Jane Sarashon

FEBRUARY 27, 2024

NABIP, whose members represent professionals in the health insurance benefits industry, drafted and adopted a new American Healthcare Consumer Bill of Rights launched at the meeting. Health Populi’s Hot Points: Is there an American Civil Right for health care?

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ACA Prescription Drug Pricing Health Insurance Hospitals 118

Bill of Health

JANUARY 26, 2022

In other words, both convicted individuals and those still presumed innocent are stripped of their access to the federal health insurance program for low-income individuals. Gamble (1976), affirmed that incarcerated individuals have the constitutional right to health care. The Humane Correctional Health Care Act (H.R.3514)

Medicaid 299

Medicaid Medicaid COVID-19 Public Health 299

Kaiser Health News

JULY 6, 2022

. “There are still some gaps that need to be filled,” said Katie Keith, a researcher at the Center on Health Insurance Reforms at Georgetown University. Medicare covers stool tests or flexible sigmoidoscopies, which screen for colon cancer, without cost sharing starting at age 50. The ACA does set parameters.

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ACA Medicare Medicare Medicaid 87

Center for Health Insurance Reform

FEBRUARY 10, 2022

Continue reading → The post January Research Roundup: What We’re Reading appeared first on Center on Health Insurance Reforms.

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Health Insurance Medicare Medicare ACA 98

Health Populi

MARCH 11, 2021

health care, patient assistance programs, Medicare Advantage plans, and the bundling of proven high-value preventive services into the Affordable Care Act. These services are enumerated in Section 2713 in the ACA , prompting Dr. Kavita Patel to assert in the first panel of the day that, “2713 is my favorite number.”

Health Insurance 101

Health Insurance ACA Medicare Medicare 101

Compliancy Group

MARCH 19, 2024

Also, all insurance and Medicare or Medicaid claims must only include charges for services and treatments ordered and deemed necessary. Department of Health and Human Services (HHS) enforces laws relevant to patient care, healthcare delivery and billing, and workplace safety in the U.S. name, phone number).

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Regulatory Compliance Compliance US Department of Health and Human Services ACA 52

MedTrainer

JANUARY 12, 2024

The adoption of electronic health records (EHRs), telemedicine , and data analytics has brought about new challenges and opportunities. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. Compliance efforts expanded to encompass EHR security.

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Compliance HIPAA Telemedicine ACA 52

Kaiser Health News

JANUARY 19, 2022

” The changes are part of a 400-page proposed rule governing the federal health insurance marketplace and a few states that use the federal platform for their own exchanges. Under the ACA, sliding-scale subsidies are available to help low- and moderate-income people buy coverage.

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ACA Health Insurance Licensing Governance 80

Compliancy Group

JANUARY 3, 2024

Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices. It pays to know the law and avoid temptations to cut corners.

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Medical Billing Compliance ACA Health Insurance 52

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. Additionally, MSOs must adhere to federal anti-kickback statutes and the Stark Law, which forbid financial incentives in patient referrals involving Medicare and Medicaid services.

Compliance 52

Compliance ACA Health Insurance Hospitals 52

Medisys Compliance

NOVEMBER 6, 2023

Compliance with Regulatory Guidelines Ensure that all claims are submitted per all applicable laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and the Medicare Fraud, Waste, and Abuse (FWA) laws.

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Compliance Medical Billing Outsourcing Medical Billing ACA 59

Center for Health Insurance Reform

JUNE 14, 2024

This month we read about the effects of health risk assessments on Medicare Advantage payments, how the Affordable Care Act transformed the healthcare landscape in this country, and finally, about hospital pricing and the values of transparency. The days are heating up and so is the summer research!

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Medicare Medicare Hospitals ACA 59

Bill of Health

APRIL 13, 2022

After the PHE, states can facilitate smooth transitions for those no longer eligible for Medicaid by taking advantage of the full 12- to 14- month period that the Centers for Medicare & Medicaid Services (CMS) has established for redetermining eligibility. What States Are Doing Now.

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Medicaid Medicaid COVID-19 Public Health 147

Health Populi

JUNE 2, 2021

The team also calculated annual health care costs per individual, which are expected to be $6,516 in 2021, about 7.6% Each year, I figure out what the average PPO cost could buy someone in exchange for that health insurance. adults living in 17 States and DC who had one of five types of health care coverage, public and private.

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COVID-19 Health Insurance Health Outcomes Public Health 174

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. Medicare Access and CHIP Reauthorization Act (MACRA): Promotes value-based care and rewards healthcare providers for quality and performance.

Compliance 52

Compliance Governance ACA HIPAA 52

MedTrainer

JUNE 28, 2023

From sophisticated Medicare fraud to a rising prevalence of telehealth fraud , healthcare organizations need to be diligent in understanding these threats. The FCA prohibits submitting false or fraudulent claims for payment to government healthcare programs, such as Medicare and Medicaid. Anti-Kickback Statute (AKS).

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Fraud Compliance Governance Compliance Officers 52

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). In states that have not expanded Medicaid, however, many postpartum women lose coverage.

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Medicaid Medicaid ACA Public Health 52

Medisys Compliance

APRIL 25, 2023

It is crucial to verify that the billing company is adhering to industry standards, such as HIPAA (Health Insurance Portability and Accountability Act) regulations, which protect patients’ medical information.

