American Medical Compliance

FEBRUARY 9, 2024

In this blog, we will explore the crucial role of compliance officers in healthcare organizations, shedding light on the challenges they face and the formidable responsibilities they shoulder. It is not just about following rules but about maintaining the highest standards of patient care and ethical behavior.

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Health Populi

FEBRUARY 5, 2020

Americans who have commercial health insurance (say, through an employer or union) are rarely thought to face barriers to receiving health care — in particular, primary care, that front line provider and on-ramp to the health care system.

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Compliancy Group

MARCH 19, 2024

In this blog, we’ll outline the fundamentals and importance of regulatory compliance in healthcare in the U.S. Department of Health and Human Services (HHS) enforces laws relevant to patient care, healthcare delivery and billing, and workplace safety in the U.S. Regulatory compliance in healthcare ensures quality care for patients.

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Healthcare Blog

NOVEMBER 9, 2023

The healthcare industry has extensive regulations, with laws such as the Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA) imposing stringent obligations on providers.

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Medisys Compliance

NOVEMBER 6, 2023

This blog will provide a comprehensive orthopedic billing compliance checklist that healthcare providers can use to verify that their billing practices are compliant with all applicable laws and regulations. Accurate coding helps prevent under-billing or overbilling. Stay up-to-date on all changes to regulatory requirements.

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Health Populi

OCTOBER 22, 2019

Punctuating the issue of costs, being able to pay for health care tops Americans’ list of the most important characteristic in the health care system — above being seen by a doctor in a timely matter/not long wait, sufficient time to spend with a doctor, access to specialists, prevention, and a choice of health plans.

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Center for Health Insurance Reform

JUNE 10, 2024

In a new post for the Commonwealth Fund's To The Point blog, CHIR's Jalisa Clark and Christine H. Monahan describe how Washington and California's quality programs are focusing on equity and highlight opportunities for other state-based marketplaces to similarly strengthen their own quality programs.

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MedTrainer

JANUARY 12, 2024

The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. HIPAA (1996): The Health Insurance Portability and Accountability Act (HIPAA) established strict standards for patient data privacy and security.

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Physician Credentialing Company

MAY 16, 2024

PHOs typically offer a wide range of services, including administrative support, billing and collections, and electronic health records (EHR) systems. IPAs offer centralized management services to aid in clinical and non-clinical operations, such as utilization review, quality assurance programs, and group purchasing.

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C&M Health Law

FEBRUARY 11, 2022

Together, the Tri-agencies’ report and EBSA fact sheet provide additional, important information for group health plans and health insurance issuers looking to comply with the 2021 Consolidated Appropriations Act’s (“CAA”) non-quantitative treatment limitation (“NQTL”) comparative analysis requirements.

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YouCompli

AUGUST 9, 2023

From a compliance perspective, this means supporting care teams based on the principles of social determinants of health (SDOH), such as understanding how to access affordable health insurance or obtaining transportation for follow-up appointments.

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Health Populi

MARCH 15, 2018

Move care to the home via telehealth, enabled through net-neutral broadband, can help if we treat connectivity as a social determinant/public utility the way public health looks at clean air and clean water. Consumers who use more primary care can lower healthcare costs, as this blog in Health Affairs pointed out this week.

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MedTrainer

JANUARY 26, 2024

healthcare providers – health systems, hospitals and post-acute care facilities – must comply with 629 discrete regulatory requirements across nine domains. At the top of the list is the Health Insurance Portability and Accountability Act (HIPAA).

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MedTrainer

MARCH 28, 2024

In this blog, we’ll outline the many roles that impact healthcare compliance , the pros and cons of each role’s management responsibilities, and what each is accountable for in concert with the others. But that’s only one aspect of this complex – and sometimes confusing – process.

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Healthcare Law Blog

MARCH 20, 2023

1] In addition to the challenges presented by provider shortages, even when patients are able to locate an available mental health provider, many are hesitant to engage in treatment due to cost uncertainties, which often arise due to limited availability for in-network care and the subsequent need to seek out-of-network care. [2]

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MedTrainer

AUGUST 31, 2023

Some common healthcare compliance regulations include the Health Insurance Portability and Accountability Act (HIPAA) for patient privacy, Stark Law for physician referrals, Anti-Kickback Statute for healthcare fraud and abuse, and the Affordable Care Act (ACA) for various provisions related to healthcare organizations and insurance providers.

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Healthcare Blog

NOVEMBER 9, 2023

The healthcare industry has extensive regulations, with laws such as the Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA) imposing stringent obligations on providers.

Compliance 52

Compliance Compliance Officers ACA Patient Satisfaction 52

MedTrainer

JANUARY 31, 2024

The introduction of laws like the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and the Medicare Modernization Act have added layers of complexity to healthcare compliance.

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VW Health Care Law Blog

JULY 8, 2019

Departments of the Treasury, Labor, and Health and Human Services (the Departments) issued a final rule allowing employers to use pretax dollars to subsidize employee premiums in the individual health insurance market. Now, employers … Continue reading Integrated HRAs.

