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”).

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Healthcare It News

JUNE 13, 2023

THE LARGER TREND Food as medicine programs from Medicaid are being tested under the supervision of the Centers for Medicare and Medicaid Services through a framework for Health-Related Social Needs services under Section 1115s.

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Healthcare Law Today

NOVEMBER 30, 2022

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released its final 2023 Medicare Physician Fee Schedule (PFS) rule. Telehealth and other digital health modalities continue to increase in importance for Medicare populations and corresponding health care providers.

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Healthicity

NOVEMBER 4, 2022

2023 is fast approaching, and so are new changes from the Centers for Medicaid & Medicare (CMS)!

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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.

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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. 2023 Feb 25;S0012-3692(23)00301-X. 2023 Feb 7;329(5):386-392. 2023 Feb 13:e226444.

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HIPAA Journal

JANUARY 31, 2024

Report: Security Breaches in Healthcare (Direct Download PDF, 1.9MB, 16 pages) An unwanted record was set in 2023 with 725 large security breaches in healthcare reported to the Department of Health and Human Services (HHS) Office for Civil Rights (OCR), beating the record of 720 healthcare security breaches set the previous year.

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Fierce Healthcare

NOVEMBER 11, 2024

Accountable care organizations in the ACO Reach program can claim credit for saving the Centers for Medicare & Medicaid Services (CMS) hundreds of millions of dollars | CMS released favorable savings results for ACO REACH Model participants, as industry group NAACOS begins to push for the program's extension through 2030.

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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. COBRA participants who qualify for Medicare and their dependents.

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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. COBRA participants who qualify for Medicare and their dependents.

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HIPAA Journal

MARCH 6, 2023

The Department of Justice has announced one of its first prosecutions under the Medicare Access and CHIP Reauthorization Act of 2015 in a case involving the theft and sale of Medicare Beneficiary Identifiers. MACRA also made it illegal to buy, sell, or distribute Medicare Beneficiary Identifiers without proper authority.

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Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

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Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

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Center for Health Insurance Reform

MARCH 31, 2022

In the proposed Notice of Benefit and Payment Parameters for 2023, the Centers for Medicare & Medicaid Services asked for feedback on how to promote health equity through ACA marketplace operations and plan certification standards.

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Healthcare It News

OCTOBER 27, 2023

In previous years, the USDA has funded food equity programs through Medicare and Medicaid. Vilsack talked about a number of initiatives and noted that the Gus Schumacher Nutrition Incentive Program , which ends in 2023, funds fruit and vegetable purchases by SNAP participants and has a produce prescription program.

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Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology.

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Bill of Health

MARCH 27, 2024

Spravato is covered by Medicare Part B , which pays 80% of expenses. Luckily, many insurers do— Cigna , Aetna , Blue Cross Blue Shield , United Healthcare , Medicaid , and Medicare all provide coverage. As such, depending on coverage , Spravato can fall under either (or both) medical or pharmacy benefits.

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HIPAA Journal

MAY 23, 2023

Largest Healthcare Data Breaches Reported in April 2023 As previously mentioned, April saw a major data breach reported that affected 3,037,303 individuals – The third largest breach to be reported by a single HIPAA-covered entity so far this year, and the 19 th largest breach to be reported by a single HIPAA-regulated entity to date.

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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.

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HIT Consultant

JANUARY 18, 2023

Community pharmacists trusted to deliver care: In 2023, pharmacists will play an integral role as part of the team managing patient care for diseases like diabetes, hypertension, or multiple comorbidities. 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.

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Compliance Now

SEPTEMBER 28, 2023

By Lee Spiegel , Compliance Director, MZQ Consulting By October 13, 2023, plan sponsors that offer prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-eligible individuals. Have a deductible that is no more than $250/year.

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Compliance Now

SEPTEMBER 28, 2023

By Lee Spiegel , Compliance Director, MZQ Consulting By October 13, 2023, plan sponsors that offer prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-eligible individuals. Have a deductible that is no more than $250/year.

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Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018.

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MRO Compliance

JULY 12, 2023

Why quality measures are a crucial on-ramp to VBC July 12, 2023 HealthData Management Technology is key to success as health systems and providers opt in to value-based contracts and away from fee-for-service reimbursement.

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Healthcare IT Today

JANUARY 6, 2023

As we head into 2023, we wanted to kick off the new year with a series of 2023 Health IT predictions. We have seen unprecedented growth in the digital healthcare space and this momentum will only continue in 2023 – bringing more innovation, smarter technology, and impactful legislation and business initiatives.

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Provider Trust

APRIL 30, 2024

This year, as always, the Medicaid Fraud Control Units (MFCUs) released an annual report dissecting the exclusions, enforcements, and overall takeaways from their work throughout the previous fiscal year (FY). MFCUs reported 1,143 total convictions in FY 2023—a marked decrease from 1,327 convictions in FY 2022.

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Natalia Mazina

OCTOBER 30, 2022

The Act – at its core – gives CMS ability to negotiate drug prices for Medicare and Medicaid plans. By 2026, CMS will directly negotiate prices for selected drugs (initially the 10 most expensive drugs ). CMS does not anticipate that these new prices will result in lower pharmacy reimbursements. .

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Healthcare IT News - Telehealth

AUGUST 29, 2024

The American Telemedicine Association and ATA Action in a letter to the Centers for Medicare and Medicaid Services seeks to preserve pandemic-era Medicare telehealth flexibilities that it says are responsible for improving access to healthcare across the U.S. Permit access virtual cardiac and pulmonary rehabilitation services.

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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.

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HealthIT Answers

JANUARY 31, 2024

The Centers for Medicare & Medicaid Services opened data submission for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the Quality Payment Program. The post Reminder: MIPS 2023 Data Submission is Open appeared first on Health IT Answers.

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Bill of Health

SEPTEMBER 25, 2024

District Court summary judgment decision for the defendants as affirmed in 2023 by the DC Circuit Court of Appeals. DSH payments are administered as part of the Medicare program. The Supreme Court will review a 2022 D.C.

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Healthcare IT Today

MARCH 7, 2023

The company continues to be the largest network of independent primary care in the country, with more than two million patients covered by more than 150 value-based contracts across Medicare, Medicare Advantage, Medicaid and commercial payers. Originally announced February 21st, 2023

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Jane Sarashon

DECEMBER 18, 2024

But today we report out the latest data from the Centers for Medicare and Medicaid Services (CMS) that national health spending in America reached $4.9 trillion in 2023. between 2022 and 2023, more than 50% faster than from 2021-2022 (which was 4.6%. Nvidia could be a $5 trillion company in 2025, as could Amazon.

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Healthcare IT Today

MAY 28, 2024

I helped build the reference products like Blue Button and Data at the Point of Care at the Centers for Medicare and Medicaid Services that became part of these regulations. According to a 2023 study , some use cases could take years. For personal health records, this may be possible.

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The Health Law Firm Blog

JUNE 14, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

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