 23, 2023

It is critical for an organization to have strategies for promoting ethical behavior in healthcare compliance. Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization.

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Healthicity

JULY 20, 2022

Mental Health Parity. Mental health services have not always had the same parity of coverage.

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Med-Net Compliance

OCTOBER 21, 2022

The Office of Inspector General (OIG) has recently posted the False Claims Act (FCA) settlements for FY 2022 Q1–Q4 on the risk spectrum. OIG cases against these parties are closed without evaluating the effectiveness of any efforts the parties have made to ensure future compliance with Federal healthcare program requirements.

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Healthcare Law Blog

OCTOBER 27, 2022

On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursing home facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program.

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Compliancy Group

NOVEMBER 16, 2022

In 2015, legislation known as the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted. Under MACRA, the Centers for Medicare and Medicaid Services created regulations for healthcare providers’ use of health information technology. MACRA MIPS 2022 is discussed in greater detail below. Find Out More!

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Healthcare IT Today

NOVEMBER 22, 2022

The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. They also look to flag “items and services that have high national error rates and are a financial risk to Medicare.” Meanwhile, Medicare also has a Fee for Service Recovery Audit Program. Tricare and Medicare).

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Overpayments Overpayment Medicare Medicare 107

Innovaare Compliance

APRIL 29, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. Multiple Medicare Advantage Prescription Drug Plans (MAPDs) have already received notification of their selection. Medicare Beneficiary Identifier (MBI) has been replaced with Enrollee ID.

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Regulatory Compliance Medicare Medicare Compliance 52

Innovaare Compliance

JUNE 27, 2024

The upcoming Medicare Prescription Payment Plan (M3P), set to launch in January 2025, marks a significant shift in Medicare’s approach to prescription drug coverage. This initiative, introduced under the Inflation Reduction Act of 2022, aims to smooth out-of-pocket costs for beneficiaries over the year.

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HIPAA Journal

OCTOBER 13, 2022

The Secretary of the Department of Health and Human Services, Xavier Becerra, is expected to extend the COVID-19 Public Health Emergency (PHE) today (October 13, 2022) for the 11th time. The COVID-19 PHE was first declared in January 2020 by then HHS Secretary, Alex Azar II, with the last extension issued by Becerra on July 15, 2022.

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Med Law Blog

APRIL 4, 2022

The Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA), was passed as part of the consolidated Budget Act for 2022, which also included the telehealth provisions I posted about last week. The definition of “covered entity” in the Act is far greater than covered entity as defined by HIPAA.

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Healthcare IT Today

NOVEMBER 14, 2023

SCAN Group , a mission-driven organization whose holdings include SCAN Health Plan , one of the nation’s largest not-for-profit Medicare Advantage plans, has made its latest strategic investment in Dina. In 2022, Dina was named to the Inc. SCAN’s care delivery affiliates collectively serve more than 36,000 members.

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Natalia Mazina

FEBRUARY 22, 2024

DIR fees were implemented with the creation of the Part D program through the passage of the Medicare Modernization Act of 2003. Other criteria utilized by PBMs include medication adherence rates, generic compliance ratios, generic effective rate, and medication therapy management implementation.

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Bill of Health

APRIL 13, 2022

After the PHE, states can facilitate smooth transitions for those no longer eligible for Medicaid by taking advantage of the full 12- to 14- month period that the Centers for Medicare & Medicaid Services (CMS) has established for redetermining eligibility. What States Are Doing Now.

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MRO Compliance

AUGUST 8, 2024

The Role of Clinical Data Registries According to the latest information from the Centers for Medicare and Medicaid Services (CMS), 90% of payments are now linked to value, with 40% flowing through alternative payment models (APMs), showing the shift towards more cost-effective care driven by data from registries.

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Patient Satisfaction Medicare Medicare Medicaid 147

MedTrainer

FEBRUARY 12, 2024

in settlements and judgments from healthcare organizations accused of filing false claims in fiscal 2022. Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. government collected $2.2B

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Innovaare Compliance

JULY 19, 2024

On April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) released potential fraud, waste and abuse (FWA) trending data collected from Medicare Advantage Prescription Drug Plans (plan sponsors) for fourth quarter 2021. The most prominent suspect was misrepresentation of services/products (48.87%).

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Fraud Medicare Medicare Compliance 52

YouCompli

JANUARY 4, 2023

The healthcare enterprise risk approach takes compliance in new directions . Featured speakers: James Bryant , Vice President and Chief Compliance Officer, Brigham and Women’s Hospital; Timothy C. Bryant, Hogan, and Wroth addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance forum in December 2022.

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Verisys

DECEMBER 22, 2021

However, based on discussions with Verisys clients and prospects, most health plans are unprepared to meet the requirements due by January 1, 2022. Should a group health plan, insurer, or state agency find that time is running out on achieving regulatory compliance with H.R. The post Ensuring Provider Directory Compliance With H.R.

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Medisys Compliance

MAY 19, 2022

During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. In this article, we shared revised Medicare billing and coding guidelines which will help in billing Medicare telehealth during COVID-19 PHE.

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Healthcare Compliance Blog

MARCH 2, 2022

An indictment was filed on February 25, 2022, against ten persons in Florida for their alleged roles in a $67 million healthcare fraud, wire fraud kickback, and money laundering scheme. The ten Florida defendants began their initial appearances in federal court during the last week of February 2022.

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YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. The CCR is determined by a hospital’s cost report that is reconciled with the local Medicare contractor.

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MedTrainer

NOVEMBER 17, 2023

This model involves specific regulations and agreements with Medicare and Medicaid, impacting how healthcare providers in the state bill for services and receive payments. Regulations Unique to Maryland To meet the standards of healthcare compliance in Maryland, there are a few additional regulations.

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Innovaare Compliance

JUNE 28, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of CMS program audits in February 2022. Even though we’re six weeks from the end of the 2022 cycle, there’s still time to review the new and changed features of the CMS audit protocol (CMS 10717) for CY 2022. What to look for during an audit .

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Overpayments Overpayment Compliance Medicare 52

Medval Compliance Blog

FEBRUARY 8, 2022

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that it will be hosting a Workers’ Compensation Medicare Set-Aside (WCMSA) webinar next Thursday, February 17, 2022 at 1:00 pm ET. The post CMS to Host Workers’ Compensation Medicare Set-Aside Webinar appeared first on Medval.

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Innovaare Compliance

APRIL 6, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% billion, to sixth place in 2022, with spending of $4.6 The cost to Medicare Part D would be $26.8 or $16 billion in 2025 over 2024 in expected MA payments.

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Innovaare Compliance

JANUARY 15, 2024

The Prescription Drug Program, commonly known as Medicare Part D, is undergoing significant transformations in 2025 due to the Inflation Reduction Act (IRA) of 2022. Medicare Part D will have three (3) phases instead of four (4) – Deductible, Initial Coverage Phase and Catastrophic Phase. generics) in the catastrophic phase.

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HIT Consultant

JANUARY 18, 2023

In 2022, 135 new bills that impacted PBM business practices were introduced in 36 states and many will continue to be in review in 2023. We’ll also be much closer to the 2024 phase-in of a new Medicare Part D out-of-pocket cost cap for seniors. However, advanced clinical roles must be balanced with maintaining compliance. With

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