AIHC

MARCH 31, 2025

The "Sunshine Act," officially known as the Physician Payments Sunshine Act, mandates those manufacturers of drugs, medical devices, and biologics report payments and transfers of value to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS).

Compliance 64

Compliance COVID-19 Compliance Officers Medicaid 64

Healthicity

JUNE 23, 2022

As compliance officers, we often focus (and rightfully so) on enforcement efforts.

Compliance Officers 98

Compliance Officers Medicaid Medicaid Medicare 98

MedTrainer

NOVEMBER 2, 2023

This critical responsibility rests on the shoulders of the healthcare compliance officer. Read on if you’ve ever wondered about the unsung heroes as we answer the question: What does a compliance officer do in healthcare? What Is the Primary Role of a Compliance Officer in Healthcare?

Compliance Officers 52

Compliance Officers Compliance HIPAA Regulatory Compliance 52

Verisys

FEBRUARY 23, 2022

As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Accordingly, maintaining compliance has become a key focus for healthcare facilities. HCO Qualifications. Reimbursement.

Compliance Officers 52

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

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

YouCompli

APRIL 9, 2025

As compliance officers, we spend a lot of time focused on how others perform their jobs. However, being self-aware of how we do our own work is paramount for an effective compliance program. Incorporating self-awareness into your healthcare compliance program can significantly enhance its effectiveness.

Compliance 52

Compliance Compliance Officers Governance Medicare 52

Health Law RX

NOVEMBER 22, 2023

The GCPG has been anticipated since the OIG announced on April 25, 2023, that it planned to modernize the accessibility and usability of its publicly available resources, including the OIG’s Compliance Program Guidance (CPG) documents. The OIG anticipates addressing Medicare Advantage and nursing facilities next.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

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

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

YouCompli

JANUARY 4, 2023

The healthcare enterprise risk approach takes compliance in new directions . Featured speakers: James Bryant , Vice President and Chief Compliance Officer, Brigham and Women’s Hospital; Timothy C. Compliance officers find that their go-to colleagues have left or changed positions. Loss of Institutional Knowledge.

Compliance Officers 52

Compliance Officers Compliance ADA Hospitals 52

YouCompli

NOVEMBER 18, 2023

In this article, we will examine four essential listening skills that help compliance officers be more effective within their organizations. Maybe you also heard that the individual who was doing Medicare coverage analyses for the oncology research area was recently promoted. Fortunately, being a better listener is possible.

Compliance Officers 52

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

Compliancy Group

MARCH 22, 2024

depend on Medicare to get the healthcare they need. Remaining in good standing with Medicare has several advantages. Compliance Program A comprehensive way to avoid Medicare exclusion is to develop an organization-wide compliance program, one of the Centers for Medicare and Medicaid Services (CMS) requirements.

Medicare 52

Medicare Medicare Compliance Compliance Officers 52

Compliancy Group

DECEMBER 25, 2024

Credentialing also ensures that all employees know the rules for filing Medicare claims and using the proper billing codes. Credentialing software can help you automate the tracking of your staff while navigating the complexities of healthcare compliance laws.

Compliance 52

Compliance Compliance Officers Licensing Doctors 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.

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Compliance Officers Medicare Medicare Compliance 130

HIPAA Journal

MARCH 30, 2023

The first of the seven elements of a compliance program is a suitable example of why it is important to view a compliance program holistically because it calls for the development of standards (etc.) under the direction of a compliance officer.

Compliance 109

Compliance Compliance Officers Fraud HIPAA 109

Compliancy Group

MARCH 12, 2025

A healthcare organization that does not follow proper methods of obtaining reimbursement from federal payor programs such as Medicare may run afoul of federal fraud, waste, and abuse laws. To avoid running afoul of potential civil or criminal liability, organizations must ensure that Medicare claim reporting is accurate.

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

JANUARY 4, 2022

Featured speakers: Craig Bennett , Vice President and Chief Compliance Officer, Boston Medical Center; Rachel Lerner , Esq., New compliance issues. This included the Medicare Final Physician Fee Schedule and noted that the Appropriate Use Criteria changes are delayed until the January first that follows the end of the pandemic.

Compliance Officers 40

Compliance Officers Public Health Compliance COVID-19 40

MedTrainer

MAY 3, 2024

From sophisticated Medicare fraud to a rising prevalence of telehealth fraud , healthcare organizations need to be diligent in understanding these threats. Designating a Compliance Officer: Compliance officers provide expert oversight and ensure the organization’s practices are in full compliance with all legal requirements.

Fraud 94

Fraud Compliance Compliance Officers Licensing 94

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Findings from OIG audits can identify compliance areas needing improvement.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

Compliancy Group

APRIL 23, 2024

When OIG Evaluation of Corporate Compliance Programs Turns Up Wrongdoing Compliance officers, and the compliance programs they oversee, represent the backbone of stringent adherence to federal, state, and internal standards of conduct. Minimizing their importance can be costly. Most CIAs last five years.

Compliance 59

Compliance Compliance Officers Regulatory Compliance Medicare 59

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

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

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. “Not

Compliance Officers 52

Compliance Officers Compliance Telemedicine COVID-19 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

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

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

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.

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Medicaid Medicaid Medicare Medicare 97

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

Compliancy Group

OCTOBER 16, 2024

There’s a significant connection between healthcare compliance and risk management. Compliance officers must thoroughly understand both concepts to protect their organizations and the patients they serve. Risk management refers to identifying, avoiding, and mitigating the factors contributing to healthcare non-compliance.

Compliance 52

Compliance Compliance Officers Fraud Regulatory Compliance 52

HIT Consultant

NOVEMBER 7, 2022

Jessica Badichek, Chief Informatics and Compliance Officer, MediTelecare. The financial benefits of accreditation are also twofold: Increased patient volume leads to increased revenue, and Medicare payments to accredited facilities are maintained due to appropriate patient status placement.

Health Insurance 98

Health Insurance Compliance Officers Health Outcomes Medicare 98

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. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse.

US Department of Health and Human Services 52

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

YouCompli

MAY 11, 2022

They offer clues for compliance professionals to spot training opportunities before they become enforcement actions. In March of 2022, a New Jersey rheumatologist was convicted by a federal jury for defrauding Medicare and other health insurance programs. Compliance officers should watch for: Follow the money.

Compliance Officers 52

Compliance Officers Fraud Compliance 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

HIPAA Journal

DECEMBER 28, 2022

It is also the case that, regardless of the level of effort put in to comply specifically with HIPAA, most hospitals already comply with HIPAA to some degree due to the measures implemented in order to participate in Medicare. The Five Areas of HIPAA Compliance for Hospitals to Focus On. What is Required to Comply with HIPAA?

HIPAA 79

HIPAA Compliance Hospitals Medicare 79

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

JUNE 21, 2024

The Office of the Inspector General (OIG) has honed in on chiropractic practices over the last few years because of improper payments and claims, and noncompliance with Medicare requirements. There seems to be a gap between chiropractic services and positive compliance outcomes.

Compliance 52

Compliance Compliance Officers Medicare Medicare 52