Bill of Health

OCTOBER 17, 2024

This article seeks to summarize these developments in the law. This aligns with recent guidance from the Centers for Medicare and Medicaid Services that Medicare Advantage plans may not make a determination of medical necessity solely based on algorithms using broad data sets. AB 3030 focuses on the use of generative AI.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

Electronic Health Reporter

MARCH 19, 2021

This article is copyrighted strictly for Electronic Health Reporter. 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released its final ruling on policy and payment changes to the Medicare Physician Fee Schedule […]. Illegal copying is prohibited.

Medicare 171

Medicare Medicare Medicaid Medicaid 171

Healthcare IT Today

DECEMBER 22, 2024

This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. DUOS updated its digital health platform for seniors to enable end-to-end applications for federal and state assistance programs such as SNAP and Medicaid.

Medicare 87

Medicare Medicare FDA Telemedicine 87

Healthcare IT Today

JANUARY 23, 2025

The following is a guest article by Ashish V. The Medicare Advantage Star Ratings program includes a Health Equity Index (HEI) Reward Factor that will be introduced in 2027 to encourage plans to deliver equitable healthcare. Furthermore, regulators are now mandating that utilization data and effectiveness be reported back to CMS.

Medicare 96

Medicare Medicare Medicaid Medicaid 96

Hall Render

JANUARY 29, 2025

The Centers for Medicare & Medicaid Services (CMS) is reinforcing its emphasis on hospice quality of care and identifying fraud. Hospice surveys are performed before their initial certification for Medicare participation. Identifying Fraud : Detecting practices that jeopardize patient safety or Medicare program integrity.

Fraud 80

Fraud Medicare Medicare Compliance 80

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. However, CMS noted that for one data source, only 49.3%

Medicare 89

Medicare Medicare Nursing Homes Medicaid 89

Healthcare IT Today

OCTOBER 25, 2024

The following is a guest article by Mike Crouse, Director of Insider Risk at Everfox Ransomware attacks on the healthcare sector continue to grow, with incidents nearly doubling from 2022 to 2023—a concerning figure considering their potential to leave patients in life-or-death situations.

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Ransomware Hospitals Medicaid Medicaid 121

HIT Consultant

JULY 16, 2024

Anish Sebastian, CEO and Co-founder, Babyscripts A discussion of technology and the Medicaid population inevitably raises the topic of the digital divide — that is, the gap between people who have access to modern information and communications technology (ICTs) and those who don’t. “We But there’s a lot of reasons to be optimistic.

Medicaid 105

Medicaid Medicaid Health Insurance Health Outcomes 105

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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Medicare Medicare Compliance Medicaid 93

Fierce Healthcare

JULY 30, 2024

As artificial intelligence rapidly makes inroads in healthcare, federal agencies already have the authority to regulator AI at the hospital bedside, according to some healthcare researche | An article published in JAMA Health Forum argues that through the conditions of participation in Medicare and Medicaid, CMS has the authority to oversee how hospitals (..)

Hospitals 132

Hospitals Medicaid Medicaid Medicare 132

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.

Medicare 130

Medicare Medicare Medicaid Medicaid 130

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

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

Bill of Health

DECEMBER 27, 2022

A full posting of abstracts/summaries of these articles may be found on our  website. Frequency of Approval and Marketing of Biosimilars With a Skinny Label and Associated Medicare Savings. Getting the Price Right: Lessons for Medicare Price Negotiation from Peer Countries. Beall RF, Glazer T, Ahmad H, et al. Healthcare Policy.

Medicare 147

Medicare Medicare Medicaid Medicaid 147

Medisys Compliance

JANUARY 23, 2025

This article provides a comprehensive overview of telehealth mental health billing updates for 2025, addressing key questions, coding changes, and regulatory updates that impact billing practices. Will Medicare Stop Paying for Telehealth in 2025? However, these extensions come with stipulations.

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Medical Billing Outsourcing Medicare Medicare Medical Billing 59

Medisys Compliance

JULY 19, 2024

Introduction The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. This article discusses the latest changes, providing a comprehensive guide to navigating the evolving billing landscape. All rights reserved.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Bill of Health

MARCH 24, 2023

The selections feature topics ranging from an analysis of the approval and marketing of biosimilars with a skinny label and their associated Medicare savings, to a discussion of the Philips Respironics recall and the need for reforms to U.S. A full posting of abstracts/summaries of these articles may be found on our  website.

Medicare 147

Medicare Medicare Medicaid Medicaid 147

Electronic Health Reporter

JUNE 25, 2020

This article is copyrighted strictly for Electronic Health Reporter. The Centers for Medicare & Medicaid Services (CMS) announced the creation of a new office, the […]. The article CMS Announces New Office (“Aubrey”) To Streamline Interoperability and Informatics appeared first on electronichealthreporter.com.

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Medicaid Medicaid Medicare Medicare 103

Electronic Health Reporter

OCTOBER 6, 2022

This article is copyrighted strictly for Electronic Health Reporter. The Centers for Medicare and Medicaid Services (CMS) has made no secret of its intentions to crack down on fraud, abuse, and waste, throwing more budget dollars into audits, heightening program […]. Illegal copying is prohibited.

