HIT Consultant

SEPTEMBER 27, 2024

billion in overpayments to MA plans with this new audit methodology over the next ten years. Improving coding training and best practices Achieving better risk adjustment results starts with ongoing training efforts and proactively planning for overpayments. million in overpayments to just one plan over the course of two years.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Health Care Law Brief

MAY 11, 2022

The vesting periods shall be up to two (per covered employer) six-month periods between October 1, 2021 and March 31, 2024 for which workers that are continuously employed by an employer during such six-month periods may become eligible for a bonus.

Medicaid 97

Medicaid Medicaid Overpayments Overpayment 97

HIT Consultant

MARCH 20, 2024

The HHS Office of Inspector General (OIG) recently reported that, from October 2014 through December 2016 , 153 audit reports were issued containing 193 overpayment recoveries totaling $648 million, largely due to errors in medical documentation.

Overpayments 52

Overpayments Overpayment 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.

Fraud 52

Fraud Compliance Overpayments Overpayment 52

Medisys Compliance

NOVEMBER 26, 2024

Exclusion management involves understanding the latest CB exclusions list, such as the 2024 update. Common Issues Impacting SNF Billing Compliance Improper Payments: Errors in coding or documentation can lead to overpayments or denials. Claims must reflect the terms of insurance contracts accurately.

Compliance 52

Compliance Medical Billing Outsourcing Medicare Medicare 52

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

Hall Render

AUGUST 4, 2023

CMS issued a final rule that will increase payments to SNFs by 4%, or $1.4B, starting in 2024. CMS described the increase as a “parity adjustment recalibration,” noting that it had previously overestimated overpayments to nursing homes, which resulted in an unintended reduction in reimbursement in 2023.

Hospitals 40

Hospitals Overpayments Overpayment Nursing Homes 40

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

Hall Render

AUGUST 1, 2024

On July 5, 2024, the Eighth Circuit Court of Appeals (“the Court”) ruled that a $7.5 Background The FCA allows private individuals (relators) to bring qui tam lawsuits for fraudulent claims resulting in federal overpayments. The AKS prohibits financial inducements for referrals in federal health programs.

Overpayments 40

Overpayments Overpayment Governance 40

Hall Render

AUGUST 1, 2024

On July 5, 2024, the Eighth Circuit Court of Appeals (“the Court”) ruled that a $7.5 Background The FCA allows private individuals (relators) to bring qui tam lawsuits for fraudulent claims resulting in federal overpayments. The AKS prohibits financial inducements for referrals in federal health programs.

Overpayments 40

Overpayments Overpayment Governance 40

Innovaare Compliance

MARCH 24, 2024

CY (Contract Year) 2024 Physician Fee Schedule Final Rule. Retrieved from [link] American Medical Association. 2021, April). 2020 AMA Prior Authorization (PA) Physician Survey. Retrieved from [link] Centers for Medicare & Medicaid Services.

Fraud 52

Fraud Compliance Health Insurance Medicaid 52

Innovaare Compliance

MARCH 24, 2024

CY (Contract Year) 2024 Physician Fee Schedule Final Rule. Retrieved from [link] American Medical Association. 2021, April). 2020 AMA Prior Authorization (PA) Physician Survey. Retrieved from [link] Centers for Medicare & Medicaid Services. The untold story: Controlling costs through payment integrity.

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

AIHC

OCTOBER 23, 2024

Corrective action includes refunding overpayments revealed during the audit. Federal law requires entities repay any overpayments received from Medicare or a State Medicaid program within 60 days after identification. This typically involves conducting Root Cause Analysis.

Compliance 52

Compliance Overpayments Overpayment Medicaid 52

C&M Health Law

DECEMBER 18, 2023

Starting in 2024, OIG will publish industry segment-specific compliance program guidance (ICPGs) for different types of providers, suppliers, and other participants in health care industry subsectors. (c)

Compliance 52

Compliance Compliance Officers Governance Overpayments 52

Hall Render

DECEMBER 11, 2024

On December 2, 2024, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) issued a proposed rule (Proposed Rule) that amended the regulations relating to exclusion authorities under the authority of OIG.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Hall Render

NOVEMBER 25, 2024

On November 20, 2024, the Office of Inspector General (“OIG”) for the U.S. The Nursing Facility ICPG provides that, even if an entity makes an isolated billing error, the entity still has an obligation to repay the overpayment to the government to avoid False Claims Act liability, as explained in the GCPG.

Nurses 40

Nurses Compliance Compliance Officers Medicare 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?

Nursing Homes 40

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.’ Health Policy Commission still missing key document in Steward sale to Optum Local obesity drug developer lands deal worth up to $600M with Novo Nordisk Mass.

Nursing Homes 40

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”). We’ve summarized some of the key changes in the Proposed Rule. Comments on due February 13, 2023. Star Ratings.

Medicare 52

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.

Nursing Homes 40

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

Hospitals 40

Hospitals Overpayments Overpayment 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

US Department of Health and Human Services 40

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

Healthcare IT Today

JANUARY 13, 2025

Melissa James, Senior Consultant, Health Language at Wolters Kluwer Health The 2024 OIG reports revealed significant overpayments tied to unsupported diagnosis codes, underscoring the urgent need for MAOs to bolster their compliance efforts.

Compliance 99

Compliance Compliance Framework HIPAA Governance 99

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? ’ NEVADA Gov.

Nursing Homes 40

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?’

Nursing Homes 40

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%

Nursing Homes 40

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?

US Department of Health and Human Services 40

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

Nursing Homes 40

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.

US Department of Health and Human Services 40

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

HealthLaw Prof Blog

JULY 1, 2024

Work Overpayments Among New Social Security Disability Insurance Beneficiaries, 84 Soc. Bulletin (2024): In this article, the authors track. Denise Hoffman (University of Michigan at Ann Arbor), Monica Farid (Mathematica), John T. Jones (Mathematica), Serge Lukashanets (Mathematica), et al.,

Overpayments 40

Overpayments Overpayment 40