Provider Trust

MAY 17, 2022

So what does that mean for your healthcare organization’s compliance program? Is your organization properly vetting and monitoring compliance of your entire vendor network? Which regulations govern vendor compliance?

Compliance 52

Compliance Medicare Medicare Due Diligence 52

Healthcare IT News - Telehealth

AUGUST 30, 2021

In doing so, Trinity also hoped to receive readmission incentives from the Centers for Medicare and Medicaid Services, avoid penalties, and reduce costs as it transitioned to value-based care reimbursement. There is definite value with continuing to monitor patients after a home care episode, Joyce noted.

Patient Satisfaction 175

Patient Satisfaction Nurses Medicare Medicare 175

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Refining Definitions for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

HIT Consultant

APRIL 19, 2024

Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule.

Nurses 102

Nurses Medicare Medicare Medicaid 102

YouCompli

DECEMBER 19, 2023

Last month, the Office of Inspector General (OIG) published a new, user-friendly, 91-page General Compliance Program Guidance (GCPG). Users are encouraged to use the electronic version, to allow access to hyperlinked definitions and resource documents.

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

Healthcare IT Today

JUNE 7, 2023

Many of our concerns center on the proposed implementation timeframes associated with various concepts included in HTI-1, as well as ONC’s failure to sufficiently consider the burden compliance will place on provider organizations and health IT developers. 31, 2024, compliance timeline is unrealistic.

FDA 97

FDA Compliance Regulatory Compliance Medicaid 97

American Medical Compliance

JUNE 21, 2024

The Department of Health and Human Services (HHS) estimated that improper payments in the Medicare and Medicaid programs exceeded $100 billion from 2016 to 2023. Fraud, waste, and abuse (FWA) in healthcare present significant challenges, causing substantial financial losses, eroding public trust, and compromising the quality of patient care.

Fraud 93

Fraud Compliance Medicaid Medicaid 93

Provider Trust

MAY 18, 2022

What the HHS-OIG says about vendor compliance. However, healthcare receives federal funding, and thus OFAC is an additional sanction list that you should add to your vendor compliance plan/program. In addition, the suit involved alleged submission of false claims for reimbursement to the Massachusetts Medicaid Agency.

Compliance 52

Compliance Due Diligence Medicaid Medicaid 52

C&M Health Law

JANUARY 18, 2023

On January 4, in its most recent effort to expand federal support for addressing health-related social needs (HRSNs), the Centers for Medicare & Medicaid Services (CMS) issued guidance to clarify an existing option for states to address HRSNs through the use of “in lieu of” services and settings policies in Medicaid managed care.

Medicaid 52

Medicaid Medicaid Federal Policy Health Outcomes 52

Healthcare IT News - Telehealth

NOVEMBER 11, 2024

This team is responsible for regulatory compliance, submitting and advising on telemedicine initiatives, education and training, selection of telemedicine technology, quality control, oversight, and user support. Telemedicine is seen as an alternative method of delivering healthcare, not as a distinct area of medicine or surgery.

Telemedicine 192

Telemedicine Nurses Regulatory Compliance COVID-19 192

Hall Render

DECEMBER 11, 2024

The Proposed Rule would codify changes made by the Medicaid Services Investment and Accountability Act of 2019 (MSIAA), that added exclusion authorities related to misclassification and false information about outpatient drugs. Information about the LEIE may be found on the OIGs Exclusions page. Under 42 CFR Sec.

Compliance 40

Compliance Licensing Nurses Medicaid 40

HIT Consultant

NOVEMBER 22, 2021

July 1, 2021 was the enforcement date for the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule. Compliance Challenges. In this light, the most significant cost of delayed compliance is a lost strategic growth opportunity. John Kelly, Principal Business Advisor, Edifecs.

Compliance 52

Compliance Medicaid Medicaid Medicare 52

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

Total HIPAA

JANUARY 18, 2022

Definition of HIPAA Breaches. Here are a few examples from the HHS website: A municipal social service agency disclosed PHI while processing Medicaid applications. You must train your employees on this process so they can help your organization maintain HIPAA compliance. A simple oversight or event may qualify as a HIPAA breach.

HIPAA 92

HIPAA US Department of Health and Human Services Compliance Medicaid 92

Innovaare Compliance

OCTOBER 6, 2022

According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. MAOs have to ensure that TPMOs use a standardized disclaimer in their marketing materials that meet the definition of marketing whether they are in print, on the website, or in television advertising. or Contact Us.

Medicare 52

Medicare Medicare Compliance Public Health 52

Innovaare Compliance

FEBRUARY 14, 2022

Healthcare organizations establish Compliance Departments with the primary purpose of providing compliance oversight for the organization. Operational teams—such as the Member Services Department and the Appeals & Grievances Department—have significant compliance regulations, so they must know to maintain compliance.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Hall Render

APRIL 6, 2022

Second, the relator pointed out that Pharmacy Benefit Managers (“PBMs”) adopted and incorporated this definition of the “usually and customary” pricing into their agreements with pharmacies. Regarding the PBM’s adoption of this definition, the Court stated that this may not serve as the basis of a fraud claim under the FCA.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

HIPAA Journal

JANUARY 12, 2024

The key provisions of the HIPAA Omnibus Rule were: Make business associates of covered entities directly liable for HIPAA compliance. One of the concerns with regards to the lack of HIPAA compliance is that large scale changes to HIPAA are forecast over the next few years.

