MRO Compliance

FEBRUARY 3, 2025

HEDIS audits are important for Medicare and Medicaid health plans because data is used to determine the efficacy of a payer to care for its members. For Medicare Advantage plans, the HEDIS review process contributes to the Star Rating system, which evaluates plan quality. Explore the HEDIS MY 2024 Measure Descriptions Guide.

Patient Satisfaction 147

Patient Satisfaction Compliance Medicare Medicare 147

HealthIT Answers

MARCH 11, 2025

This is notification that eligible hospitals and critical access hospitals participating in the Centers for Medicare & Medicaid Services Promoting Interoperability Program that there is an upcoming data submission deadline on March 14, 2025, at 11:59 p.m. Pacific Time.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Fierce Healthcare

JUNE 4, 2024

SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services (CMS) inappropriately calculated its star ratings for the 2024 plan | SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services inappropriately calculated (..)

Medicare 117

Medicare Medicare Medicaid Medicaid 117

Compliancy Group

JANUARY 31, 2025

The most shocking part is that the Change Healthcare breach wasnt the only massive breach in 2024. With 2024 behind us, its time to take a look at the years most significant breaches. On June 20, 2024, OCR updated its guidance after courts found a portion of its previous guidance unlawful. Not so shocking? The damage?

Ransomware 52

Ransomware HIPAA Medicare Medicare 52

Healthcare IT Today

DECEMBER 22, 2024

Access to home health for Medicare beneficiaries is decreasing , according to a recent report from Trella Health, with the number of home health visits per day down more than 17% between 2017 and 2023. That said, rejection rates hit a trough in 2018 and have increased 16% since then.

Medicare 87

Medicare Medicare FDA Telemedicine 87

AIHC

NOVEMBER 12, 2024

Written by Gabriella Neff, RHIA, CHA, CHC, CHRC, CHPC This past year, in 2024, revisions were made to clarify hospital guidelines related to informed consent specifically addressing UIEs (unconsented intimate exams) to patients while under anesthesia. April 1, 2024. April 1, 2024. April 1, 2024. April 3, 2024.

Informed Consent 98

Informed Consent HIPAA Compliance Hospitals 98

Healthcare IT Today

JANUARY 23, 2025

Shah, Co-Founder and CEO at Dina Payers Lean on Technology to Coordinate New Innovative Supplemental Benefits to Improve Quality, Outcomes, and Costs for Seniors Non-medical supplemental benefits like in-home support services, meal delivery, home modifications, and transportation have skyrocketed with Medicare Advantage (MA) plans.

Medicare 96

Medicare Medicare Medicaid Medicaid 96

Healthcare It News

OCTOBER 31, 2022

With the Centers for Medicare & Medicaid Services mandating hospitals be ready to report on SDOH screening quality in 2024, a multi-stakeholder effort to advance an FHIR-based approach is needed to help providers meet CMS requirements, according to HL7 CEO Dr.

Licensing 342

Licensing Medicaid Medicaid Health Outcomes 342

Modern Healthcare

JULY 31, 2023

Skilled nursing faciltiies will receive a higher Medicare pay bump in fiscal 2024 than proposed by the Centers for Medicare and Medicaid Services in April.

Nursing Homes 80

Nursing Homes Medicare Medicare Nurses 80

HIPAA Journal

MARCH 28, 2025

The email account was secured the same day, and the forensic investigation confirmed the account was compromised from December 2 to December 4, 2024. This breach also involved a compromised email account and was detected by Restorix on May 30, 2024. Restorix sent notification letters to the affected patients on December 18, 2024.

Licensing 63

Licensing Health Insurance HIPAA Medicaid 63

Hall Render

JANUARY 29, 2025

The Centers for Medicare & Medicaid Services (CMS) is reinforcing its emphasis on hospice quality of care and identifying fraud. Hospice surveys are performed before their initial certification for Medicare participation. Identifying Fraud : Detecting practices that jeopardize patient safety or Medicare program integrity.

Fraud 80

Fraud Medicare Medicare Compliance 80

Modern Healthcare

JULY 3, 2023

Nursing homes, rehab providers and psychiatric hospitals urged the Centers for Medicare and Medicaid Services to account for economic conditions in fiscal 2024 rates

Medicare 93

Medicare Medicare Nursing Homes Medicaid 93

Fierce Healthcare

JULY 13, 2023

The Centers for Medicare & Medicaid Services has released its proposed Medicare payment rates and policy updates under the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory S | The CY 2024 OPPS and ASC Payment System Proposed Rule includes a 2.8%

Payment Systems 98

Payment Systems Medicare Medicare Medicaid 98

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.

Medicare 150

Medicare Medicare Medicaid Medicaid 150

HIT Consultant

JULY 16, 2024

Anish Sebastian, CEO and Co-founder, Babyscripts A discussion of technology and the Medicaid population inevitably raises the topic of the digital divide — that is, the gap between people who have access to modern information and communications technology (ICTs) and those who don’t. “We But there’s a lot of reasons to be optimistic.

Medicaid 105

Medicaid Medicaid Health Insurance Health Outcomes 105

MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

Medicare 93

Medicare Medicare Compliance Medicaid 93

HIT Consultant

APRIL 19, 2024

Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule.

