Hall Render

MARCH 4, 2025

Department of Health and Human Services (HHS) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community. Medical Directors in Nursing Homes 42 CFR 483.70(g) See 42 C.F.R.

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Compliance Nursing Homes Nurses Medicare 52

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

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Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

Bill of Health

JANUARY 19, 2022

A full posting of abstracts/summaries of these articles may be found on our? Factors Associated with Compliance to the Hospital Price Transparency Final Rule: a National Landscape Study. Raising Medicaid Rebates For Drugs With Accelerated Approval. Barber M, Sarpatwari A, Cepuch C. JAMA Intern Med. 2021 Dec 13. J Gen Intern Med.

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COVID-19 Medicaid Medicaid FDA 182

Healthcare IT Today

APRIL 4, 2025

The following is a guest article by Patrick Kehoe, EVP of Product Management at Messagepoint, Inc. For Dual Special Needs Plans (DSNPs), compliance is even more complex as they must meet both Medicare and Medicaid translation requirements, supporting as many as 24 languages in some states.

Medicare 84

Medicare Medicare Medicaid Medicaid 84

Medisys Compliance

APRIL 8, 2025

Given the complexities of psychiatric billing, which involves specialized CPT codes, insurance policies, and evolving compliance requirements, providers often struggle with claim denials, delayed payments, and administrative burdens. Compliance and Documentation Management: Adhering to HIPAA and payer-specific billing policies.

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Medical Billing Medical Billing Outsourcing Compliance HIPAA 59

Medisys Compliance

JANUARY 23, 2025

As we step into 2025, mental health providers must stay informed about evolving telehealth billing regulations to ensure compliance and optimize reimbursement. Mental health providers should monitor updates from the Centers for Medicare & Medicaid Services (CMS) to ensure uninterrupted reimbursement. Service delivery mode (e.g.,

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medicare Medicare Medical Billing 59

AIHC

DECEMBER 27, 2024

This article explores the legal framework surrounding these practices, emphasizing case law, Federal law, and institutional policies while calling for systemic reform to secure equal protection for all patients from all unwanted and non-consensual intimate encounters before, during, and after elective medical procedures. April 1, 2024.

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Informed Consent Bioethics ADA Medical Personnel 98

Compliancy Group

MARCH 12, 2025

With such a wide range of potential noncompliance incidents, more compliance officers are exploring ways to combat these penalties so they can respond proactively instead of reactively. Such noncompliance can result in non compliance fines. Using compliance software can prevent upcoding.

Fraud 52

Fraud Compliance Medicare Medicare 52

Hall Render

FEBRUARY 17, 2025

According to a statement released on the Center for Medicare and Medicaid Services (CMS) website, effective February 14, 2025, implementation of the Hospice Special Focus Program for calendar year 2025 has ceased so that CMS may further evaluate the program. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 89

Medicare Medicare Nursing Homes Medicaid 89

MRO Compliance

SEPTEMBER 19, 2023

The Centers for Medicare and Medicaid Services (CMS) Medicare Advantage Risk Adjustment Data Validation (RADV) audit season peaks from March through April every year. View Full Article  Health information (HI) professionals nationwide anticipate a looming tsunami of payer requests for medical records.

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MRO Compliance

JULY 12, 2023

Accurate, properly documented, interoperable patient data is required to achieve CMS’s goal for 100 percent of Medicare (and the majority of Medicaid) beneficiaries to be enrolled in some type of accountable, or value-based, care arrangement by 2030. View Full Article

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Medicaid Medicaid Medicare Medicare 130

Healthcare IT Today

JULY 16, 2024

The following is a guest article by Nick Barger, PharmD, Vice President, Product at DrFirst. This article is the fourth in the Healthcare Regulatory Talk series. Preparing for the new standards now and understanding how they fit into the broader regulatory roadmap will position you well for future compliance.

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Compliance Medicaid Medicaid Medicare 124

Medisys Compliance

JANUARY 16, 2025

The Centers for Medicare & Medicaid Services (CMS) provides comprehensive behavioral health billing guidelines, which can be overwhelming due to their technical nature and breadth. While some flexibilities have been made permanent, providers should stay updated on the latest CMS guidelines to ensure compliance. All rights reserved.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Fraud 59

MedTrainer

JANUARY 21, 2025

Todays healthcare organizations face mounting pressures to keep impeccable compliance records while managing increasingly complex operations. Proactivity in the form of continuous OIG exclusion list monitoring is key to minimizing risk, maintaining compliance, and avoiding costly mistakes.

Compliance 52

Compliance Fraud Regulatory Compliance Medicare 52

Hall Render

MARCH 11, 2025

Government fraud enforcement remains aggressive : Despite this ruling, health care providers should continue prioritizing compliance with Medicare and Medicaid billing regulations. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 52

Medicare Medicare Governance Fraud 52

Medisys Compliance

JULY 19, 2024

Introduction The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. Understanding these updates is crucial for behavioral health providers to ensure compliance, maximize reimbursements, and continue delivering high-quality care.

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Medicaid Medicaid Medicare Medicare 52

Medisys Compliance

FEBRUARY 27, 2024

Introduction Radiology billing compliance is a critical aspect of managing a successful radiology practice. With a myriad of regulations and the potential for audits looming, radiologists and billing staff need to have a solid understanding of compliance requirements.

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Compliance Medical Billing Outsourcing Medicare Medicare 59

Verisys

FEBRUARY 10, 2025

These changes are designed to enhance patient safety, data accuracy, and compliance efficiency for health plans. Verisys Licensure solution ensures seamless compliance with the new NCQA standards, keeping your organization ahead of regulatory changes. Key NCQA 2025 Compliance Changes 1.

