Hall Render

DECEMBER 30, 2024

On November 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance under QSO-25-09-ALL, updating Core Appendix Q of the State Operations Manual regarding findings of immediate jeopardy. Hall Render blog posts and articles are intended for informational purposes only.

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Verisys

MARCH 6, 2025

Supporting Healthcare Compliance Healthcare facilities must comply with a myriad of legal and regulatory standards set by accreditation bodies that oversee general medical practices, including the maintenance of quality provider data.

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Compliance Licensing Doctors Malpractice 52

Verisys

APRIL 3, 2025

As a centralized hub of critical practitioner data, the NPDB serves as a powerful ally in provider credentialing , helping hospitals, medical boards, and institutions verify backgrounds, track malpractice claims, and ensure regulatory compliance. What Is the National Practitioner Data Bank (NPDB)?

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Verisys

MARCH 6, 2025

Further, the failure of a hospital to verify a practitioners qualifications can have a direct impact on patient safety, regulatory compliance, and the operational success of healthcare organizations. Why Provider Credentialing Matters Without proper credentials, healthcare workers cannot practice in their field.

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Licensing Compliance Nurses Malpractice 52

MedTrainer

JANUARY 21, 2025

Understanding the OIG Exclusion List The OIG maintains the List of Excluded Individuals/Entities (LEIE), which provides comprehensive information to the healthcare industry on those currently excluded from participating in Medicare, Medicaid, and any other federal healthcare programs.

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Healthcare IT Today

DECEMBER 17, 2023

News In a blog post, ONC highlighted trends in patient access to electronic health information. Business process management company Sagility launched its Utilization Management as a Service offering , which aims to help providers with CMS regulatory compliance.

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Healthcare Blog

JANUARY 19, 2025

However, the success of swing bed programs hinges on strict adherence to Medicare Swing Bed Rules , a set of regulations established by the Centers for Medicare & Medicaid Services (CMS) to ensure compliance and optimize patient care. As CMS regulations evolve, staying ahead of compliance requirements will be crucial.

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MedTrainer

JULY 29, 2024

These tools make it easier for healthcare organizations to maintain a culture of compliance, adapt to evolving industry standards, and ensure that all staff members are consistently informed and compliant. Corporate Compliance vs. Regulatory Compliance Corporate compliance and regulatory compliance are not the same thing.

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

Physician Credentialing Company

DECEMBER 20, 2024

In case of suspicion of non-compliance, claims can be rejected, and even healthcare facilities may have serious implications. Medicare and Medicaid allow non-credentialed providers to get reimbursement but under strict rules. These are true examples that show the importance of regulatory compliance.

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Verisys

APRIL 1, 2025

When the Centers for Medicare and Medicaid Services ( CMS ) Medicare Preclusion List went into effect in 2019, it added restrictions on Medicare payments to certain providers. If someone is enrolled in both Medicare and Medicaid and sees a precluded provider, who is responsible for payment? What is the CMS Preclusion List?

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Compliancy Group

JANUARY 17, 2024

The OIG Work Plan, sometimes referred to as “the Work Plan” or “the Plan,” is an essential tool in securing and maintaining healthcare regulatory compliance for patient safety, privacy, and quality care. The OIG Compliance Work Plan identifies significant risks and areas that require attention within the healthcare system.

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Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. organizations that receive any funds from Medicare, Medicaid, TRICARE, or other federal programs cannot afford to employ individuals or entities excluded from even one program. 38 Medicaid Sanctions.

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Medicare Medicare Regulatory Compliance Medicaid 52

Verisys

FEBRUARY 3, 2025

Ensuring compliance with healthcare regulatory compliance standards is essential to maintaining operational efficiency and delivering quality care. This includes verifying qualifications, submitting proof of malpractice insurance , and ensuring compliance with all healthcare regulatory compliance standards.

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Malpractice Regulatory Compliance Licensing Compliance 52

MedTrainer

AUGUST 30, 2023

Medicaid Managed Care. Some state Medicaid programs contract with managed care organizations to provide healthcare services to eligible beneficiaries. These plans follow managed care principles to control costs and improve care coordination for Medicaid recipients.

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Compliance Regulatory Compliance Medicaid Medicaid 52

MedTrainer

FEBRUARY 1, 2024

Why do healthcare facilities use corporate compliance programs? We’ll answer that question in this blog along with assessments of a good corporate compliance process. What is Corporate Compliance in Healthcare? Corporate compliance can help to reduce these potential costs by helping companies uphold compliance standards.

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Healthcare Blog

AUGUST 23, 2023

Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization. Use the following strategies to promote ethical behavior in regulatory compliance. 2022, December 5).

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Verisys

JANUARY 8, 2024

This type of audit is essential in the healthcare industry for several reasons: Regulatory Compliance It ensures that the healthcare organization complies with various federal and state laws and regulations. Compliance with state-specific healthcare laws and regulations is also assessed.

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Innovaare Compliance

FEBRUARY 14, 2022

Operational teams—such as the Member Services Department and the Appeals & Grievances Department—have significant compliance regulations, so they must know to maintain compliance. This includes CMS regulations for Medicare Plans, regulations for Commercial Plans and Medicaid regulations for state plans.

