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 99

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 99

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]

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Medicaid Medicaid Compliance Overpayments 52

Medisys Compliance

FEBRUARY 27, 2024

Introduction Radiology billing compliance is a critical aspect of managing a successful radiology practice. With a myriad of regulations and the potential for audits looming, radiologists and billing staff need to have a solid understanding of compliance requirements.

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Compliance Medical Billing Outsourcing Medicare Medicare 59

HIT Consultant

OCTOBER 22, 2024

These interpretations have led to the development of detailed guidelines and enforcement actions to ensure compliance. Making HPH-CPGs a Condition of Participation (CoP) for CMS : The Centers for Medicare & Medicaid Services (CMS) could require adherence to HPH-CPGs as a condition for participating in Medicare and Medicaid programs.

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HIPAA Compliance Public Health Medicaid 139

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds.

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Medicaid Medicaid Compliance Governance 59

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

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Fraud Medicaid Medicaid Compliance 59

Total Medical ComplianceHIPAA

APRIL 12, 2024

As healthcare providers navigate the complex web of rules and regulations in compliance, one aspect that needs more attention is exclusion screening of those working with federally funded healthcare programs. Non-compliance with these requirements could result in financial penalties and jeopardize participation in Federal healthcare programs.

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Compliance Fraud Medicaid Medicaid 72

Bill of Health

DECEMBER 6, 2023

To tackle this issue, federal and state governments should strengthen the regulation of insurance networks and insurers should address underlying causes of inadequate networks. The Consolidated Appropriations Act of 2023 requires Medicaid plans to publish and update accurate and searchable provider directories.

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Governance Medicaid Medicaid Medicare 147

Compliancy Group

NOVEMBER 1, 2024

Anyone in this industry should know the healthcare compliance laws and regulations that guide how they do their jobs and provide quality care. Here’s your healthcare compliance 101 for the critical federal regulations all employees should know.

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Compliance HIPAA Electronic Medical Records Fraud 52

Health Law Advisor

AUGUST 25, 2023

It is axiomatic that New York State requires every Medicaid provider to have an “effective” compliance program. These regulations were proposed to implement portions of the New York State 2020-2021 Budget Bill amending the mandatory compliance program requirements. New York Social Services Law § 363-d.

Compliance 52

Compliance Overpayments Overpayment Compliance Officers 52

Verisys

FEBRUARY 8, 2024

– The best resource for monthly healthcare regulatory compliance updates. CA SB 372 Idaho: Idaho Administrative Rule 350 governing Pharmacist Prescribing was revised in September 2023 to allow all Idaho practitioners to prescribe controlled and non-controlled substances, including pharmacists.

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Regulatory Compliance Compliance Licensing Nurses 52

MedTrainer

JANUARY 12, 2024

At its core, healthcare compliance ensures the quality of care, patient safety, and integrity of healthcare systems. Over the years, healthcare compliance has evolved significantly, driven by changing regulations, advances in technology, and a growing emphasis on patient-centric care. What is Healthcare Compliance?

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Compliance HIPAA Telemedicine ACA 52

MedTrainer

NOVEMBER 14, 2023

While federal operations are slowed, reduced, or put on pause during a government shutdown, healthcare services must continue to operate. Compliance officers, human resource leaders, credentialing teams, and administrators are all asking themselves these critical questions. What Is a Government Shutdown?

Governance 52

Governance Medicaid Medicaid Medicare 52

MedTrainer

APRIL 11, 2024

There is one way to describe the relationship between HR professionals and compliance officers: It’s complicated. As you see these roles work together, you might wonder about the difference between a compliance officer and human resources in healthcare. Ultimately, both roles foster a healthy, law-abiding, and efficient workplace.

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Compliance Officers Compliance Medicaid Medicaid 52

American Medical Compliance

APRIL 17, 2024

The following Comprehensive Affordable Care Act (ACA) and Americans with Disabilities Act (ADA) Compliance Training educates healthcare providers on the historical context of both Acts. American Medical Compliance designates this activity for a maximum of 1 AMA PRA Category 1 Credits.

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ADA ACA Compliance Health Care Reform 52

Verisys

JANUARY 8, 2024

A healthcare compliance audit is a thorough review and examination of an organization’s adherence to regulatory guidelines. This type of audit is essential in the healthcare industry for several reasons: Regulatory Compliance It ensures that the healthcare organization complies with various federal and state laws and regulations.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

MRO Compliance

JUNE 1, 2022

Each year HEDIS rating criteria is updated, meaning your organization needs to stay up-to-date on the latest news and trends for HEDIS compliance audits. HEDIS works as a government rating tool. Compliance with HEDIS specifications. HEDIS audits are important for Medicare and Medicaid health plans. What is HEDIS?

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Medicare Medicare Compliance Medicaid 130

MedTrainer

MAY 21, 2024

With the odds of a person entering your healthcare facility dealing with a behavioral or mental health issue at about 20% , new and existing clinical providers must receive behavioral health compliance training to ensure patients receive the highest quality care. Training requirements vary by role and specific healthcare setting.

Compliance 52

Compliance Medicaid Medicaid HIPAA 52

MedTrainer

FEBRUARY 12, 2024

government collected $2.2B Knowingly or falsely claiming monies from federal programs such as Medicare and Medicaid has cost healthcare entities $72B since 1986. How are healthcare organizations ensuring compliance and minimizing exposure risks to false claims?

