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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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 (..)

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Hospitals Medicaid Medicaid Medicare 133

Hall Render

DECEMBER 20, 2023

Finalized Revisions to Form CMS-855A For SNFs, the aforementioned data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). For NFs, the data would be reported via means prescribed by the applicable state Medicaid agency.

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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

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

Electronic Health Reporter

APRIL 23, 2020

This article is copyrighted strictly for Electronic Health Reporter. The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS), in conjunction with the HHS Office of Inspector General (OIG) announced a policy of enforcement discretion […].

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Hall Render

OCTOBER 22, 2024

Effective October 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) introduced significant updates to the CMS-855A form , specifically requiring a new Skilled Nursing Facility (“SNF”) Attachment for every SNF. Hall Render blog posts and articles are intended for informational purposes only.

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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.

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Electronic Health Reporter

MARCH 10, 2020

This article is copyrighted strictly for Electronic Health Reporter. The Centers for Medicare & Medicaid Services (CMS) issued a fact sheet with additional guidance for healthcare providers and patients about the telehealth benefits in the agency’s Medicare program. Illegal copying is prohibited.

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Hall Render

MARCH 8, 2024

On January 30, 2024, the Centers for Medicare and Medicaid Services (“CMS”) issued a Request For Information (“RFI”) seeking input from interested parties regarding Medicare Advantage (“MA”) data. Hall Render blog posts and articles are intended for informational purposes only.

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Medicare Medicare Medicaid Medicaid 40

Electronic Health Reporter

APRIL 8, 2019

This article is copyrighted strictly for Electronic Health Reporter. The article Contract Year 2020 Medicare Advantage and Part D Flexibility Final Rule appeared first on electronichealthreporter.com. Illegal copying is prohibited. CMS took significant action to increase MA plan choices for the […].

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Medisys Compliance

JANUARY 31, 2024

Introduction Understanding the details of Medicare coding and claims submission can be daunting for anyone. This article serves as a guide to help you avoid billing mistakes for Medicare and ensure smooth claims processing for your Medicare patients. Common Billing Mistakes 1.

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Electronic Health Reporter

APRIL 7, 2020

This article is copyrighted strictly for Electronic Health Reporter. The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). Illegal copying is prohibited.

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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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Hall Render

SEPTEMBER 10, 2024

On July 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its calendar year 2025 Medicare Physician Fee Schedule (“MPFS”) proposed rule (“Proposed Rule”), to implement certain payment updates effective January 1, 2025.

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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.

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Fraud Medicaid Medicaid Medicare 113

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.

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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).

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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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Medisys Compliance

FEBRUARY 20, 2023

Healthcare providers often get confused about the appropriate use of modifiers GA, GX, GY, and GZ while billing Medicare. GA modifier indicates that an Advance Beneficiary Notice (ABN) is on file and allows the provider to bill the patient if not covered by Medicare. Medicare does not pay for all health care costs.

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Health Law RX

FEBRUARY 21, 2024

The Centers for Medicare & Medicaid Services (CMS) has revised certain payment policies under the Medicare physician fee schedule, and updated provider and supplier enrollment regulations. Summary of Major Updates The below outlined changes are described in more detail in this article.

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Medicare Medicare Licensing Compliance 52

Hall Render

JULY 28, 2023

Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”).

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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 148

Medicare Medicare Medicaid Medicaid 148

Medisys Compliance

MAY 19, 2022

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. Eligible services.

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Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. 1395w-22(a) ). d)(2) ).

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Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. Special thanks to summer associate, Liliann Stoll, for her assistance with this article.

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Hall Render

DECEMBER 12, 2023

On November 16, 2023, the Centers for Medicare & Medicaid Services (“CMS”) published proposed changes to the Medicare provider enrollment requirements in the Calendar Year 2024 Physician Fee Schedule final rule (“Final Rule”).

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Medisys Compliance

JUNE 16, 2023

G0108 is a Medicare code used for the initial preventive physical examination, also known as the IPPE or “Welcome to Medicare” visit. In this article, we will explore the guidelines surrounding how often G0108 can be billed.

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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

Medisys Compliance

JULY 13, 2023

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

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Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025.

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Medicare Medicare Medicaid Medicaid 40

Hall Render

JUNE 23, 2023

In the latest effort to increase price transparency and lower prescription drug costs, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule (“Proposed Rule”) that, in part, intends to reveal the actual cost of drugs covered by Medicaid.

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Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

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Medicare Medicare Licensing Health Insurance 52

Hall Render

AUGUST 6, 2024

The Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) on August 1, 2024. Background on Rural and Urban Delineations Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

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Hall Render

AUGUST 6, 2024

The Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) on August 1, 2024. Background on Rural and Urban Delineations Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

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Medisys Compliance

JANUARY 20, 2022

The Centers for Medicare & Medicaid Services (CMS) recognizes that CCM services are critical components of primary care that promote better health and reduce overall health care costs. Billing Guidelines for Medicare Chronic Care Management. Practitioner and Patient’s Eligibility.

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Hall Render

MAY 23, 2023

The Centers for Medicare & Medicaid Services (“CMS”) is now accepting applications from ACOs to participate in the Medicare Shared Savings Program (“MSSP” or “Program”) for the agreement period beginning January 1, 2024. Hall Render blog posts and articles are intended for informational purposes only.

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