MRO Compliance

FEBRUARY 3, 2025

For healthcare organizations, the HEDIS season, which typically spans February to May, requires a proactive approach to ensure data accuracy, compliance, and efficiency. Reminder of the audit process: According to NCQA , the HEDIS compliance audit contains two parts information system capabilities and HEDIS specification standards.

Patient Satisfaction 147

Patient Satisfaction Compliance Medicare Medicare 147

Compliancy Group

APRIL 18, 2025

Healthcare regulatory compliance means healthcare organizations are meeting a wide range of laws and standards that includes everything from billing and safety to data protection and patient rights. This compliance means ensuring patient safety, protecting their privacy, and making sure quality care is delivered. With annual U.S.

Regulatory Compliance 52

Regulatory Compliance Compliance Fraud HIPAA 52

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.

HIPAA 139

HIPAA Compliance Public Health Medicaid 139

Compliancy Group

FEBRUARY 12, 2025

The Office of Inspector General (OIG) released an updated Nursing Facility Industry Compliance Program Guidance (ICPG) in November 2024 to assist nursing facilities in navigating the complex regulatory landscape and mitigating compliance risks. The ICP covers the areas listed below.

Nurses 52

Nurses Compliance Medicare Medicare 52

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.

Compliance 52

Compliance HIPAA Electronic Medical Records Fraud 52

Bill of Health

APRIL 13, 2022

When the PHE ultimately expires, this will also trigger the end of the Medicaid continuous enrollment requirement, under which states must provide continuous Medicaid coverage for enrollees through the end of the last month of the PHE in order to receive enhanced federal funding. Continuity of Coverage.

Medicaid 147

Medicaid Medicaid COVID-19 Public Health 147

MRO Compliance

NOVEMBER 21, 2024

The Centers for Medicare & Medicaid Services (CMS) 2025 Physician Fee Schedule (PFS) Final Rule brings notable updates to the Quality Payment Program (QPP), which will impact eligible clinicians, groups, virtual groups, subgroups, and APM entities. CMS’s 2025 Final Rule introduces both challenges and opportunities.

Compliance 147

Compliance Medicare Medicare Medicaid 147

Verisys

MARCH 6, 2025

In the healthcare industry, compliance with regulatory standards is not merely a requirement but a cornerstone of safe, effective, and ethical patient care. When healthcare organizations fail to meet compliance standards, the consequences can be severespanning legal and financial realms. What is Non-Compliance in Healthcare?

Compliance 52

Compliance HIPAA Licensing Governance 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

American Medical Compliance

FEBRUARY 15, 2025

In the complex world of healthcare, maintaining compliance with federal regulations is crucial for the integrity of healthcare providers. “Mastering Compliance in Federal Health Care Program Billing, Coding, and Claims Training” is designed to equip you with the knowledge needed to navigate these complex systems with confidence.

Compliance 52

Compliance Medicare Medicare Medicaid 52

Healthcare IT Today

NOVEMBER 12, 2024

Best Positioned to Deliver Transformative Technology that Accelerates the Industry’s Evolution and its Ability to Improve Health Outcomes HHAeXchange , a leader in homecare management solutions for providers, caregivers, managed care organizations (MCOs), and state Medicaid programs, today announced that it has acquired Sandata Technologies.

Medicaid 111

Medicaid Medicaid Health Outcomes Compliance 111

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. He was also ordered to pay $557,000 in restitution to Indiana Medicaid and Medicare. As such, providers should prioritize billing compliance.

Fraud 40

Fraud Compliance Medicaid Medicaid 40

HealthIT Answers

JUNE 7, 2024

By Chris Emper - On April 22, CMS released an 895-page final regulation titled, “Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality.” The post New CMS Regulation Establishes Maximum Appointment Wait Time Standards for Medicaid appeared first on Health IT Answers.

Medicaid 105

Medicaid Medicaid Health Insurance Compliance 105

MRO Compliance

JANUARY 16, 2025

To address these gaps, the Centers for Medicare & Medicaid Services (CMS) now mandates the use of FHIR-based APIs for data sharing. Such proactive engagement helps meet compliance standards, builds trust, and improves outcomes. Embracing Innovation and Change In 2025, the future belongs to those who adapt, innovate, and lead.

