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 195

Patient Satisfaction Nurses Medicare Medicare 195

Compliancy Group

JANUARY 3, 2024

This article discusses the issues related to medical billing compliance policy and the steps for providers to maintain financial integrity and adherence to all requirements. Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the Bureau of Facility Standards , provide oversight with certain standards, adding a layer of complexity to successfully managing healthcare compliance in Idaho. Continue reading this overview for key aspects of healthcare compliance specific to the state of Idaho.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

Medisys Compliance

APRIL 8, 2025

Definitive drug testing (CPT 80320-80377): These codes are used for confirmatory testing, typically using more sophisticated methods like mass spectrometry, to identify specific drugs and their concentrations. CMS Guidelines The Centers for Medicare & Medicaid Services (CMS) plays a significant role in laboratory billing.

Medical Billing Outsourcing 52

Medical Billing Outsourcing COVID-19 Medical Billing Medicare 52

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

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 105

Fraud Compliance Medicaid Medicaid 105

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

MedTrainer

MARCH 28, 2024

Healthcare compliance. Just as perplexing is who is responsible for compliance in healthcare organizations. The answer has as many layers as the definition of compliance itself. The answer has as many layers as the definition of compliance itself. And they’d be partly right.

Compliance 52

Compliance Compliance Officers Licensing Regulatory Compliance 52

AIHC

FEBRUARY 17, 2025

This article follows a road less-traveled by discussing the potential of audit managers knowingly skewing audit results causing unintended consequences within what appears to be a well-functioning compliance program. The list of terms and definitions used throughout are below for reference. An explanation is far more effective.

Fraud 52

Fraud Compliance Overpayments Overpayment 52

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

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

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

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

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

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

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.

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ADA COVID-19 Medicare Medicare 98

Medisys Compliance

MARCH 9, 2025

Always consult the most current CMS guidelines for the definitive word on “incident-to” billing as regulations can be nuanced.

Medicare 59

Medicare Medicare Medical Billing Medical Billing Services 59

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 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.

Public Health 94

Public Health Payment Systems Medicare Medicare 94

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 126

Medical Device Industry Medicaid Medicaid Nurses 126

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 62

HIPAA Compliance Health Services Administration Medicare 62

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

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

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

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 135

HIPAA Governance FDA Medicaid 135

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

Hall Render

FEBRUARY 14, 2025

The Centers for Medicare & Medicaid Services (CMS) recently finalized a rule (Final Rule) that expands its ability to impose a Provisional Period of Enhanced Oversight (PPEO) on providers, including post-acute providers, reactivating their Medicare enrollment.

Medicare 52

Medicare Medicare Compliance Payment Systems 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

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 55

HIPAA Compliance Fraud Medicare 55

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

Hall Render

OCTOBER 22, 2024

Effective October 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) introduced significant updates to the CMS-855A form , specifically requiring a new Skilled Nursing Facility (“SNF”) Attachment for every SNF. Accompanying guidance to the revised form may be found here.

Medicare 40

Medicare Medicare Nurses Medicaid 40

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 124

Health Outcomes Medicaid Medicaid Nurses 124