Medisys Compliance

APRIL 18, 2022

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. Many states are taking advantage of Medicaid program flexibility and federal financing to implement APMs in a variety of ways. Types of Alternative Payment Models.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

AIHC

JANUARY 28, 2022

For more information on filing compliance cost reports, attend the Medicare Cost Report Camp in March 2022 presented by KraftCPAs and sponsored by the American Institute of Healthcare Compliance. LTCHs are paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS).

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Hall Render

AUGUST 1, 2022

The proposed payment policies include an initial monthly facility fee of approximately $268,000 per month, which will adjust in future years based on a market-basket update. Public comments on the payments policies and other proposed policies are due September 13, 2022. Proposed REH Payments. 5 Percent OPPS Increase.

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Hall Render

MARCH 1, 2023

Following this reporting, impacted providers and teaching hospitals will have until May 15, 2023, to review reported payments and investments and to dispute any incorrect reports. For more details regarding the 2022 updates to the Sunshine Act reporting requirements, please access our prior alert here.

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Hospitals Payment Systems Nurses Medical Device Industry 40

Compliancy Group

OCTOBER 5, 2023

Under MACRA, the Centers for Medicare and Medicaid Services (CMS) created regulations to encourage healthcare providers to use secure health information technology. One of these incentives is the Merit-Based Incentive Payment System, or MIPS, program. The MIPS rules for 2023 are discussed below. What Are the MIPS Rules for 2023?

HIPAA 52

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C&M Health Law

DECEMBER 23, 2022

The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). Most of the Proposed Rule’s provisions will be effective on January 1, 2026. Our initial takeaways are summarized below.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

YouCompli

FEBRUARY 22, 2023

Price increases can sometimes result in inappropriate outlier payments. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS).

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Compliance US Department of Health and Human Services Overpayment Overpayments 52

Hall Render

NOVEMBER 6, 2024

CMS took regulatory action through the Calendar Year 2022 Home Health Prospective Payment System rule to extend those requirements through December 31, 2024. The COVID data reporting through the National Healthcare Safety Network (“NHSN”) was first required of nursing homes in May 2020 through an interim final rule.

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Verisys

JUNE 13, 2023

Centers for Medicare & Medicaid Services : The US Department of Health and Human Services has issued a final rule update concerning guidelines for COVID-19 vaccination requirements for Long-Term Care Facilities (LTC) and Intermediate Care for Individuals with Intellectual Disabilities (ICFs-IID). All are effective July 5, 2023.

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COVID-19 Vaccine US Department of Health and Human Services COVID-19 Licensing 52

AIHC

NOVEMBER 15, 2022

The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for enforcement and has been working with the American Hospital Association (AHA) to comply with challenges related to compliance. In June 2022, CMS issued CMP notices to two hospitals for failure to comply with the final rule.

Hospitals 52

Hospitals US Department of Health and Human Services Compliance Governance 52

AIHC

NOVEMBER 29, 2023

A 2022 report from the Commonwealth Fund U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. healthcare system were exorbitant. We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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%

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

C&M Health Law

AUGUST 10, 2022

On July 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment policies and rates for skilled nursing facilities (SNFs) and enacts changes to the SNF Quality Reporting Program and the SNF Value-Based Purchasing Program beginning in FY 2023.

Medicare 52

Medicare Medicare COVID-19 Nursing Homes 52

Hall Render

FEBRUARY 14, 2025

The Centers for Medicare & Medicaid Services (CMS) recently finalized a rule (Final Rule) that expands its ability to impose a Provisional Period of Enhanced Oversight (PPEO) on providers, including post-acute providers, reactivating their Medicare enrollment. CMS finalized new 42 CFR Sec. Specifically, new 42 CFR Sec.

Medicare 52

Medicare Medicare Compliance Payment Systems 52

Hall Render

SEPTEMBER 2, 2022

On July 26, 2022, the Centers for Medicaid and Medicare (“CMS”) published the 2023 Hospital Outpatient Prospective Payment System (OOPS) and Ambulatory Surgery Center Payment System Proposed Rule. CMS is currently seeking public comments to the proposed changes with comments due on September 13, 2022.

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Payment Systems Hospitals Medicare Medicare 40

HIT Consultant

JUNE 7, 2023

turnover , over the last 5 years, according to Daily Pay’s Healthcare Turnover Rates [2022 Edition]. Recently introduced by the Center for Medicare and Medicaid Services (CMS), remote therapeutic monitoring (RTM) codes are revolutionizing the way care is delivered. What’s contributing to such high levels of burnout?

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Payment Systems FDA Medicaid Medicaid 52

Redox

OCTOBER 12, 2023

In 2022, the FDA announced that some types of risk-scoring tools were to be regulated as medical devices. AI reimbursement Medicare and Medicaid are beginning to reimburse for AI applications on a per-use basis, though adoption is still in its infancy. 63, 20 May 2022. phData , 18 Feb. Accessed 3 Oct. NCSL, www.ncsl.org.

