Fierce Healthcare

MARCH 21, 2024

More than 100 provider organizations want the Centers for Medicare & Medicaid Services (CMS) to take a tougher stance on Medicare Advantage (MA) plans’ practices following an industry survey es | Providers spent nearly $20 billion in 2022 pursuing delays and denials across all payer types, yet those efforts are substantially more costly on average (..)

Medicare 144

Medicare Medicare Medicaid Medicaid 144

Kaiser Permanente

JANUARY 1, 2022

Medicaid and the Children’s Health Insurance Program (CHIP) have served as critical supports to children, pregnant women, parents, seniors, and individuals with disabilities – covering 80 million individuals during the COVID-19 pandemic. Since February 2020, Medicaid enrollment has grown sharply to cover an additional 9.9

Medicaid 92

Medicaid Medicaid Medicare Medicare 92

Bill of Health

APRIL 13, 2022

When the PHE ultimately expires, this will also trigger the end of the Medicaid continuous enrollment requirement, under which states must provide continuous Medicaid coverage for enrollees through the end of the last month of the PHE in order to receive enhanced federal funding. What States Are Doing Now. Continuity of Coverage.

Medicaid 147

Medicaid Medicaid COVID-19 Public Health 147

Healthcare IT News - Telehealth

JUNE 19, 2023

Over the last few years, Medicare Advantage plans have dramatically increased their deployment of telehealth systems for seniors. While some in the healthcare industry may be skeptical of telehealth’s utilization, particularly within the Medicare population, these plans continue to move full steam ahead.

Medicare 171

Medicare Medicare Telemedicine Medicaid 171

HIPAA Journal

NOVEMBER 21, 2022

million being defrauded from Medicaid, Medicare, and private health insurance programs. Five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers were tricked into changing the bank account details for payments. He was sentenced to 4 years in jail on September 15, 2022.

Medicaid 101

Medicaid Medicaid Medicare Medicare 101

HIPAA Journal

APRIL 27, 2023

The Centers for Medicare & Medicaid Services (CMS) has started notifying certain Medicaid beneficiaries about an impermissible disclosure of some of their protected health information due to a mailing error at one of its contractors. The CMS believes that the risk of identity theft and Medicare fraud is minimal.

Medicare 114

Medicare Medicare Medicaid Medicaid 114

HIPAA Journal

DECEMBER 15, 2022

On November 14, 2022, Fairmont, WV-based Health Care Management Solutions (HMS) reported a data breach to the HHS’ Office for Civil Rights that affected up to 500,000 individuals. It has now been confirmed that HMS suffered a ransomware attack on October 8, 2022. At the time, few details about the breach were released.

Ransomware 117

Ransomware Medicare Medicare HIPAA 117

Healthcare IT Today

OCTOBER 25, 2024

The following is a guest article by Mike Crouse, Director of Insider Risk at Everfox Ransomware attacks on the healthcare sector continue to grow, with incidents nearly doubling from 2022 to 2023—a concerning figure considering their potential to leave patients in life-or-death situations.

Ransomware 121

Ransomware Hospitals Medicaid Medicaid 121

Bill of Health

DECEMBER 27, 2022

2022 Nov;18(2):14-26. Frequency of Approval and Marketing of Biosimilars With a Skinny Label and Associated Medicare Savings. 2022 Nov 28. 2022 Nov 14. 2022 Nov 19. 2022 Nov 1;24(11):E1083-1090. 2022 Nov 7:e224131. Getting the Price Right: Lessons for Medicare Price Negotiation from Peer Countries.

Medicare 147

Medicare Medicare Medicaid Medicaid 147

HIPAA Journal

OCTOBER 18, 2022

Chambersburg, PA-based Keystone Health has recently announced that it fell victim to a cyberattack on August 19, 2022, which caused temporary disruption to its computer systems. The forensic investigation revealed the hackers first gained access to its systems on July 28, 2022, with access terminated on August 19.

HIPAA 122

HIPAA Health Insurance Licensing Medicaid 122

HIT Consultant

AUGUST 8, 2022

FAIR Health Monthly Telehealth Regional Tracker, May 2022, United States. The data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid. – FAIR Health reports national telehealth utilization increased 10.2 percent, from 4.9 percent in May.