HIPAA 91

HIPAA Compliance Health Insurance Medicaid 91

Healthcare IT Today

FEBRUARY 15, 2024

To mitigate this, continuous investment in cybersecurity measures and adding modern security and compliance protocols is essential. Sarah Carroll, Senior Vice President, Center for Care Transformation at AVIA Health Medicaid and Medicare have become one of the biggest quiet crises in health systems today.

Medical Device Industry 130

Medical Device Industry Medicaid Medicaid Nurses 130

MedTrainer

AUGUST 8, 2024

In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Why Additional Training Is Required for Medicare-Enrolled Providers Training helps providers understand and adhere to Medicare’s complex regulations and guidelines, essential for maintaining compliance.

Medicare 52

Medicare Medicare Compliance Medicaid 52

C&M Health Law

OCTOBER 18, 2023

Section 504 covers all health care and human services programs and activities funded by HHS, from providers, like hospitals and doctors that accept Medicare or Medicare, to state child welfare programs, as well as Medicare Advantage Plans, and Medicaid Managed Care Plans. Web and mobile accessibility.

ADA 98

ADA COVID-19 Medicare Medicare 98

HIPAA Journal

MAY 12, 2023

The term “continuity of care” has various definitions. Some definitions imply care is continuous within the same healthcare organization (or Organized Health Care Arrangement), while others extend the definition to multiple healthcare settings. 42 CFR Part 2). The post HIPAA Continuity of Care appeared first on HIPAA Journal.

HIPAA 68

HIPAA Compliance Health Services Administration Medicare 68

AIHC

FEBRUARY 7, 2024

Medicaid policies on this issue vary from state to state. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”.

HIPAA 59

HIPAA Medicaid Medicaid Telemedicine 59

Healthcare IT Today

NOVEMBER 12, 2023

News The 2024 Medicare Physician Fee Schedule continues many telehealth flexibilities first adopted during the public health emergency, such as an expanded scope of originating sites an expanded definition of qualified practitioners. As a result, these flexibilities will be in place until at least Dec.

Payment Systems 97

Payment Systems Public Health Medicare Medicare 97

Compliancy Group

OCTOBER 1, 2024

Compliance officers and other organizational leaders must be constantly vigilant of resource waste and the inappropriate and illegal use of funds from Medicare and other federal programs. Compliance with Medicare and other programs requires relevant staff to take regular fraud, waste, and abuse (FWA) training.

Fraud 52

Fraud Compliance Medicare Medicare 52

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2 and 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Medisys Compliance

JANUARY 4, 2024

This article equips primary care providers with the latest knowledge and technical expertise to navigate the process seamlessly, maximizing new patient visit billing accuracy and minimizing compliance risks. However, specific definitions might differ depending on payers and specialties.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Compliance Medical Billing Services 59

Innovaare Compliance

JUNE 30, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Chapter 5 and under Definitions in Chapter 12, EOC) Lengthy explanation for requesting exceptions to the formulary (Sections 6.2, Section 2.1 Chapter 9, EOC) A monthly cap of $35.00 and Section 3.2, Section 2.1

Medicare 52

Medicare Medicare Compliance Medicaid 52

AIHC

FEBRUARY 7, 2024

Medicaid policies on this issue vary from state to state. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”.

HIPAA 52

HIPAA Medicaid Medicaid Telemedicine 52

Healthcare Law Blog

MARCH 2, 2023

Effective March 1 st , certain providers choosing to self-disclose Stark Law violations must use forms updated by the Centers for Medicare & Medicaid Services (“CMS”). 411.352 it failed to satisfy.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Healthcare IT Today

JANUARY 8, 2024

It is key for pharmaceutical companies to recognize that efficiency does not override compliance, patient safety or regulatory standards. There are considerable risks to adoption that may have deep compliance implications. As new systems and automated technologies are built, global health authorities will need to respond accordingly.

Pharmaceutical Industry 93

Pharmaceutical Industry Due Diligence Compliance Regulatory Compliance 93

HIPAA Journal

JULY 4, 2024

The above HIPAA rules and regulations are mostly administered and enforced by HHS’ Office for Civil Rights (Parts 160 and 164) and HHS’ Centers for Medicare and Medicaid (Part 162). What are Covered Entities? What is PHI under HIPAA? Limited Data Sets under HIPAA?

HIPAA 58

HIPAA Compliance Fraud Medicare 58

Healthcare Blog

OCTOBER 19, 2023

Compliance with any policy has a much better success rate when it is understood. If your policy affects visitors, you must get the information out to the public to assure compliance. The Centers for Medicare and Medicaid Services has a vast information depository on regulations and guidance for healthcare policy. 2021, May 6).

Public Health 105

Public Health Compliance Hospitals Health Insurance 105

HIPAA Journal

NOVEMBER 4, 2022

The Department of Health and Human Services (HHS) is the Sector Risk Management Agency (SRMA) for the healthcare industry, but within the HHS agencies such as the Office for Civil Rights (OCR), Centers for Medicare and Medicaid Services (CMS), and the Food and Drug Administration (FDA) have their own jurisdictions and cybersecurity policies.

HIPAA 125

HIPAA Governance FDA Medicaid 125

Healthcare IT Today

MAY 10, 2023

To support compliance with therapy and level the playing field for all patients, healthcare providers need access to patients’ medication history, including prescription fill data, so they can identify medication non-adherence on an individual and population level.

Health Outcomes 128

Health Outcomes Medicaid Medicaid Nurses 128