Nurses 102

Nurses Medicare Medicare Medicaid 102

Modern Healthcare

MARCH 31, 2023

The Centers for Medicare and Medicaid Services estimates health insurance companies will see a 3.32% increase in Medicare Advantage revenue next year.

Medicare 80

Medicare Medicare Health Insurance Medicaid 80

Healthcare It News

APRIL 5, 2024

During open enrollment for the 2024 plan year, the AI agent handled 14.5% of calls to affiliated brokers or Nevada Medicaid – about 2,100 additional calls. of the call center's demand, approximately 2,700 calls. Also, it transferred another 9.6%

US Department of Health and Human Services 312

US Department of Health and Human Services Medicaid Medicaid Hospitals 312

Center for Health Insurance Reform

MARCH 31, 2023

With the twin goals of building on the enrollment gains and improving the consumer experience, the Centers for Medicare & Medicaid Services (CMS) has proposed an annual set of requirements. Stakeholder Perspectives on CMS’s 2024 Notice of Benefit and Payment Parameters: Health Insurers

Health Insurance 97

Health Insurance ACA Medicaid Medicaid 97

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

Healthcare IT Today

JANUARY 4, 2024

As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. We believe that trend will accelerate further in 2024 as obesity medication options and supply grow. In 2024, nurse leaders will drive the paradigm shift toward AI-enabled virtual nursing.

Nurses 95

Nurses Medicaid Medicaid Medicare 95

Medisys Compliance

JULY 15, 2024

Introduction As an internal medicine practitioner, staying updated with the latest Medicare billing changes is crucial for maximizing reimbursements and ensuring compliance. In 2024, several significant updates have been introduced that directly impact the billing processes for internal medicine.

Medicare 59

Medicare Medicare Medical Billing Outsourcing COVID-19 59

Healthcare IT Today

JANUARY 5, 2024

As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. With legislation currently being drafted for nurses to receive the same reimbursement doctors and physicians do, this will likely become a top-of-mind topic in 2024.

Nurses 105

Nurses Medicare Medicare Medicaid 105

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.”

Medicaid 100

Medicaid Medicaid COVID-19 Compliance 100

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.”

Medicaid 100

Medicaid Medicaid COVID-19 Compliance 100

HIT Consultant

SEPTEMBER 27, 2024

Power 2024 U.S. Power 2024 U.S. The data is based on responses from 4,070 healthcare customers who utilized telehealth services in the past year, collected between September 2023 and July 2024. In contrast, Medicare and private insurance beneficiaries, suburban residents, and older generations report lower satisfaction.

Patient Satisfaction 105

Patient Satisfaction Medicaid Medicaid Public Health 105

MedTrainer

JANUARY 10, 2024

It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024. It may seem a little early to do some spring cleaning, but not when it comes to compliance!

Compliance 94

Compliance Fraud HIPAA Compliance Officers 94

Compliancy Group

OCTOBER 28, 2024

Its compliance program guidance (CPG) has improved the efficiency and effectiveness of Medicare and many other federal programs. Last November, the OIG published industry-specific compliance guidance for 2024 for several healthcare subsectors, including nursing homes and facilities.

Nurses 52

Nurses Compliance Nursing Homes Compliance Officers 52

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.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

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.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Fierce Healthcare

NOVEMBER 1, 2023

Centers for Medicare & Medicaid Services (CMS) released a rule Wednesday that increases the 2024 home health payments by 0.8%, or $140 million. | CMS' new proposed rule will increase home health payments by 0.8%, or $140M, among other changes.

Medicaid 117

Medicaid Medicaid Medicare Medicare 117

Modern Healthcare

MARCH 31, 2023

The Centers for Medicare and Medicaid Services proposed a 2.8% increase in hospice payments for fiscal 2024, which would amount to $720 million across the sector.

Medicaid 112

Medicaid Medicaid Medicare Medicare 112

Fierce Healthcare

JANUARY 29, 2024

In 2024, 50 accountable care organizations are new to the Medicare Shared Savings Program and 71 ACOs renewed participation, according to new numbers released by Centers for Medicare & Medicaid | CMS released new data Monday showing ACO participation in the Medicare Shared Savings Program, with 19 ACOs set to participate in a new payment option, (..)

Medicare 109

Medicare Medicare Medicaid Medicaid 109

Medisys Compliance

JULY 19, 2024

Introduction The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. Expanded Telehealth Services One of the most notable changes in Medicare/Medicaid billing for behavioral health is the expanded coverage for telehealth services. All rights reserved.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HealthIT Answers

MARCH 28, 2025

The Centers for Medicare & Medicaid Services would like to remind clinicians of important upcoming MIPS dates and deadlines for the 2024 performance year, including changes to the Targeted Review timeline effective this year.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Fierce Healthcare

JUNE 12, 2023

Industry hospital groups are pushing the Centers for Medicare & Medicaid Services to consider a higher annual pay bump and to shed some light on why it believes the number of uninsured patients | Public comments submitted to CMS by the hospital lobby were critical of a "woefully inadequate" 2.8%

Hospitals 119

Hospitals Payment Systems Medicaid Medicaid 119