AIHC

SEPTEMBER 30, 2024

Medicare & the OIG are performing Risk Adjustment audits, are you? This was originally mandated by the Centers for Medicare & Medicaid Services (CMS) back in 1997 and implemented in 2004. Recent OIG reports of risk adjustment audits published in September 2024 indicate noncompliance with Federal requirements.

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Overpayments Overpayment Compliance Medicare 52

HIT Consultant

SEPTEMBER 27, 2024

Increasingly rigorous oversight from the Centers for Medicare & Medicaid Services (CMS) and Office of the Inspector General (OIG) are calling for better diligence, planning and administrative oversight for effective risk adjustment. billion in overpayments to MA plans with this new audit methodology over the next ten years.

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Overpayments Overpayment Medicare Medicare 52

Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. Compliance requires strict attention to billing guidelines, proper coding, and understanding Medicare rules such as the Consolidated Billing (CB) policy.

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Compliance Medical Billing Outsourcing Medicare Medicare 52

HIT Consultant

MARCH 20, 2024

The Centers for Medicare and Medicaid Services (CMS) estimated that for payment year 2018 alone , it will recover $428.4 To address these concerns and other matters, CMS announced significant regulatory changes to the Medicare Advantage (MA) program beginning in 2024. million (net) and $4.7

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Overpayment Overpayments Medicare Medicare 52

AIHC

FEBRUARY 17, 2025

There are also self-reporting mechanisms in place to report overpayments on the OIG website ( Self-Disclosure ) and Self-Referral Disclosure for voluntary self-reporting of overpayments on the Centers for Medicare and Medicaid Services (CMS) website. loss; whereas Managers caused a massive $184,000.00 median loss.

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Fraud Compliance Overpayment Overpayments 52

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. Retrieved from [link] Centers for Medicare & Medicaid Services. Retrieved from [link] Centers for Medicare & Medicaid Services.

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Fraud Compliance Health Insurance Medicaid 52

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. Retrieved from [link] Centers for Medicare & Medicaid Services. CY (Contract Year) 2024 Physician Fee Schedule Final Rule. 2021, April).

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Fraud Health Insurance Medicaid Medicaid 52

AIHC

OCTOBER 23, 2024

Examples of these types of audits would be a Joint Commission, or CMS (Centers for Medicare and Medicaid Services) contractor audit. Corrective action includes refunding overpayments revealed during the audit. Independence of the audit organization is a key component of a third-party audit.

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Compliance Overpayment Overpayments Medicaid 52

Hall Render

NOVEMBER 25, 2024

On November 20, 2024, the Office of Inspector General (“OIG”) for the U.S. When a nursing facility submits a claim to Medicare or Medicaid for reimbursement, the claim submission form includes certifications that the claimed services were provided in compliance with all applicable statutes, regulations and rules.

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Nurses Compliance Compliance Officers Medicare 40

Hall Render

DECEMBER 11, 2024

On December 2, 2024, the Office of Inspector General (OIG) for the U.S. The section currently requires OIG to take into account access of beneficiaries to physician services for which payment may be made under Medicare, Medicaid or other federal health care programs in determining whether to impose an exclusion.

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Compliance Licensing Nurses Medicaid 40

Hall Render

FEBRUARY 23, 2024

hospital sees less severe cases Georgia Supreme Court vacates judgement in case with Northside Hospital, NGMC Poor Health: How Is Georgia Addressing The State’s Mental Health Woes?

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Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

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Nursing Homes Nurses Hospitals Medicaid 40

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Health Equity in Medicare Advantage. We’ve summarized some of the key changes in the Proposed Rule.

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Medicare Medicare Medicaid Medicaid 52

Hall Render

APRIL 26, 2024

lays off 1,000 workers New York ASC sued following July data breach New York governor reaches deal to keep SUNY Downstate open See who tops the 2024 Independent Living Communities List New York health system names network VP of revenue cycle SUNY Downstate gets $300M in New York 2025 budget Changing demographics in nursing homes across N.Y.

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

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M

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

Hall Render

DECEMBER 31, 2024

The $5,000 limit is adjusted annually for inflation and will increase from the 2024 limit of $5,913 to $6,055 beginning January 1, 2025, for the 2025 calendar year. The post 2025 Non-Monetary Compensation to Physicians (and Chance to Review 2024) appeared first on Law Firm | Health Care Law Firm in the USA | Hall Render.

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Hospitals Overpayment Overpayments Medicaid 40

Hall Render

APRIL 19, 2024

to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M Can lawmakers do anything about it?

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Nursing Homes Nurses Hospitals Doctors 40

Hall Render

JANUARY 19, 2024

Bipartisan Ky. hospital company Kansas City Orthopaedic Institute appoints new CEO Kansas City University’s new research center aims to answer: ‘How do we keep people well?’

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Nursing Homes Nurses COVID-19 Hospitals 40

Hall Render

NOVEMBER 10, 2023

NATIONAL 340B repayments welcomed but concern remains, hospital group says 4 pieces of legislation fighting to alleviate the physician shortage crisis AHA Files Lawsuit Challenging HHS Guidance on Tracking Technologies AHA says 3.1%

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Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

MARCH 15, 2024

NATIONAL 3 things to expect from the pharmaceutical supply chain in 2024 Absence of AI hospital rules worries nurses American Academy of Dermatology votes to keep its diversity policies after anti-DEI proposal Are digital health partnerships replacing M&A?

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

Hall Render

MARCH 22, 2024

To qualify, facilities must close their beds Amazon’s physician acquisition strategy As Many Hospitals Continue to Face Significant Financial Challenges, MedPAC Recommends Highest Ever Medicare Payment Update Change competitors step in but breaking up may be hard to do CMS to launch new primary care ACO program Congress unveils $1.2T

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

Hall Render

MARCH 7, 2025

in 2024 Lilly cuts undisclosed number of jobs, nothing large scale Several Indiana health care measures focus on the 340B Drug Pricing Program. expansion Mayo Clinic to invest nearly $2 billion in Valley hospital campus, hire thousands Mayo plans $1.9B Vincent Hot Springs Walker Foundation Donates $1.5M What is it? operating income, 6.5%

US Department of Health and Human Services 40

US Department of Health and Human Services Medicaid Medicaid Nursing Homes 40

Hall Render

FEBRUARY 21, 2025

billion in 2024 Cone Health opens virtual care at housing complex: 5 notes Cone Health board chair and community leader will represent system on Risant Health board NC DHHS denies Novant Healths request for $287M Triangle hospital North Carolina needs more doctors. Patients are noticing.

US Department of Health and Human Services 40

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

Hall Render

APRIL 4, 2025

Hospital price lists remain largely unhelpful Leapfrog makes updates to annual hospital survey Nonprofit hospital margins flipped positive in 2024: Fitch Oracle Health Breach Affects Patients of Multiple U.S. appoints new medical staff officers Morris Plains Resident Appointed to Serve as Infection Preventionist at Atlantic Medical Group N.J.

US Department of Health and Human Services 40

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