Overpayments 130

Overpayments Overpayment Regulatory Compliance Patient Satisfaction 130

American Medical Compliance

AUGUST 7, 2024

Notably, many of these incidents are preventable and could have been avoided with proper compliance measures. Compliance with healthcare regulations is crucial not only for avoiding legal repercussions but also for ensuring high standards of patient care and safety. It ensures its confidentiality and maintains security.

Compliance 105

Compliance HIPAA Medicaid Medicaid 105

Medisys Compliance

DECEMBER 19, 2024

From managing CPT codes for procedures like nail debridement and wound care to ensuring compliance with Medicares podiatry-specific guidelines, the billing process can be confusing. Compliance with Podiatry Billing Guidelines Staying compliant with constantly evolving guidelines is crucial. Ready to optimize your billing process?

Medical Billing Outsourcing 105

Medical Billing Outsourcing Medicare Medicare Compliance 105

HIT Consultant

OCTOBER 10, 2024

Donna Migoni Executive Managing Director, Medicaid Enterprise Services at Maximus More than 75 million people access comprehensive and cost-effective care through Medicaid, including low-income families, older adults, and individuals with disabilities or chronic conditions. 1) Analyze and prioritize. 4) But don’t forget the data.

Medicaid 105

Medicaid Medicaid Governance Fraud 105

MRO Compliance

FEBRUARY 26, 2025

Likewise, payers are mandated by the Centers for Medicare & Medicaid Services to make member data available to external stakeholders via application program interfaces. Clinical data is a two-way street for payers. These organizations require timely and accurate patient data from their healthcare provider partners.

Medicaid 147

Medicaid Medicaid Medicare Medicare 147

HIPAA Journal

APRIL 17, 2025

One of the objectives of the HIPAA Journal 2024/25 Annual Survey was to obtain insights into HIPAA compliance best practices. This was so that organizations experiencing compliance challenges could use the information to resolve the challenges and better support compliance activities.

HIPAA 62

HIPAA Compliance Medicaid Medicaid 62

American Medical Compliance

MARCH 15, 2024

Among the various areas of compliance, Fraud, Waste, and Abuse (FWA) compliance stands out as a critical pillar. Therefore, for healthcare providers to prevent these charges from happening, understanding FWA compliance is essential. In this comprehensive guide, we delve into FWA compliance in healthcare.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

Compliance Now

AUGUST 10, 2023

This request is not mandatory for employers, and there are significant compliance considerations for employers that extend the enrollment window for this population. During the recent public health emergency declared as a result of the COVID-19 pandemic, state agencies did not terminate individuals’ Medicaid or CHIP coverage.

Medicaid 100

Medicaid Medicaid Compliance COVID-19 100

Compliance Now

AUGUST 10, 2023

This request is not mandatory for employers, and there are significant compliance considerations for employers that extend the enrollment window for this population. During the recent public health emergency declared as a result of the COVID-19 pandemic, state agencies did not terminate individuals’ Medicaid or CHIP coverage.

Medicaid 100

Medicaid Medicaid Compliance COVID-19 100

Hall Render

MARCH 4, 2025

Department of Health and Human Services (HHS) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community. Medical Directors in Nursing Homes 42 CFR 483.70(g) See 42 C.F.R.

Compliance 52

Compliance Nursing Homes Nurses Medicare 52

Compliancy Group

JANUARY 23, 2025

billion in recuperated funds account for federal losses, many cases also involved Medicaid losses at the state level, in which the federal government was instrumental in aiding recovery efforts. Compliancy Group supports healthcare organizations through robust regulatory compliance training and incident reporting tools.

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

Hall Render

JANUARY 29, 2025

The Centers for Medicare & Medicaid Services (CMS) is reinforcing its emphasis on hospice quality of care and identifying fraud. CMSs Focus on Surveys and Fraud Identification The CMS Memo highlights the dual purpose of hospice surveys: Ensuring Compliance : Evaluating whether hospice providers meet CoPs.

