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

MRO Compliance

JANUARY 16, 2025

To address these gaps, the Centers for Medicare & Medicaid Services (CMS) now mandates the use of FHIR-based APIs for data sharing. Product Marketing Manager at MRO, contributed to the above blog post. Ready to explore how MROs modern solutions can support your organizations growth? Visit our website to learn more.

Overpayments 130

Overpayments Overpayment Regulatory Compliance Patient Satisfaction 130

MRO Compliance

FEBRUARY 3, 2025

HEDIS audits are important for Medicare and Medicaid health plans because data is used to determine the efficacy of a payer to care for its members. For Medicare Advantage plans, the HEDIS review process contributes to the Star Rating system, which evaluates plan quality. Measures Collected Using Electronic Clinical Data Systems.

Patient Satisfaction 147

Patient Satisfaction Compliance Medicare Medicare 147

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.

Medicare 93

Medicare Medicare Compliance Medicaid 93

Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. 3d 1, 18 n.19

Medicare 105

Medicare Medicare Overpayments Overpayment 105

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

Health Law Checkup

JANUARY 20, 2022

Can a whistleblower successfully allege Medicaid/Medicare fraud if the whistleblower lacked direct access to records related to the alleged fraud? While the appellate circuits are still split on this issue, we look at recent decisions that indicate a possible shift in the Seventh Circuit’s pleading standard.

Fraud 95

Fraud Medicaid Medicaid Medicare 95

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

Hall Render

APRIL 3, 2025

VMG Health published a report highlighting the pros and cons of site-neutral payment legislation, which seeks to equalize Medicare reimbursement rates across different care settings. Site-neutral payments stand to save Medicare billions of dollars and reduce out-of-pocket costs for patients who pay higher copays for hospital-based services.

Hospitals 52

Hospitals Medicare Medicare 52

Healthcare IT News - Telehealth

FEBRUARY 18, 2021

million commercially insured and Medicare Advantage enrollees from January through June 2020. In a separate Health Affairs blog, health policy experts noted that Medicaid users have had "less consistent" access to telemedicine. THE LARGER TREND.

COVID-19 218

COVID-19 Telemedicine Medicaid Medicaid 218

American Medical Compliance

OCTOBER 25, 2024

In this blog, we will explore how healthcare providers can conduct effective compliance audits, ensuring both thoroughness and efficiency. Why Compliance Audits Matter in Healthcare A compliance audit is a critical process that reviews an organization’s adherence to internal policies and external regulations.

Compliance 105

Compliance Fraud Compliance Framework HIPAA 105

Healthcare IT News - Telehealth

SEPTEMBER 6, 2022

In March, Signify Health acquired Caravan Health , which serves Medicare beneficiaries through accountable care organizations. " wrote Dr. Marc Rothman, CMO of Signify Health, in a company blog post. In 2022, Signify Health clinicians are expected to serve 2.5 million members at their homes, both in person and virtually.

Doctors 199

Doctors Medicare Medicare Hospitals 199

Hall Render

JANUARY 29, 2025

The United States Department of Justice (DOJ) recently settled part of a qui tam lawsuit under the False Claims Act for alleged violations of the Medicare 14-Day Rule for $388,667. The DOJ, therefore, claimed the laboratory and health system knowingly caused the submission of false claims for reimbursement to Medicare.

Medicare 52

Medicare Medicare Hospitals Compliance 52

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. In this blog post, we’ll explore these and how behavioral health practices are adopting technology to prepare for the future. Behavioral health credentialing certainly has a unique and challenging credentialing process.

Medicare 52

Medicare Medicare Licensing Compliance 52

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

MRO Compliance

AUGUST 3, 2022

This blog post serves as a summary to increase efficiency and security in the audit process. Consider auditing software that can instantly transmit charts, discussions, and appeal filings to Medicare, Medicaid and commercial auditors, preventing file loss and delivery delay. Audit Software Helps You Work Smarter, Not Harder.

Compliance Officers 130

Compliance Officers Medicare Medicare Compliance 130

Healthcare IT Today

DECEMBER 29, 2020

The piece, which appears in the Health Affairs blog, looks at the state of telehealth in the U.S. Today I read an interesting piece by Sean Cavanaugh, chief policy officer of ACO sponsor Aledade Inc. and how we got where we are. It also makes some recommendations on how to think about telehealth in the […].

