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In doing so, we encouraged contributors to comment on the Principles’ potential usefulness as guidance in addressing real emergency situations, as well as any possible gaps and weaknesses. They also were intended to be of application to a wide range of emergencies, not public health emergencies specifically.
This approach enhances both performance and compliance while minimizing human error. According to a Black Book survey , 90% of HIM professionals believe that upcoding is a significant ethical concern, while 85% say that discrepancies identified during coding audits often lead to denied claims or repayment demands due to system complexity.
One of the most important lessons from the ongoing COVID-19 pandemic needs to be about health surveillance of marginalized health populations — indeed, “who counts depends on who is counted.”. By Doron Dorfman and Scott Landes. Without such data, our laws and policies will be fundamentally incomplete. are woefully inadequate.
The third report in the six-part series, which is focused on drug policing explains, “The primary W-G task that lies ahead for both federal and state governments is to recognize what the evidence has been telling us, that the ‘war on drugs’ is a failure, and escalation will only double-down on that failure.
If you don’t know the work of Dr. Verghese, and since you’re reading the Health Populi blog, you must get to know Dr. V now. We want our physicians to know us, deeply indeed, through all of our “omes:” genome, proteome, metabolome, transcriptome, and so on, Dr. V observes. million views. ” The U.S.
These six students are a fantastic cohort of scholars who join us from Harvard Law School and Harvard Medical School. Each will undertake a year-long research project with mentorship from Center faculty and affiliates and will blog here at Bill of Health regularly. Keep an eye out for their bylines! Spencer Andrews (J.D.
While this is not a new case, it serves as a good reminder that even a small healthcare provider is subject to potential monetary penalties under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Our other relevant blog posts: “ OCR increases HIPAA audits ,” “ When was the last time you trained your workforce on HIPAA?
Some of these bodies were released, back into a society not prepared to receive, due to their own post-COVID health needs.). Supposedly, under the watchful eye of Lady Justice, prisoners are afforded certain inalienable rights and privileges, like religious and education services, for the redemptive qualities they both provide.
Technologies continue to transform the healthcare industrythe da Vinci Surgical Robot performs precise movements that enable minimally invasive surgeries, the CyberKnife delivers targeted radiotherapy, and smart devices provide practitioners with instantaneous updates to patient health. What Is AI in Healthcare Compliance?
Poor communication between departments : Credentialing requires input from many players, including HR, compliance teams, and insurance payers. This can result in providers being unable to bill for services, disruptions in patient care, and compliance violations.
A small breach can be a simple release of information (ROI) process error involving a patient’s protected health information (PHI). Most of those disclosure points occur outside the health information management (HIM) department in areas where individuals are not trained in PHI disclosure management. Social media.
To ensure the protection of sensitive information related to Substance Use Disorder (SUD) patients, the USDepartment of Health and HumanServices and The Substance Abuse and Mental HealthServices Administration (HHS and SAMHSA) collaborated to create the HIPAA Drug and Alcohol Records Law, also known as 42 CFR Part 2.
Board Certified by The Florida Bar in Health Law This is part two of two in a blog series in which the effects and scope of OIG exclusion on health care professionals will be discussed. Click here to read part one of this blog series. Indest III, J.D.,
Board Certified by The Florida Bar in Health Law This is part one of two in a blog series in which the effects and scope of OIG exclusion on health care professionals will be discussed. The paramount effect of exclusion is that payment is prohibited for items or services that an excluded individual or entity provides.
Insurance agents who handle protected health information (PHI) are required to comply with the Health Insurance Portability and Accountability Act (HIPAA). In this blog post, we’ll discuss the potential consequences of HIPAA non-compliance for insurance agents. 104-191 Department of Health and HumanServices.
Insurance agents who handle protected health information (PHI) are required to comply with the Health Insurance Portability and Accountability Act (HIPAA). In this blog post, we’ll discuss what insurance agents need to know about HIPAA compliance audits. 104-191 Department of Health and HumanServices.
Join us for our complimentary webcast, “Navigating Increased Scrutiny for Health Care Deals in 2024,” to be held on March 5 at 10 am PT. CLICK HERE TO REGISTER We encourage all stakeholders in the health care space contemplating mergers and acquisitions and strategic transactions to attend this webinar.
Monthly Healthcare Compliance News: January 2025 Overlook: Federal Legislation Licensure Compacts Other Legislation Board Updates USDepartment of Health and HumanServices: The Secretary of the US DHHS has issued a new amendment under the Public Readiness and Emergency Preparedness Act (PREP Act) effective January 1, 2025.
Monthly Healthcare Compliance News: January 2025 Overlook: Federal Legislation Licensure Compacts Other Legislation Board Updates USDepartment of Health and HumanServices: The Secretary of the US DHHS has issued a new amendment under the Public Readiness and Emergency Preparedness Act (PREP Act) effective January 1, 2025.
BetterHelp, an on-line mental health platform, engaged in unfair and unreasonable privacy practices according to the FTC’s complaint , leading to a proposed $7.8 Department of Health and HumanServices (HHS) warned us that use of on-line tracking technologies can violate HIPAA.
A home healthservices company headquartered in Kentucky, and its related entities, paid $2.1 million to the United States government to settle claims of improperly billing the Medicare Program for home healthservices provided to beneficiaries living in Florida.