Fraud 80

Fraud Medicare Medicare Compliance 80

AIHC

NOVEMBER 12, 2024

6] The letter also notes that obtaining informed consent for sensitive examinations is the standard of care and that OCR will continue to focus on provider compliance with HIPAA and proper informed consent. About the Author Gabriella Neff , RHIA, CHA, CHC, CHRC, CHPC is a Research Compliance Officer for H.

Informed Consent 98

Informed Consent HIPAA Compliance Hospitals 98

Verisys

APRIL 8, 2025

Youll learn how each level works, what databases they include, and how to choose the right option for your organizations compliance and patientsafety goals. FACIS Level 1M meets and exceeds the minimum standards set forth by the Office of Inspector General (OIG) Compliance Program Guidance.

Fraud 52

Fraud Medicaid Medicaid Compliance 52

Healthicity

MARCH 6, 2025

The 60-day rule under the Affordable Care Act is one of the most important compliance regulations for healthcare providers accepting Medicare or Medicaid payments. It requires organizations to identify, report, and return any overpayments within 60 days of discovery.

Overpayment 59

Overpayment Overpayments Medicaid Medicaid 59

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

YouCompli

FEBRUARY 4, 2025

The HHS OIG recently issued its first Industry Segment-Specific Compliance Program Guidance, or ICPG , with many more expected. When a nursing facility submits a claim to Medicare or Medicaid for reimbursement, it certifies the services were provided in compliance with all applicable statutes, regulations, and rules.

Nurses 52

Nurses Overpayments Overpayment Compliance 52

Compliancy Group

DECEMBER 13, 2024

Maintaining healthcare compliance includes being vigilant for warning signs of potential waste, abuse, and fraud due to identity theft. For example, some medical identity thieves take insurance information and make fraudulent claims to Medicare or Medicaid for services or goods.

Compliance Officers 94

Compliance Officers Compliance Electronic Medical Records Fraud 94

Medisys Compliance

APRIL 15, 2025

Complex and Varying Payer Rules: Each insurance company (private, Medicare, Medicaid) has its own unique set of rules, policies, and submission requirements, making it challenging to ensure compliance and avoid claim denials. Reputable medical billing companies in USA prioritize compliance.

Medical Billing 59

Medical Billing Medical Billing Services Medical Billing Outsourcing Compliance 59

Medisys Compliance

DECEMBER 24, 2024

Medicaid Policies Medicaid coverage for teletherapy varies by state, but most states now offer robust telehealth benefits for mental health services. Check state-specific Medicaid guidelines to ensure compliance. Reimbursement Rates: Typically the same as in-person visits when appropriate modifiers are applied.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medicaid Medicaid Medical Billing 59

Compliancy Group

FEBRUARY 5, 2025

The individuals and entities on the list are excluded from participation in federal healthcare programs because they have committed a crime, such as Medicare or Medicaid fraud, or have engaged in other misconduct. States maintain their own exclusion lists for their Medicaid programs. The list reveals the basis of an exclusion.

Compliance 52

Compliance Fraud Medicaid Medicaid 52

Healthcare It News

APRIL 5, 2024

of calls to affiliated brokers or Nevada Medicaid – about 2,100 additional calls. During open enrollment for the 2024 plan year, the AI agent handled 14.5% of the call center's demand, approximately 2,700 calls. Also, it transferred another 9.6% " The company noted that it processes 5.5

US Department of Health and Human Services 303

US Department of Health and Human Services Medicaid Medicaid Hospitals 303

HIPAA Journal

SEPTEMBER 11, 2024

The Department of Health and Human Services Office of Inspector General (HHS-OIG) conducted an audit of New Mexico’s state Medicaid agency’s personal care services (PCS) program and found that it did not always ensure that PCS were provided by appropriately qualified personnel, which put Medicaid enrollees at risk.

Medicaid 70

Medicaid Medicaid Compliance HIPAA 70

American Medical Compliance

MARCH 6, 2025

Fraud, Waste, and Abuse (FWA) remain critical challenges in the healthcare industry, impacting patient care, financial integrity, and regulatory compliance. Whether you’re a season professional or new to compliance training, this course will help you navigate FWA-related challenges with confidence and accountability.

Fraud 52

Fraud Medicare Medicare Compliance 52