Medisys Compliance

FEBRUARY 19, 2025

Billing Update: Medicare Radiology Reimbursement Cuts 2025 Effective January 2025, radiology practices nationwide are facing reduced Medicare reimbursements due to finalized changes in the Physician Fee Schedule. Now, in February 2025, these proposed rules are our current reality. Here are key steps you can take: 1.

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Electronic Health Reporter

APRIL 8, 2020

This article is copyrighted strictly for Electronic Health Reporter. There are several regulatory compliance requirements that healthcare organizations must follow. The article Regulatory Compliance For Healthcare Organizations appeared first on electronichealthreporter.com. Illegal copying is prohibited.

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Regulatory Compliance Compliance HIPAA Health Insurance 132

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. He was also ordered to pay $557,000 in restitution to Indiana Medicaid and Medicare. As such, providers should prioritize billing compliance.

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AIHC

NOVEMBER 12, 2024

This article addresses how these privacy rights extend beyond rules designated under HIPAA and States passing rules banning unauthorized pelvic exams. These revisions resulted from recent articles, media reports, and concerns from nurses, some physicians, and medical students opposing these exams. [3],[4]

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Informed Consent HIPAA Compliance Hospitals 98

Medisys Compliance

MARCH 21, 2025

Accurately understanding physical therapy billing units is crucial for healthcare providers to ensure proper reimbursement and compliance. In this article, well break down physical therapy billing units, explain the 8-minute rule, and highlight best practices to simplify your billing process What Are Physical Therapy Billing Units?

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Medical Billing Outsourcing Compliance Medicare Medicare 59

Healthcare IT Today

OCTOBER 28, 2024

The following is a guest article by Alexander Norell, Senior Director and Global Security Architect at VikingCloud One cannot overstate the benefits of data sharing in healthcare, which grows more prevalent as the years pass and technologies make the process more seamless.

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Ransomware Compliance Hospitals HIPAA 115

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) When the services are DHS for purposes of the PSL (e.g.,

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MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

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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. Will Medicare Stop Paying for Telehealth in 2025? Congresss decision reflects the growing recognition of telehealth’s role in improving healthcare access.

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Medical Billing Outsourcing Medicare Medicare Medical Billing 59

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. The Final Rule added 42 CFR 488.1135 and created the SFP for hospice providers.

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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. Providers must ensure that these services meet Medicares criteria for medical necessity.

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Medicare Medicare Medical Billing Outsourcing Fraud 59

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

Healthcare IT Today

OCTOBER 26, 2024

Each week, we’ll be providing a look back at the articles we posted and why they’re important to the healthcare IT community. Read more… It’s Time to Combat “Instafraud” in Medicare Advantage. Medication tracking software maker Bluesight acquired Sectyr , a compliance and audit management platform.

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HIPAA Journal

MARCH 30, 2023

The seven elements of a compliance program are integrated processes organizations in all industries can adopt to help them develop a culture of compliance in the workplace. While the seven elements of a compliance program apply to all industries, they originated in the healthcare industry in the 1990s.

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Healthcare IT Today

DECEMBER 11, 2024

Contact us here with a link to the open position and we’ll be happy to feature it in next week’s article at no charge! Do you have an open health IT position that you are looking to fill? Note: These jobs are listed byHealthcare IT Today as a free service to the community.

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HIPAA Journal

DECEMBER 28, 2022

Discussing HIPAA compliance for hospitals in a single article is challenging. This means there is no one-size-fits-all guide to HIPAA compliance for hospitals, but rather checklists that can help hospitals cover the basics of the compliance requirements. The Five Areas of HIPAA Compliance for Hospitals to Focus On.

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MedTrainer

MAY 3, 2024

Non-compliance with these regulations can result in jail time, large fines, and even loss of license. Keeping compliance and fraud prevention top of mind can help to protect both your organization and its staff. For those who are not, there are five main federal laws they are likely violating related to healthcare fraud.

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Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. To avoid running afoul of potential civil or criminal liability, organizations must ensure that Medicare claim reporting is accurate.

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Medisys Compliance

DECEMBER 30, 2024

This article serves as a detailed guide for providers, addressing key aspects of CBT billing to ensure compliance, accuracy, and maximize reimbursement. Compliance with Payer Guidelines Each insurance payer has unique requirements for CBT billing. Medicare: Pays based on the Medicare Physician Fee Schedule (e.g., $85$130

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Medical Billing Outsourcing Medical Billing Medicare Medicare 59

Healthcare IT Today

APRIL 9, 2025

The following is a guest article by Andrew Mahler, JD, CIPP/US, AIGP, CHC, CHPC, CHRC , Vice President of Privacy, Compliance Services at Clearwater When the healthcare information ecosystem operates as it should, it mirrors a healthy circulatory system. Reputations can tank. And the cost of inaction?

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Hall Render

MARCH 11, 2025

Background Following a whistleblower lawsuit alleging fraudulent Medicare billing, a jury found that HCAT submitted 21,844 false claims, causing $2,753,641.86 Government fraud enforcement remains aggressive : Despite this ruling, health care providers should continue prioritizing compliance with Medicare and Medicaid billing regulations.

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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

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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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

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.

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Innovaare Compliance

DECEMBER 11, 2023

Before the Medicare Advantage Open Enrollment Period (MA OEP) [1] begins on January 1, 2024, Medicare Advantage Organizations (MAOs) still have time to review if they are completely ready for a new contract year. This blog article focuses on some of the “must make” changes to take effect as of January 1, 2024, or before.

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AIHC

SEPTEMBER 3, 2024

Celebrating the Healthcare Compliance Officer The American Institute of Healthcare Compliance is recognizing healthcare Compliance Officers – hats off to you! The primary goal of a compliance officer is to mitigate risk. This involves investigating complaints and conducting internal auditing and monitoring for compliance.

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Healthcare IT Today

NOVEMBER 15, 2023

The previous article in this series explained some of the ways payers, providers, and digital health companies demonstrate that they have made a positive difference in their patients’ lives. ” This article looks at the measurements and reporting strategies used by some specific companies. offering in-home treatment.

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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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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. As healthcare providers navigate the complexities of SNF billing, maintaining compliance is essential to avoid penalties, denials, and financial losses.

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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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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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Medisys Compliance

JULY 15, 2024

Introduction As an internal medicine practitioner, staying updated with the latest Medicare billing changes is crucial for maximizing reimbursements and ensuring compliance. This article explores these changes, providing insights to help you navigate the evolving landscape of Medicare billing.

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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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Compliancy Group

FEBRUARY 28, 2025

In this article, we explore some alarming healthcare cyberattack statistics and the most common ways hackers invade cyber systems. We also discuss how to prevent cyberattacks in healthcare, including incorporating compliance software. At Compliancy Group , we know the devastating effects a healthcare cyberattack can have.

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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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YouCompli

OCTOBER 16, 2024

Radiology services can be accompanied by some unique compliance challenges that do not always exist with other types of health care services. The following tips can help compliance professionals as they develop strategies to monitor compliance associated with typical radiology services. Any claim billed with ICD-10 code R51.9

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