Medicare 139

Medicare Medicare Telemedicine Hospitals 139

Healthcare Law Blog

JANUARY 31, 2023

This blog is the second installment of our Digital Health Trends series. vii] “Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule,” Centers for Medicare & Medicaid Services (Nov. The reimbursement landscape has changed since the start of the pandemic.

COVID-19 105

COVID-19 Medicare Medicare Medicaid 105

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.

Medicare 64

Medicare Medicare Medicaid Medicaid 64

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

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

The Health Law Firm Blog

JUNE 14, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

MARCH 12, 2025

Background of the Case Relator Rosales filed a qui tam action in June 2020 against a hospice care provider and its subsidiaries, alleging fraudulent conduct aimed at securing payments from Medicare and Medicaid. Hall Render blog posts and articles are intended for informational purposes only.

Fraud 52

Fraud Governance Medicaid Medicaid 52

MRO Compliance

SEPTEMBER 21, 2023

I imagine you know that Medicare Advantage, for the first time, enrollment in Medicare Advantage is going to surpass Medicare fee for service, which means that there will be more people enrolled in Medicare Advantage plans than there are in traditional Medicare.

Medicare 182

Medicare Medicare 182

Healthcare IT Today

DECEMBER 22, 2023

Wave HDC offers several insurance “curators” including Coordination of Benefits, Eligibility, and Medicare Beneficiary Identifiers, and serves hospitals, laboratories, billing companies, and physician groups. To learn more about how providers can benefit from these enhanced offerings from Experian Health, read our Global News Blog.

Medical Billing 126

Medical Billing Hospitals Medicare Medicare 126

Hall Render

MARCH 20, 2025

In December 2024, the Centers for Medicare & Medicaid Services (CMS) made many revisions to its Guidance for SNF Attachment on Form CMS-855A (Guidance). Hall Render blog posts and articles are intended for informational purposes only.

Nurses 52

Nurses Medicaid Medicaid Medicare 52

MedTrainer

SEPTEMBER 20, 2023

If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations. There are several accrediting organizations that require facilities to meet or exceed Medicaid and Medicare guidelines. Accreditation.

Medicaid 97

Medicaid Medicaid Medicare Medicare 97

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

MARCH 4, 2025

SNF services covered by the Medicare Part A Skilled Nursing Prospective Payment System (PPS) payment are not designated health services (DHS) for purposes of the PSL. Hall Render blog posts and articles are intended for informational purposes only. When the services are DHS for purposes of the PSL (e.g.,

Compliance 52

Compliance Nursing Homes Nurses Medicare 52

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

Fraud 52

Fraud Medicare Medicare Telemedicine 52

Bill of Health

SEPTEMBER 25, 2024

The plaintiffs argue that those enrolled in the SSI program at the time of hospitalization qualify, whereas the Department of Health and Human Services (HHS), which oversees the Centers for Medicare and Medicaid Services, argues that only those entitled to receive SSI cash payments qualify.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Med Law Blog

FEBRUARY 8, 2024

Penn State Health has agreed to pay $11,712,336 to settle allegations of civil liability from submitting improper claims to Medicare for Annual Wellness Visit services.

Medicare 59

Medicare Medicare 59

MRO Compliance

AUGUST 8, 2024

The Role of Clinical Data Registries According to the latest information from the Centers for Medicare and Medicaid Services (CMS), 90% of payments are now linked to value, with 40% flowing through alternative payment models (APMs), showing the shift towards more cost-effective care driven by data from registries.

Patient Satisfaction 147

Patient Satisfaction Medicare Medicare Medicaid 147

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

The Health Law Firm Blog

MARCH 4, 2024

Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that decreased overall payment rates for services provided under the Physician Fee Schedule [.] By George F. Indest III, J.D.,

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MRO Compliance

JUNE 1, 2022

HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. Depending on the score of a health plan, payers may receive considerable Medicare financial incentives if a score exceeds a certain level. HEDIS audits are important for Medicare and Medicaid health plans.

Medicare 130

Medicare Medicare Compliance Medicaid 130