His exclusion means that no federal healthcare program payment may be made, either directly or indirectly, for any items or services furnished by him or at his direction or prescription. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”.
That’s TMI for me to write about in the Health Populi blog, but this story has a current-events twist: the pharmacist could not electronically link with my insurance company to transact my payment. The Department of Health and HumanServices finally weighed in on the situation on March 5th.
Insurance agents who handle protected health information (PHI) are required to comply with the Health Insurance Portability and Accountability Act (HIPAA). In this blog post, we’ll discuss the requirements for HIPAA training for insurance agents and some strategies for providing effective training.
In this blog, we’ll describe near-miss events and how incident reporting software helps healthcare organizations better understand causes and ways to prevent future problems. Near-Miss Events are Common A study by the National Institutes of Health (NIH) found that near-miss events occurred in nearly 23% of 5,582 emergency department cases.
The Office of Inspector General (OIG) for the USDepartment of Health and HumanServices (HHS) has made educational resources available for healthcare providers to comply with federal healthcare laws and regulations. Department of Health and HumanServices (hhs.gov).
million individuals, reported to the USDepartment of Health and HumanServices’ (HHS) Office for Civil Rights (OCR) data breach portal so far in 2022. A recent report revealed that ransomware, double extortion, and software vulnerability exploits were increasingly used rather than traditional data encryption.
The Centers for Medicare & Medicaid Services (“CMS”), on behalf of the U.S. Department of Health and HumanServices (“HHS”), recently issued a proposed rule to adopt standards under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) for “health care attachment” transactions (the “Proposed Rule”).
These hackers are costing health organizations millions of dollars and threatening the safety of patients. In January of 2018, Hancock Health of Indiana experienced a serious ransomware attack that forced their entire network to shut down. Another complication that healthcare organizations face is the US HHS itself.
The provider had created a business to provide home and community-based services to Medicaid recipients. The provider had created a business to provide home and community-based services to Medicaid recipients. An ineligible Medicaid provider was arrested in Florida for defrauding Medicaid of more than $68,000.
Healthcare data breaches that affect greater than 500 individuals are required to be reported to the USDepartment of Health and HumanServices’ Office for Civil Rights (OCR) within 60 days of discovery. All staff must fully understand how they can help safeguard protected health information (PHI).
On December 5, 2022, the Department of Health and HumanServices (“ HHS ”), Office of Inspector General (“ OIG ”), released their Semiannual Report to Congress for the period beginning on April 1, 2022, and ending on September 30, 2022 (the “ Semiannual Report ”). [1]. million $1.19 billion Questioned Costs $1.17
How to use the SBAR Framework. The same tool nurses use to communicate about health emergencies – can help you secure investment in your compliance department. . While its primary use is in clinical cases, healthcare professionals across the organization are finding it useful for communicating with clinical leaders.
by Frank Fairchok, Vice President of Medicare Reporting Services. Last week, the Centers for Medicare & Medicaid Services (CMS) advanced the rulemaking process in two long-awaited areas. 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047). 0938-AT85 – Medicare Secondary Payer and Future Medicals (CMS-6047).
Writing in their latest quarterly newsletter, the USDepartment of Health and HumanServices’ Office for Civil Rights (OCR) reported that the number of hacking or IT incidents which led to ePHI data breaches increased 45% from 2019 to 2020. Phishing attacks are one of the most common types of cyberattacks.
Following an internal review and audit, the hospital discovered irregularities regarding its billing of certain services, and proactively contacted the United States to self-disclose the issues.?The If the patient was going to receive ICR for longer than 30 days, a physician must complete and sign updates to the ITP every 30 days thereafter.?
The USDepartment of Health and HumanServices (HHS) Office for Civil Rights (OCR) has announced the resolution of three investigations and one matter related to compliance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. OCR imposed a $50,000 civil money penalty.
Do your hiring managers and Human Resources colleagues know what to look for? Department of Health and HumanServices Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. Provision of unnecessary or substandard services.
Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations. It also reduces waste, fraud, and abuse that threaten the efficiency of healthcare delivery and services. name, phone number).
Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Department of Health & HumanServices ( HHS ). monitorship or reporting obligations).”
In this blog post, we look closely at the intricacies of the Plan, exploring how it shapes the healthcare compliance landscape. Department of Health and HumanServices (HHS), is tasked with combating fraud, waste, and abuse in health programs, ensuring efficiency, and promoting the integrity of HHS programs, including Medicare and Medicaid.
This surge in cyberattacks has prompted the Department of Health and HumanServices (HHS) to publish voluntary cybersecurity performance goals to help healthcare organizations plan and prioritize their cybersecurity implementations. Our zero trust implementation allowed us to meet all of those goals.
On Thursday, March 16, the Office of the Inspector General for the Department of Health and HumanServices (“OIG”) issued OIG Advisory Opinion (“AO”) No. Millions of people in the US suffer from heart failure each year, resulting in billions of dollars in healthcare costs.
Unfortunately, with a title like “compliance officer,” we have some image issues to overcome if we want our healthcare leaders to see us more like a business partner and less like an obstacle. Let’s imagine someone is conducting an audit involving the review of medical-necessity documentation for physical therapy services.
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