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FDA Medicare Medicare Hospitals 69

Hall Render

MAY 20, 2022

On May 10, 2022, CMS published its proposed revisions to the Inpatient Prospective Payment System for 2023. First, CMS proposed to update the way that it calculates direct GME (“DGME”) payments for fellows in some training programs, responding to the court’s decision in Milton S.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

AIHC

NOVEMBER 29, 2023

A 2022 report from the Commonwealth Fund U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes indicates that in 2021 the U.S. healthcare system were exorbitant. We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Medisys Compliance

JUNE 20, 2022

If a patient receiving home infusion therapy is also under a home health plan of care and receives a visit that is unrelated to the administration of the home infusion drug, then payment for the home health visit would be covered under the Home Health Prospective Payment System (HH PPS) and billed on the home health claim.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 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. in June 2022.

Medicare 52

Medicare Medicare Payment Systems COVID-19 52

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

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Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CY 2023 HH Payment Update. payment update. Permanent BA Adjustment Factor.

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COVID-19 Payment Systems Medicare Medicare 40

Health Care Law Brief

NOVEMBER 17, 2021

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its final rules for the 2022 Medicare Physician Fee Schedule (PFS Final Rule) and 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS Final Rule). 77492 (Dec.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Physician Credentialing Company

OCTOBER 25, 2024

Medicare and Medicaid may have different payment systems from those of the private health insurance plans. The lack of documentation may result in an audit, leading to claim denial and fines for noncompliance with Medicare and Medicaid regulations. 2022: $112.29 2021: $103.28 2020: $94.55 between 2020 to 2021.

Licensing 52

Licensing Medical Billing Telemedicine Medicare 52

Hall Render

MAY 2, 2023

In the CY 2022 Rule, CMS set December 31, 2024, as a termination date for most COVID SNF notification requirements. CMS ended several of the SNF blanket waivers in 2021 and 2022. The F-Tag associated with this regulation is F-884. The F-Tag associated with this regulation is F-885.

Nursing Homes 40

Nursing Homes Public Health Nurses COVID-19 40

Hall Render

NOVEMBER 28, 2023

On November 1, 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 Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. 7,137 2022 4,770 78.0% 7,872 2018 5,851 77.1%

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

Hall Render

MARCH 28, 2023

The end of the PHE has a significant impact on skilled nursing facilities (“SNFs”) as it ends the remaining regulatory blanket waivers, revisits resident Medicaid eligibility and changes many COVID regulations that were issued during the PHE. CMS ended several of the SNF blanket waivers in 2021 and 2022.

Public Health 40

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Health Law Advisor

NOVEMBER 2, 2022

In the 2023 Outpatient Prospective Payment System Final Rule (OPPS Final Rule), released in pre-publication form on November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) adopts final regulations governing REHs. CMS did not finalize the proposed exception for ownership or investment interests in an REH.

Medicare 52

Medicare Medicare Hospitals Malpractice 52

Hall Render

JULY 12, 2022

CMS recently announced the Enhancing Oncology Model (“EOM”), which will build on the Oncology Care Model that ended on June 30, 2022. The MEOS payment will be higher for beneficiaries dually eligible for Medicare and Medicaid. Applications will be accepted through September 30, 2022. PGP’s across the U.S.

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Healthcare IT Today

MARCH 12, 2023

Reports By the middle of 2022, behavioral health visit volume was 18% higher that pre-pandemic levels , according to an analysis from Trilliant Health. in January 2023 compared to January 2022) was offset by bad news about month-over-month margins (down 2.2% The good news about year-over-year margins (up 3.7% from December to January).

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Telemedicine Medicaid Medicaid Payment Systems 75

HIT Consultant

SEPTEMBER 7, 2021

The No Surprises Act, in addition to recent revisions to existing Centers for Medicare and Medicaid Services (CMS) price transparency regulations 1 and a policy push by President Biden 2 , aims to continue the trend toward more patient-centric healthcare that makes it easier for patients to navigate the inherent complexity. References.

Medical Billing 52

Medical Billing Hospitals Medicaid Medicaid 52

Hall Render

AUGUST 4, 2023

1 CMS final rule boosts Medicare hospice payments by 3.1% Will Nemours’ Medicaid move leave 10,000 special-needs kids behind? To Address SDOH Needs U.S. sues UnitedHealth over ‘thousands’ of denied claims What’s a fair price for a prescription drug?

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COVID-19 Nursing Homes Hospitals Nurses 40

Hall Render

DECEMBER 23, 2024

Nursing homes will also be required to provide individual notice to current and prospective residents and ombudsmen of exemption status and degree of noncompliance, and the Centers for Medicare & Medicaid Services (CMS) will post this information publicly on Care Compare. Nursing Home Provisions in the CY2025 Home Health Proposed Rule.

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Nursing Homes Nurses Compliance Medicare 40

Hall Render

SEPTEMBER 15, 2023

GoFundMe page RHODE ISLAND Police: RI Hospital nurse ‘violently assaulted’ by patient Blue Cross certifies 37 new LGBTQ Safe Zones Miriam Hospital attains national accreditation for rectal cancer care R.I.

US Department of Health and Human Services 40

US Department of Health and Human Services COVID-19 Nursing Homes Nurses 40

Hall Render

MARCH 15, 2024

of Labor projects 6000 health care job openings per year Negotiations between Local 17 Nurses and Providence St. Patrick Hospital to take place at later date St.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

APRIL 21, 2023

health-tech startup MemoryWell pivots, eyes new funding to roll out software for insurers Department of Veterans Affairs health system kicks off multiyear Greater Washington expansion Georgetown to open Southeast D.C.

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US Department of Health and Human Services COVID-19 Nursing Homes Nurses 40