COVID-19 98

COVID-19 Medicare Medicare Medicaid 98

AIHC

MARCH 31, 2025

The "Sunshine Act," officially known as the Physician Payments Sunshine Act, mandates those manufacturers of drugs, medical devices, and biologics report payments and transfers of value to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS).

Compliance 64

Compliance COVID-19 Compliance Officers Medicaid 64

Bill of Health

NOVEMBER 17, 2022

2022 Oct 3:e224226. 2022 Oct 24. 2022 Oct 5;379:e071752. Medicare’s National Coverage Determination for Aducanumab – A One-Off or a Pragmatic Path Forward? 2022 Oct 27;387(17):1539-1541. Epub 2022 Oct 22. 2022 Oct 13. 2022 Oct 13;387(15):1347-1349. Epub 2022 Oct 8.

FDA 189

FDA World Health Medicaid Medicaid 189

HIT Consultant

MAY 9, 2022

FAIR Health Monthly Telehealth Regional Tracker, February 2022, National. The FAIR Health data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid. percent nationally in February 2022, from 5.4 Telehealth Utilization Decline.

COVID-19 98

COVID-19 Medicare Medicare Medicaid 98

Medisys Compliance

JUNE 27, 2022

The Centers for Medicare and Medicaid Services (CMS) has announced a shift in its eligibility criteria for coverage of lung cancer screening using low-dose CT (LDCT), with implementation date of October 3 rd , 2022. CMS Announcement for Revised Coverage. Preventive Services Task Force recommendation.

Medicare 97

Medicare Medicare Medical Billing Medical Billing Outsourcing 97

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.

Medicaid 189

Medicaid Medicaid Medicare Medicare 189

Compliance Now

SEPTEMBER 27, 2022

The October 14, 2022 deadline by which plan sponsors that offer prescription drug coverage to provide notices of creditable or non-creditable coverage to Medicare-eligible individuals is fast approaching. Active employees who qualify for Medicare and their dependents. By: Lee Spiegel, Director, Compliance, MZQ Consulting.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Compliance Now

SEPTEMBER 28, 2022

The October 14, 2022 deadline by which plan sponsors that offer prescription drug coverage to provide notices of creditable or non-creditable coverage to Medicare-eligible individuals is fast approaching. Active employees who qualify for Medicare and their dependents. By: Lee Spiegel, Director, Compliance, MZQ Consulting.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Healthcare It News

OCTOBER 25, 2022

With those flexibilities due to sunset 151 days after the federal Public Health Emergency expires, HIMSS is calling on its members to contact their senators and representatives and urge them to extend coverage of telehealth services under Medicare until at least December 31, 2024.

COVID-19 264

COVID-19 Medicaid Medicaid Public Health 264

Bill of Health

MARCH 25, 2022

2022 Feb 9. 2022 Feb 3. 2022 Feb 24. 2022 Feb 9. 2022 Feb;97(2):250-260. 2022 Feb 9. 2022 Feb 21. 2022 Feb;23(2):e58. Medicaid Expenditures and Estimated Rebates on Line Extension Drugs, 2010-2018. 2022 Feb 22. 2022 Feb 10. 2022 Feb 19. 2022 Feb 1;182(2):228-229.

FDA 208

FDA COVID-19 Medicaid Medicaid 208

Kaiser Health News

FEBRUARY 8, 2022

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest. Paradoxically, all those hospitals have five stars, the best rating, on Medicare’s Care Compare website.

Medicare 127

Medicare Medicare Hospitals COVID-19 127

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.

Medicare 98

Medicare Medicare Medical Billing Medical Billing Outsourcing 98

HIT Consultant

NOVEMBER 30, 2022

Key Themes and Ideas Regarding Value-Based Care Reimbursement 2022. Significant Growth Anticipated for Medicaid and Capitation Contracts: Most respondents report strategic plans to expand their VBC contracts over the next three years.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Healthcare IT News - Telehealth

JANUARY 23, 2023

With Congress providing telehealth waivers as part of its omnibus spending bill at the close of 2022, delaying the "telehealth cliff" for two years, HIMSS says it's now ready to make the case for permanent reimbursement of virtual care. We now have three years of data on the impact to the Medicare Trust Fund," he said.