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MedTrainer

APRIL 8, 2024

These requirements include but are not limited to: Health Insurance Portability and Accountability Act (HIPAA): Protects the privacy and security of patients’ health information. Affordable Care Act (ACA): Ensures access to affordable healthcare and prevents fraud and abuse.

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MedTrainer

AUGUST 2, 2023

They evaluate whether healthcare organizations comply with laws such as the Health Insurance Portability and Accountability Act (HIPAA) , the Affordable Care Act (ACA), and other industry-specific regulations.

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Healthcare Law Blog

DECEMBER 15, 2022

In this post, we focus on the potential impact on MAOs of 1) the payer-to-payer data exchange and 2) prior authorization requirements.

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Center for Health Insurance Reform

JANUARY 20, 2022

The federal government has taken a series of actions to strengthen the Affordable Care Act (ACA) and Medicaid, and the Biden administration has announced its intent to do more in this arena.

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Center for Health Insurance Reform

MARCH 1, 2024

In November, the Biden administration released the proposed Notice of Benefits and Payment Parameters for plan year 2025, an annual rule setting standards for the Affordable Care Act (ACA) Marketplaces and health insurers.

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ACA Health Insurance 98

MedTrainer

NOVEMBER 15, 2023

Medicaid: a joint state and federal program that provides health coverage to some people with limited income, including families and children, pregnant women, the elderly, and people with disabilities. The Health Insurance Marketplaces: created under the Affordable Care Act (ACA) to enable individuals to find health coverage.

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Hall Render

JULY 8, 2024

Although Section 1557 took effect immediately upon the signing of the Affordable Care Act (“ACA”), a final rule was not promulgated until 2016 (the “2016 Rule”). Nondiscrimination in health insurance coverage and other health-related coverage (§ 92.207(b)(6)) By the first day of the first plan year beginning on or after January 1, 2025.

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Healthcare Law Blog

APRIL 6, 2022

The new state plan option allows state Medicaid and Children’s Health Insurance Program (“CHIP”) agencies to provide 12 months of continuous postpartum coverage, regardless of any changes in circumstances, through a state plan amendment (“SPA”). This option is available for five years and ends on March 31, 2027.

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Medicaid Medicaid ACA Public Health 52

Bill of Health

MAY 12, 2023

Frequently, in these low-wage positions, workers earn just enough to pay for their health insurance premiums and sometimes the associated cost-sharing requirements. The infertility shift further distorts the already fun-house mirror effects of employer-sponsored insurance on the labor economy.

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Healthcare Law Blog

JANUARY 26, 2023

The amendment defines healthcare entity to include any individual physician or other healthcare professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of healthcare facility, organization, or plan.

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Bill of Health

NOVEMBER 9, 2023

has some of the world’s leading medical facilities and research institutions, and the ability to deliver the highest available quality of care, it ranks last among rich nations in providing equitable, accessible, affordable, and high-quality health care. America is the only wealthy nation to lack universal health coverage.

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Hall Render

MAY 2, 2023

Guidance from the DOL reminds group health plans and health insurance issuers are required to notify in advance their participants, beneficiaries, and/or enrollees of reductions in benefits, which could include changes in coverage of COVID-19 diagnosis and treatment, including testing.

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Healthcare Law Blog

AUGUST 25, 2022

Additional updates of note include: ACA Premium Tax Credit Eligibility. The IRA includes a three-year extension of enhanced financial assistance for people enrolled in health insurance through the marketplaces under the Affordable Care Act. For more information on this final rule, see our blog. Other Updates.

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Health Populi

NOVEMBER 5, 2018

In my 11 years of writing every one of over 2,000 Health Populi posts on this blog, I have never, ever mentioned the “f-word” here. In this case, I feel it’s important to capture the Zeitgeist of the Republican Party’s commitment to cutting down the ACA since President Trump took office in January 2017.

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Healthcare Law Blog

MAY 17, 2022

The 2023 NBPP final rule makes regulatory changes in the individual and small group health insurance markets and establishes requirements for the 2023 benefit year. Clayton County. This provision was strongly supported by various stakeholders.

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Healthcare Law Blog

JANUARY 4, 2023

The HHS Notice of Benefit and Payment Parameters for 2024 (“Proposed Rule”) would streamline ACA health plan selection, simplify marketplace enrollment, and expand access to care for low-income and medically underserved consumers through revision of network adequacy and essential community provider (“ECP”) standards.

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Kaiser Health News

JULY 24, 2023

House Republicans have advanced a package of bills that could reduce health insurance costs for certain businesses and consumers, partly by rolling back some consumer protections. Health policy experts aren’t surprised. Chan School of Public Health in Boston, who worked on the original ACA legislation.

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Center for Health Insurance Reform

FEBRUARY 18, 2022

In a new post for the Commonwealth Fund’s To the Point blog, CHIR’s Justin Giovannelli examines current state and federal approaches to network adequacy, and what would change under the new standards proposed by the Biden administration.

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