Compliancy Group

JUNE 6, 2024

Centers for Medicare and Medicaid (CMS) : Waiver (applied retroactively) from March 1, 2020, through May 11, 2023, for physician owners of independent freestanding emergency departments serving Medicare patients during the COVID-19 pandemic.

Compliance Officers 59

Compliance Officers Compliance US Department of Health and Human Services Medicare 59

Compliancy Group

OCTOBER 4, 2024

For example, internal audits help compliance officers and executives maintain operational efficiency, reduce errors, improve workflows, and enhance the bottom line. An internal audit is an excellent opportunity to detect factors contributing to non-compliance, mitigate risk, and address potential problems.

Compliance Officers 59

Compliance Officers Compliance Regulatory Compliance Fraud 59

AIHC

NOVEMBER 12, 2024

About the Author Gabriella Neff , RHIA, CHA, CHC, CHRC, CHPC is a Research Compliance Officer for H. Lee Moffit Cancer Center and also serves as a Board Member for the American Institute of Healthcare Compliance.

Informed Consent 98

Informed Consent HIPAA Compliance Hospitals 98

Compliancy Group

OCTOBER 28, 2024

Medicare Beneficiaries Making Extra Payments In some nursing homes, residents or their families erroneously pay for services that Medicare or Medicaid already cover. However, in smaller facilities with staffing challenges, a compliance officer may need to fulfill other roles.

Nurses 52

Nurses Compliance Nursing Homes Compliance Officers 52

American Medical Compliance

OCTOBER 25, 2024

The healthcare industry is highly regulated, with various laws such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH), and the Medicare and Medicaid Services (CMS) regulations shaping operations.

Compliance 105

Compliance Fraud Compliance Framework HIPAA 105

Provider Trust

APRIL 22, 2025

Our clients trust us with their most critical data, said Donna Thiel, chief compliance officer at ProviderTrust. To learn more about ProviderTrusts solutions and approach to data-driven compliance, visit www.providertrust.com.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

AUGUST 8, 2024

In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Required Training for Medicaid-Enrolled Providers Though this article discusses Medicare-enrolled provider training requirements, I want to discuss how Medicaid enrollment and training differ. and state regulations.

Medicare 93

Medicare Medicare Compliance Medicaid 93

Healthcare Law Blog

FEBRUARY 3, 2023

New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R. Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1]

Medicaid 52

Medicaid Medicaid Compliance Overpayment 52

MRO Compliance

AUGUST 3, 2022

Consider auditing software that can instantly transmit charts, discussions, and appeal filings to Medicare, Medicaid and commercial auditors, preventing file loss and delivery delay. If errors are found, the internal compliance officer can determine if repayment in accordance with the 60-day rule is appropriate.

Compliance Officers 130

Compliance Officers Medicare Medicare Compliance 130

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. Part 521, make several important changes that will affect all Medicaid Providers’ compliance programs throughout New York State. New York Social Services Law § 363-d.

Compliance 52

Compliance Overpayment Overpayments Compliance Officers 52

Provider Trust

MAY 26, 2023

Thursday, June 22, 2023 | 12-1pm CST Join us for an information session where Donna Thiel, Chief Compliance Officer at ProviderTrust, will share her expertise and valuable feedback from the 2023 HCCA Compliance Institute.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

Verisys

MARCH 6, 2025

Healthcare executives and compliance officers must consistently update and verify provider data to enhance patient care, adhere to regulatory standards, and streamline administrative tasks. Similarly, insurance companies that process thousands of claims daily require up-to-date provider information to avoid claims delays and denials.

Compliance 52

Compliance Licensing Doctors Malpractice 52

Verisys

APRIL 3, 2025

Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Medicare and Medicaid Compliance Requirements , which mandate reporting of program exclusions. State licensing board regulations , which require disclosure of disciplinary actions.

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

MedTrainer

FEBRUARY 7, 2024

The complex world of healthcare compliance demands a clear understanding of responsibilities. For those new to the role of compliance officer, the question often arises: “Who is responsible for compliance in healthcare?” Who is Responsible for Compliance in Healthcare?

Compliance 52

Compliance Compliance Officers Health Insurance Medicaid 52

Verisys

MARCH 6, 2025

Healthcare administrators and compliance officers must be prepared to navigate these obstacles to maintain a seamless, efficient process. This process helps guarantee that providers stay in line with state and federal regulations, keeping healthcare organizations in good standing with insurers, regulators, and other key players.

Licensing 52

Licensing Compliance Nurses Malpractice 52

MedTrainer

JANUARY 30, 2024

The professionals who manage compliance are the front lines of preventing medical errors, deterring fraud, and staying in good standing with federal payers like the Centers for Medicare and Medicaid Services (CMS). Certified Compliance and Ethics Professional (CCEP) offered by the Compliance Certification Board (CCB).

Compliance 52

Compliance Compliance Officers Fraud Medicaid 52

Compliancy Group

JULY 8, 2024

That’s why it’s essential to understand and apply the Center for Medicare and Medicaid (CMS) Rule for Emergency Preparedness. Each organization must comply with the CMS Emergency Preparedness Rule to participate in Medicare and Medicaid. To this end, your CMS emergency preparedness plan should contain these components.

Compliance Officers 52

Compliance Officers Compliance Medicaid Medicaid 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

Compliancy Group

MARCH 12, 2025

With such a wide range of potential noncompliance incidents, more compliance officers are exploring ways to combat these penalties so they can respond proactively instead of reactively. Whether a business is facing civil penalties or monetary losses, each penalty can have a domino effect on adverse events for the business.