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Compliance Fraud Medicaid Medicaid 52

MedTrainer

NOVEMBER 30, 2023

Like other regions in the United States, Wisconsin is characterized by its unique blend of rules and mandates that govern healthcare compliance within the state. This post sheds light on certain aspects of healthcare compliance in Wisconsin, with tips for effectively managing your healthcare organization.

Compliance 52

Compliance Medicaid Medicaid Licensing 52

MedTrainer

JANUARY 12, 2024

Healthcare compliance is serious business for regulators. In this blog post, we’ll outline who regulates healthcare compliance, how rules are enforced, and why organizations need a robust compliance platform to stay in the good graces of regulators. What is Healthcare Compliance? Who Regulates Healthcare Compliance?

Compliance 52

Compliance Fraud Medicaid Medicaid 52

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. Are the claims accurate and complete?

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

Compliancy Group

OCTOBER 28, 2024

Its compliance program guidance (CPG) has improved the efficiency and effectiveness of Medicare and many other federal programs. Last November, the OIG published industry-specific compliance guidance for 2024 for several healthcare subsectors, including nursing homes and facilities.

Nurses 52

Nurses Compliance Nursing Homes Compliance Officers 52

Healthcare IT News - Telehealth

JUNE 15, 2020

This past week, Centers for Medicare and Medicaid Services Administrator Seema Verma said she "can't imagine going back" to making beneficiaries return to in-person visits after the agency's relaxation of telehealth regulations in response to the coronavirus pandemic.

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Telemedicine Licensing HIPAA COVID-19 204

American Medical Compliance

APRIL 24, 2024

Furthermore, there is an intricate legal landscape governing financial relationships in healthcare compliance. Moreover, they not only shape the foundation of healthcare compliance, but also ensure that medical providers do not compromise their judgment due to financial incentives. AMA PRA Category 1 Credits.

Compliance 52

Compliance Medicaid Medicaid Medicare 52

MedTrainer

FEBRUARY 12, 2024

Failing to report healthcare non-compliance is a lot like failing to tell your parents you got sent to the principal’s office. In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare.

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Compliance Licensing Governance Fraud 52

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. To become a provider for Ohio Medicaid, you must first enroll in the Ohio Medicaid program. Here are the steps of provider enrollment for Ohio Medicaid: Provider Enrollment for Ohio Medicaid 1.

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Medicaid Medicaid Licensing Medical Billing Outsourcing 52

Compliancy Group

OCTOBER 4, 2024

Despite your best efforts in meeting healthcare compliance requirements, errors may still occur. We also discuss how compliance software can help ensure regulatory compliance and maximize efficiency and accuracy in all your compliance activities. What is an Audit in Healthcare?

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Compliance Officers Compliance Regulatory Compliance Fraud 59

MedTrainer

NOVEMBER 14, 2023

When it comes to healthcare delivery, compliance is not just a matter of ticking boxes; it’s the backbone of patient trust and safety. In this blog post, we’ll explore the many reasons why healthcare compliance isn’t just important — it’s vital. What Is Healthcare Compliance?

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Compliance HIPAA Governance Medicare 52

MedTrainer

NOVEMBER 27, 2023

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

AUGUST 1, 2024

Compliance audits are critical to healthcare management, ensuring that healthcare organizations adhere to legal and regulatory standards. Audits help identify areas of non-compliance, mitigate risks, and support high standards of patient care and data security. What is a Healthcare Compliance Audit?

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Compliance Regulations Compliance Patient Satisfaction Governance 52

MedTrainer

OCTOBER 4, 2023

To ensure organizations meet these standards, federal healthcare compliance requirements have been put in place. Let’s look at some of the key federal healthcare compliance requirements, state-specific variations, and accreditation standards healthcare organizations must adhere to. What Are Federal Healthcare Compliance Requirements?

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Compliance Fraud HIPAA Governance 52

MedTrainer

FEBRUARY 1, 2024

A corporate compliance program in healthcare is a comprehensive set of policies, procedures, and practices that healthcare organizations establish and maintain to ensure that they operate compliant with all applicable laws, regulations, and ethical standards. Why do healthcare facilities use corporate compliance programs?

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Compliance Fraud Regulatory Compliance Regulations Compliance 52

MedTrainer

JULY 29, 2024

Healthcare compliance is complicated for organizations of any size. However, the complexities grow exponentially for large or enterprise organizations with hundreds or thousands of employees who must complete and pass rigorous compliance training. What Is Corporate Compliance Training?

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

MedTrainer

DECEMBER 7, 2023

Healthcare compliance in New Mexico mirrors the state’s diverse culture, with unique regulations that differ from other states, such as credentialing documentation requirements for managed care organizations. New Mexico’s parity law requires insurers to cover telemedicine services to the same extent as in-person services.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 4, 2023

Responsible healthcare providers and compliance professionals in each state of the United States must follow specific regulations, and achieving healthcare compliance in Kentucky is no exception. Regulations Unique to Kentucky To meet the standards of healthcare compliance in Kentucky , there are a few additional regulations.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Compliancy Group

AUGUST 30, 2024

Ensuring compliance in your hospital, private practice, or healthcare company means safeguarding patient data, optimizing working conditions for employees, and promoting the highest quality of care. We suggest incorporating them into an annual compliance checklist for companies across the healthcare sector.

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Compliance Fraud Compliance Officers HIPAA 52