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Healthcare Blog

APRIL 13, 2023

As hospitals have become increasingly complex organizations, effective governance, risk, and compliance (GRC) strategies have become essential for ensuring patient safety and regulatory compliance. Improve GRC in Your Facility GRC strategies are essential for ensuring hospital patient safety and regulatory compliance.

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Governance Compliance Hospitals Regulatory Compliance 40

MedTrainer

JULY 12, 2023

Regulatory Compliance. Organizations like The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration (FDA), and Occupational Safety and Health Administration (OSHA) require incident reporting and response documentation as part of regulatory compliance.

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MedTrainer

JULY 12, 2023

Regulatory Compliance. Organizations like The Joint Commission (TJC), Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration (FDA), and Occupational Safety and Health Administration (OSHA) require incident reporting and response documentation as part of regulatory compliance.

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MedTrainer

NOVEMBER 2, 2023

Most compliance officers possess a bachelor’s degree, often in healthcare administration, law, or a related field. Additionally, hands-on experience in healthcare or regulatory compliance provides a foundation for this role.

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Med Com Blog

DECEMBER 2, 2022

This streamlined approach enables care providers to focus solely on their patients – without the burden of data entry and complex coding while knowing a high standard of regulatory compliance is upheld. RemitOne technology software will be fully integrated in all aspects throughout our facility.

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Compliance Hospitals Electronic Medical Records Regulatory Compliance 40

Med Com Blog

DECEMBER 5, 2022

This streamlined approach enables care providers to focus solely on their patients – without the burden of data entry and complex coding while knowing a high standard of regulatory compliance is upheld. RemitOne technology software will be fully integrated in all aspects throughout our facility.

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Compliance Hospitals Electronic Medical Records Regulatory Compliance 40

MedTrainer

AUGUST 5, 2024

Proper privileging documentation is also critical to meet the standards of regulatory bodies such as the Centers for Medicare and Medicaid Services ( CMS ) and the National Committee for Quality Assurance ( NCQA ). Ongoing Process: Privileging is not a one-time event.

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MedTrainer

MARCH 28, 2024

Just as perplexing is who is responsible for compliance in healthcare organizations. The answer has as many layers as the definition of compliance itself. Law by law, regulations were added, increasing the complexity of maintaining compliance for healthcare organizations.

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Verisys

FEBRUARY 14, 2024

Healthcare compliance is a critical component in the operation of healthcare organizations, encompassing a broad range of activities designed to ensure adherence to applicable laws, regulations, and ethical standards. For instance, within the realm of healthcare compliance, HIPAA compliance plays a pivotal role.

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MedTrainer

NOVEMBER 20, 2023

Florida Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Florida Department of Health (DOH) plays a crucial role in promoting and safeguarding the wellbeing of Floridians. While many states have rules that prohibit the storage of Medicaid data outside the U.S.,

Compliance 52

Compliance Licensing Regulatory Compliance Medicaid 52

Healthcare Blog

AUGUST 23, 2023

Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization. Use the following strategies to promote ethical behavior in regulatory compliance. 2022, December 5).

Compliance 52

Compliance Nurses Regulatory Compliance Medicaid 52

Hall Render

NOVEMBER 25, 2024

When a nursing facility submits a claim to Medicare or Medicaid for reimbursement, the claim submission form includes certifications that the claimed services were provided in compliance with all applicable statutes, regulations and rules. Hall Render blog posts and articles are intended for informational purposes only.

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Innovaare Compliance

NOVEMBER 4, 2021

This blog is to inform California MMP Plans of the changes to the CMS 2022 protocols for MMP SARAG & MMP CDAG Universes (as it relates to Appeals & Grievances). Armed with this regulatory compliance information, you should be in a better position to create accurate universes that comply with the latest Medicare and Medicaid protocols.

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Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. The Readiness List is comprehensive and touches on all aspects of administering a Medicare Advantage plan (MA), a Prescription Drug Plan (PDP), an 1876 Cost Plan, and a Medicare-Medicaid Plan (MMP).

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Medicare Medicare Compliance Medicaid 52

MedTrainer

APRIL 20, 2023

Providers need a strong compliance program to inform the creation of compliance checklists. The Seven Core Compliance Program Requirements The Centers for Medicare & Medicaid Services (CMS) criteria promote an effective compliance program in healthcare organizations.

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MedTrainer

AUGUST 2, 2023

Legal and Regulatory Compliance Healthcare facilities and insurance companies are legally obligated to credential providers before allowing them to practice or join their networks. By verifying education, training, and experience, organizations help prevent unqualified or incompetent individuals from delivering care to patients.

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Health Care Law Brief

NOVEMBER 17, 2021

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its final rules for the 2022 Medicare Physician Fee Schedule (PFS Final Rule) and 2022 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS Final Rule). Both rules take effect January 1, 2022. at 1396b(s).

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MedTrainer

OCTOBER 5, 2023

As a key member of your facility’s healthcare compliance programming, you understand the significance of regulatory compliance and the critical role it plays in ensuring the privacy and security of patient information. Your organization’s ability to practice regulatory compliance is only as good as what’s been documented.

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MedTrainer

NOVEMBER 15, 2023

In the United States, there are several compliance frameworks and entities that govern requirements for the healthcare industry. Each governing body oversees a different aspect of regulatory compliance. To understand which compliance frameworks govern which requirements, we need to break it down entity by entity.

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