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Licensing Compliance Medicaid Medicaid 40

MedTrainer

AUGUST 8, 2024

In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Why Additional Training Is Required for Medicare-Enrolled Providers Training helps providers understand and adhere to Medicare’s complex regulations and guidelines, essential for maintaining compliance.

Medicare 93

Medicare Medicare Compliance Medicaid 93

MRO Compliance

JUNE 23, 2022

I recently wrote an article titled “Revenue Integrity: How to Reduce Costs and Retain Revenue” where I provided several tips on how to assess costs and resources and how to better prepare for audits to avoid denials. Maintaining and managing audits is one of the most time-consuming yet critical parts to ensure revenue integrity.

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Medicaid Medicaid Medicare Medicare 130

Medisys Compliance

APRIL 19, 2023

The Medicaid program in Florida provides medical services and assistance to low-income individuals and families. To participate in the Medicaid program, healthcare providers must meet several general requirements set forth by the Agency for Health Care Administration (AHCA).

Medicaid 52

Medicaid Medicaid Medical Billing Outsourcing Licensing 52

MRO Compliance

AUGUST 3, 2022

I recently wrote an article titled “Internal Audits Help Combat Payer Risk” where I described several keys for a smooth-running revenue cycle. By tracking and understanding audit activity, organizations can eliminate redundancy while filling in the gaps in revenue cycle compliance.

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Compliance Officers Medicare Medicare Compliance 130

MedTrainer

MAY 21, 2024

With the odds of a person entering your healthcare facility dealing with a behavioral or mental health issue at about 20% , new and existing clinical providers must receive behavioral health compliance training to ensure patients receive the highest quality care. Training requirements vary by role and specific healthcare setting.

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Compliance Medicaid Medicaid HIPAA 52

MedTrainer

JULY 29, 2024

Healthcare compliance is complicated for organizations of any size. However, the complexities grow exponentially for large or enterprise organizations with hundreds or thousands of employees who must complete and pass rigorous compliance training. What Is Corporate Compliance Training?

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

MedTrainer

DECEMBER 4, 2023

Responsible healthcare providers and compliance professionals in each state of the United States must follow specific regulations, and achieving healthcare compliance in Kentucky is no exception. Regulations Unique to Kentucky To meet the standards of healthcare compliance in Kentucky , there are a few additional regulations.

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Compliance Licensing Medicaid Medicaid 52

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. To become a provider for Ohio Medicaid, you must first enroll in the Ohio Medicaid program. Here are the steps of provider enrollment for Ohio Medicaid: Provider Enrollment for Ohio Medicaid 1.

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Medicaid Medicaid Licensing Medical Billing Outsourcing 52

MedTrainer

NOVEMBER 27, 2023

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

FEBRUARY 7, 2024

The complex world of healthcare compliance demands a clear understanding of responsibilities. For those new to the role of compliance officer, the question often arises: “Who is responsible for compliance in healthcare?” Who is Responsible for Compliance in Healthcare?

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Compliance Compliance Officers Health Insurance Medicaid 52

Compliancy Group

JANUARY 3, 2024

This article discusses the issues related to medical billing compliance policy and the steps for providers to maintain financial integrity and adherence to all requirements. Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

MedTrainer

MAY 20, 2024

Understanding the differences in these requirements can ensure staff are taking the most relevant courses to maintain regulatory and accreditation compliance. In this article, we’ll explore the requirements for FQHC training and ways to simplify training delivery. However, meeting FQHC requirements is not as easy as it sounds!

Compliance 52

Compliance HIPAA Health Insurance Medicaid 52

MedTrainer

DECEMBER 7, 2023

To sail smoothly through the complex rules and requirements, you need a deep knowledge of the most essential aspects of healthcare compliance in Maine. A successful compliance program involves adaptability, comprehensive planning, and insight into key compliance factors, including credentialing requirements.

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Compliance Licensing Compliance Officers Medicaid 52

MedTrainer

AUGUST 9, 2024

Establishing measurable compliance objectives enables organizations to track their progress, identify areas for improvement, and mitigate risks before they escalate into significant issues. But how do you write healthcare compliance goals that accomplish this? We’ll tackle that question and more in this article.

Compliance 52

Compliance HIPAA Governance Health Insurance 52

Medisys Compliance

MARCH 24, 2025

In this article, well break down the essentials of urgent care billing, including coding guidelines, reimbursement insights, best practices, and tips to streamline your practices billing operations. This article is for informational purposes only. Frequently Asked Questions (FAQs) 1. What is the POS for urgent care?

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Medicaid 59

MedTrainer

NOVEMBER 28, 2023

Healthcare providers, organizations, and compliance officers in Michigan State need to be aware of their state-specific laws and regulations in order to navigate compliance successfully. This article serves as a quick-reference guide for maintaining healthcare compliance in Michigan State.

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Compliance Licensing Public Health Compliance Officers 52

MedTrainer

JULY 11, 2024

Maintaining regulatory compliance has never been easy, and the pace of change isn’t slowing. In this article, I will share the impact of change on regulatory compliance and a few strategies to reduce disruption. Let’s start by defining regulatory compliance. What Is Regulatory Compliance?

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Regulatory Compliance Compliance Compliance Officers Hospitals 52

MedTrainer

DECEMBER 7, 2023

Healthcare compliance in New Mexico mirrors the state’s diverse culture, with unique regulations that differ from other states, such as credentialing documentation requirements for managed care organizations. New Mexico’s parity law requires insurers to cover telemedicine services to the same extent as in-person services.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 7, 2023

All healthcare organizations, along with their providers and compliance officers, must understand the requirements of each regulatory state agency that provides oversight. Robust, flexible, and reliable compliance programs must be developed to maintain compliance in Hawaii.

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Compliance Compliance Officers Licensing Medicaid 52