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Regulatory Compliance ACA Medical Billing Outsourcing Compliance 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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Compliance Fraud Governance ACA 52

Healthcare IT Today

APRIL 10, 2023

The only way to actually change health behaviors—and therefore health outcomes—is by creating motivation on an individual basis. Behavioral Economics at the Core We partner with health insurers and providers to set up a monthly reward system that’s built on behavioral science, utilizing concepts such as loss aversion.

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Health Outcomes Hospitals ACA Doctors 104

MedTrainer

AUGUST 2, 2023

Federal Government Audits These audits are performed by government agencies such as the Centers for Medicare and Medicaid Services (CMS). They aim to ensure compliance with federal healthcare programs like Medicare and Medicaid, reviewing claims, billing practices, and overall adherence to program requirements.

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Compliance ACA Medicaid Medicaid 52

MedTrainer

MARCH 28, 2024

Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations.

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Compliance Compliance Officers Licensing Regulatory Compliance 52

Health Populi

NOVEMBER 19, 2019

In research from HealthPocket , 2 in 5 Americans said they needed to reduce other household expenses to be able to afford their monthly insurance premiums. Four in ten consumers said their monthly health insurance premiums were increasing. Health insurance costs increased a whopping 20.1%

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Health Insurance Hospitals Doctors Nurses 71

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]

Medicaid 52

Medicaid Medicaid Licensing ACA 52

Health Populi

AUGUST 16, 2019

Co-pay accumulators are being discussed across health plan types, including government-sponsored plans like Medicare along with commercial health insurance programs. The margins between voters’ demands for single payer versus Medicare4All versus public option/ACA update may become increasingly thin.

Governance 79

Governance Health Care Reform FDA ACA 79

CMS.gov

MARCH 6, 2013

By: Christine Stahlecker, Director, Administrative Simplification Group, Office of E-Health Standards and Services, Centers for Medicare & Medicaid Services. These requirements are in place to lower costs, create uniform electronic standards, and streamline exchanges between health care providers and payers.

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ACA HIPAA Medicaid Medicaid 30

Healthcare Law Blog

DECEMBER 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

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Medicaid Medicaid Medicare Medicare 52

Health Populi

OCTOBER 8, 2019

More savings would accrue through the quicker adoption of value-based payment models, the authors assert, where clinicians take on financial risk for managing population health. The Centers for Medicare and Medicaid Services (CMS) forecasts that prescription drug spending will be the fastest-growing cause of rising health spending by 2027.

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Prescription Drug Pricing Medicare Medicare ACA 108

Center for Health Insurance Reform

DECEMBER 12, 2022

As part of CHIR’s weekly installment of FAQs from our updated Navigator Resource Guide, we highlight questions about the marketplace and reproductive health care. Continue reading → The post Navigator Guide FAQs of the Week: Coverage of Reproductive Health Care appeared first on Center on Health Insurance Reforms.

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Health Insurance ACA Medicaid Medicaid 72

Health Populi

MAY 6, 2018

Over time, America’s approach to health care provision fragmented by plan sponsor, whether U.S. government (which offers several flavors of plans through the VA, Tricare for active military, Medicare for aging people and Medicaid for people with low-incomes) or private sector employers, unions, and other insurance-conveners.

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Medicaid Medicaid Medicare Medicare 54

Healthcare Law Blog

AUGUST 25, 2022

The expansive legislation includes key health care provisions, including drug pricing reforms, inflationary rebates, Medicare Part D benefit redesign, as well as myriad other updates. Medicare Drug Price Negotiation Program. The Inflation Reduction Act (“IRA”) was signed into law by President Biden on August 16, 2022.

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Medicare Medicare Medicaid Medicaid 52

AIHC

AUGUST 13, 2024

Written by Corliss Collins , BSHIM, RHIT, CRCR, CSM, CCA, CBCS, CPDC and Joanne Byron , BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS The 2024 Final Rule for Section 1557 of the Affordable Care Act (ACA) was issued by the Department of Health and Human Services (HHS) on April 26, 2024.

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Compliance ACA Health Insurance Medicaid 52

MedTrainer

NOVEMBER 15, 2023

Department of Health and Human Services The United States Department of Health and Human Services (HHS) is the primary federal agency responsible for protecting the health of all Americans and providing essential human services.

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Compliance Framework Governance Compliance Medicaid 52

Hall Render

JULY 8, 2024

On May 6, 2024, the Centers for Medicare and Medicaid Services (“CMS”) and the Office for Civil Rights of Health and Human Services (“HHS”) issued a final rule implementing Section 1557 of the Affordable Care Act (“Section 1557”) (the “Final Rule”). The Final Rule went into effect on July 5, 2024.

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Health Insurance Compliance Medicare Medicare 40

Healthcare Law Blog

JANUARY 26, 2023

The PHS Act requires post-graduate physician training programs that do not perform induced abortions to be deemed accredited and protects governmental payments provided as reimbursement for carrying out health related activities. Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat.

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ACA Medicaid Medicaid Compliance 105

Fierce Healthcare

NOVEMBER 6, 2024

President Donald Trump has won back the White House, and with his win, many health plans are seeing their stocks rise. Major health insurers are seeing stocks increase as investors ready for a Trump term receptive to Medicare Advantage and mergers. Health plans reliant on Medicaid and the ACA saw their stocks dip.

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Compliance Now

JANUARY 13, 2022

The Biden Administration recently announced the new out-of-pocket (OOP) limits that will apply to group and individual health plans during the 2023 plan year, as well as the Patient-Centered Outcomes Research Institute (PCORI) Fee for plan or policy years ending on or after October 1, 2021, and before October 1, 2022. This is a $.13

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