Medicare 188

Medicare Medicare Governance Medicaid 188

HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

Medicaid 98

Medicaid Medicaid Ransomware Health Insurance 98

Fierce Healthcare

NOVEMBER 2, 2023

The Centers for Medicare & Medicaid Services has dropped the final rule to remedy the invalidated 340B-acquired drug payment policy for calendar years 2018 to 2022. |

Hospitals 117

Hospitals Medicare Medicare Medicaid 117

Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. 2022 Dec 1;182(12):1321-1323. JAMA Intern Med. Johnston JL, Ross JS, Ramachandran R.

Medicare 147

Medicare Medicare Medicaid Medicaid 147

Fierce Healthcare

OCTOBER 24, 2023

The Center for Medicare and Medicaid Innovation (CMMI) unveiled 2022 calendar year results for the Direct Contracting Model on Monday. More than three-quarters of those who participated in the program reaped savings, data from CMMI revealed.

Medicaid 115

Medicaid Medicaid Medicare Medicare 115

Fierce Healthcare

DECEMBER 13, 2023

trillion, or $13,493 per person, according to a new report from the Centers for Medicare & Medicaid Services published in Health Affairs. trillion in 2022, or $13,493. Healthcare spending has increased 4.1% Health care spending increased to $4.5 Here's how that breaks down.

Medicaid 113

Medicaid Medicaid Medicare Medicare 113

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.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

American Medical Compliance

MARCH 6, 2025

By staying vigilant, you help protect Medicare enrollees, preserve the integrity of the Medicare Program, and safeguard the Medicare Trust Fund. It strictly prohibits intentional payments – whether monetary or in-kind – in exchange for referrals or securing business under programs like Medicare and Medicaid.

Fraud 52

Fraud Medicare Medicare Compliance 52

AIHC

NOVEMBER 12, 2024

2022 Jan;52(1):28-31. This article addresses how these privacy rights extend beyond rules designated under HIPAA and States passing rules banning unauthorized pelvic exams. 1],[2] UIEs are training and education-related examinations, including, but not limited to, pelvic, breast, prostate, and rectal examinations. April 1, 2024.

Informed Consent 98

Informed Consent HIPAA Compliance Hospitals 98

Healthcare IT News - Telehealth

FEBRUARY 3, 2023

An excepted benefit allows employers to finance additional medical care, like vision or dental coverage, according to the Centers for Medicare & Medicaid Services FAQs for insurance agents and brokers, requiring Congress to amend previous public health and funding laws. In an announcement about the bipartisan bill, Rep.

COVID-19 180

COVID-19 Public Health Medicare Medicare 180

Healthcare IT Today

JULY 23, 2022

Medical imaging vendor Intelerad announced a growth investment from TA Associates that is expected to close in the third quarter of 2022. Pediatric virtual behavioral health provider Brightline received a $10 million extended Series C investment from Northwell Health , which is the largest pediatric care provider in the state of New York.

Hospitals 88

Hospitals Medicaid Medicaid Medicare 88

Healthcare IT News - Telehealth

MARCH 2, 2023

WHY IT MATTERS The dual team study published by Epic found that 60% of the time, the virtual primary care telehealth appointments held between March 1, 2020, and October 15, 2022, did not result in subsequent doctors visits. They also looked at the differences in the rate of in-person follow-up based on a patient’s insurance coverage.

Doctors 189

Doctors Telemedicine Medicaid Medicaid 189

Innovaare Compliance

JUNE 28, 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.

Medicare 94

Medicare Medicare Prescription Drug Pricing Compliance 94

Bill of Health

SEPTEMBER 25, 2024

The Supreme Court will review a 2022 D.C. The plaintiffs argue that those enrolled in the SSI program at the time of hospitalization qualify, whereas the Department of Health and Human Services (HHS), which oversees the Centers for Medicare and Medicaid Services, argues that only those entitled to receive SSI cash payments qualify.

Medicare 100

Medicare Medicare Medicaid Medicaid 100