Fraud 113

Fraud Medicaid Medicaid Medicare 113

Compliancy Group

FEBRUARY 12, 2025

This article provides an in-depth overview of the key compliance risk areas and recommendations outlined in the ICPG, emphasizing the importance of a proactive approach to compliance and quality assurance. The ICPG was issued after creating the GCPC , a general compliance reference guide for healthcare stakeholders.

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Nurses Compliance Medicare Medicare 52

Healthcare IT Today

JUNE 10, 2021

The following is a guest article by Phyllis Wojtusik, RN, Executive VP, Health System Solutions at Real Time Medical Systems.

Medicaid 109

Medicaid Medicaid Medicare Medicare 109

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.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Fraud 59

Hall Render

MARCH 10, 2025

On March 7, 2025, the Centers for Medicare & Medicaid Services (CMS) posted a memo dated March 10, 2025, that gives nursing homes and surveyors more time to prepare for implementation of new rules and updates to allow surveyors to add extra attention and increase oversight in nursing homes.

Nursing Homes 52

Nursing Homes Nurses Medicaid Medicaid 52

Healthcare IT Today

JANUARY 22, 2025

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.

Due Diligence 68

Due Diligence Medicaid Medicaid Medicare 68

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.

Fraud 40

Fraud Compliance Medicaid Medicaid 40

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.

Medicare 52

Medicare Medicare Governance Fraud 52

Hall Render

MARCH 27, 2025

The Centers for Medicare & Medicaid Services (CMS) has given surveyors additional rules and updates to allow surveyors to assess and cite violations of the regulations on nursing homes with admission agreements that create prohibited third-party guarantee of resident payments.

Nursing Homes 52

Nursing Homes Nurses Medicaid Medicaid 52

Healthcare IT Today

JANUARY 14, 2025

Medicare Advantage (MA) will likely see expanded backing, further solidifying its role as a cornerstone of value-based care. Michael Poku, MD, MBA, Chief Clinical Officer at Equality Health In 2025, Value-Based Care will reach a pivotal crossroads, especially for Medicaid populations. We could not do this without all of your support.

ACA 82

ACA Medicaid Medicaid Fraud 82

Bill of Health

NOVEMBER 17, 2022

A full posting of abstracts/summaries of these articles may be found on our? Medicare’s National Coverage Determination for Aducanumab – A One-Off or a Pragmatic Path Forward? Medicaid Spending on Antiretrovirals from 2007-2019. Brown BL, Mitra-Majumdar M, Darrow JJ, Moneer O, Pham C, Avorn J, Kesselheim AS.

FDA 189

FDA World Health Medicaid Medicaid 189

Healthcare IT Today

MAY 28, 2024

The following is a guest article by Shannon West, Chief Product Officer at Datavant Since the dawn of electronic medical records, American healthcare delivery systems have traced a winding path toward the dream of seamless and timely health data interoperability.

Electronic Medical Records 126

Electronic Medical Records Medicaid Medicaid Medicare 126

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.

Medicare 59

Medicare Medicare Medical Billing Outsourcing COVID-19 59

Healthcare IT Today

FEBRUARY 6, 2025

Healthcare providers look to policymakers and advocates to work together to further tackle these challenges on a larger scale by increasing funding, expanding Medicaid coverage and access, strengthening data collection and reporting, and empowering communities to take action to address social determinants of health.

Medicaid 75

Medicaid Medicaid Federal Policy COVID-19 75

Healthcare IT Today

DECEMBER 30, 2024

Allison Combs, Head of Product, Payer, Clinical Effectiveness at Wolters Kluwer Health In 2024, Medicare Advantage faced decreasing reimbursement rates alongside surging enrollment, and both trends are likely to continue into and beyond 2025. MA and Medicaid plans will be working overtime to harvest data and influence rating outcomes.

US Department of Health and Human Services 91

US Department of Health and Human Services Nurses Medicare Medicare 91

HIT Consultant

AUGUST 6, 2023

In an article that appeared on the Skilled Nursing News website , Mark Zimmet, CEO of Zimmet Healthcare Services Group, LLC, summarized the issue as follows: “SNF stakeholders now have access to an array of diverse resources to inform decision-making. Nursing homes are evolving. percent of U.S. healthcare payments, representing close to 238.8

Nursing Homes 98

Nursing Homes Nurses Medicare Medicare 98

Bill of Health

MARCH 25, 2022

A full posting of abstracts/summaries of these articles may be found on our? Medicaid Expenditures and Estimated Rebates on Line Extension Drugs, 2010-2018. Bakker E, Hendrikse NM, Ehmann F, van der Meer DS, Llinares Garcia J, Vetter T, Starokozhko V, Mol PGM. Hwang TJ, Vokinger KN. Lancet Oncol. 2022 Feb;23(2):e58. PMID: 35114127.

FDA 208

FDA COVID-19 Medicaid Medicaid 208

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.

Medicare 123

Medicare Medicare Hospitals Compliance 123

Healthcare IT Today

JANUARY 14, 2024

This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Welcome to the weekly edition of Healthcare IT Today Bonus Features. The therapies are commonly prescribed to treat type 2 diabetes and are increasingly prescribed for weight loss.

Medicaid 97

Medicaid Medicaid FDA Medicare 97