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

DECEMBER 19, 2023

Exclusions (page 26) : OIG recommends that any entity participating in the federal Medicaid program should check the state Medicaid program exclusion list for each applicable state. In organizations where compliance reports to legal, conflicts of interest exist and can create barriers that lead to timing and resource inefficiencies.

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

YouCompli

NOVEMBER 29, 2023

“As previous OIG compliance guidance(s) are retired to ‘archival’ status, we all should recognize that the original guidance may have been the most important document ever written for healthcare compliance professionals.” — Roy Snell In 1998, the Office of Inspector General (OIG) issued its first General Compliance Program Guidance (GCPG).

Compliance 52

Compliance Compliance Officers Medicaid Medicaid 52

YouCompli

JUNE 29, 2022

With it, compliance officers have guided their healthcare organizations in complying with changing documentation, coding, and confidentiality requirements. As virtual care requirements for telehealth evolve, we explore how compliance officers can support patient care and help their organizations stay up to date.

Compliance Officers 52

Compliance Officers Compliance Telemedicine COVID-19 52

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Medicare/Medicaid Compliance Reviews. The OIG performs regular compliance reviews of Medicare and Medicaid providers.

Fraud 98

Fraud Compliance Medicaid Medicaid 98

AIHC

MAY 31, 2022

When the federal government covers items or services rendered to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply. Government programs, such as the Centers for Medicare & Medicaid Services (CMS), find the investment in their audit and monitoring programs are effective.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Compliancy Group

APRIL 17, 2024

For example, the OIG has focused on billing and coding, quality of care, data security and privacy, and Medicare compliance. Compliance officers and other healthcare leaders should stay updated on these focus areas and be able to anticipate annual changes in audit policy. Organizations using M.A.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

YouCompli

APRIL 27, 2022

As more healthcare professionals obtain licensure under compacts, compliance officers need to be aware of interstate licensure requirements – and their effects on patient care. And healthcare compliance officers have processes and procedures to update. Compliance considerations.

Compliance Officers 52

Compliance Officers Licensing Nurses Compliance 52

Healthicity

APRIL 24, 2025

Whether its Medicare, Medicaid, or a commercial payer, understanding how to respond is key to protecting your organization. No healthcare provider wants to receive a third-party audit noticebut many will.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

YouCompli

SEPTEMBER 13, 2023

Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic. For staff, compliance officers should support annual online FWA compliance training.

US Department of Health and Human Services 52

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

Verisys

MAY 3, 2023

7 Core Elements of Healthcare Compliance Plan and How to Measure Them Healthcare compliance regulations are complex and ever-changing, but are an essential part of any healthcare organization’s effort to provide safe, high-quality care for patients. Measuring effectiveness: Who is your designated compliance officer?

Compliance 52

Compliance Compliance Officers ADA Governance 52

MedTrainer

JULY 29, 2024

Corporate compliance training software is vital to tailoring programs to staff, departments, and locations. Corporate compliance training software helps healthcare executives and compliance officers mitigate legal and financial risks while fostering a culture of ethical behavior. monitorship or reporting obligations).”

Compliance 52

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

Provider Trust

MAY 16, 2024

This landmark milestone represents a continued commitment by ProviderTrust and its nearly 1,000 healthcare client organizations to ensure Medicare and Medicaid dollars are protected from fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

Provider Trust

MAY 16, 2024

This landmark milestone represents a continued commitment by ProviderTrust and its nearly 1,000 healthcare client organizations to ensure Medicare and Medicaid dollars are protected from fraud, waste, and abuse.

Fraud 52

Fraud Medicaid Medicaid Licensing 52

C&M Health Law

DECEMBER 18, 2023

Compliance policies should be developed under the direction and supervision of the compliance officer and compliance committee and should address the implementation and operation of an entity’s compliance program and processes. OIG’s updated take on the seven elements is briefly summarized below. (1)

Compliance 52

Compliance Compliance Officers Governance Overpayment 52

Provider Trust

JUNE 15, 2022

The OIG alleged that Summa employed an individual on the Ohio Provider Medicaid Exclusion and Suspension List as well as an individual who was excluded from participation in Federal health care programs. In this particular case, the exclusion came from the Ohio Provider Medicaid Exclusion and Suspension List. Donna Thiel.

Medicaid 52

Medicaid Medicaid Compliance Compliance Officers 52

MedTrainer

DECEMBER 7, 2023

All healthcare organizations, along with their providers and compliance officers, must understand the requirements of each regulatory state agency that provides oversight. The Med-QUEST Division administers Hawaii’s Medicaid program, providing essential healthcare services to low-income individuals and families across the state.

Compliance 52

Compliance Compliance Officers Licensing Medicaid 52

Healthcare Compliance Blog

APRIL 26, 2022

The compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with federal healthcare program standards. Toolkits: The OIG has created several toolkits to help providers ensure they are in compliance with healthcare laws.

US Department of Health and Human Services 59

US Department of Health and Human Services Fraud Compliance Medicaid 59

Health Care Performance

JULY 20, 2022

A New York ENT physician was convicted of filing false claims with Medicare and Medicaid. The physician submitted claims totaling about $585,000 to Medicare and Medicaid and was paid roughly $191,000. It is impossible to draft policies and train staff on for every possible compliance risk scenario. L earn more.

Fraud 52

Fraud Compliance Medicaid Medicaid 52