This site uses cookies to improve your experience. To help us insure we adhere to various privacy regulations, please select your country/region of residence. If you do not select a country, we will assume you are from the United States. Select your Cookie Settings or view our Privacy Policy and Terms of Use.
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Used for the proper function of the website
Used for monitoring website traffic and interactions
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Strictly Necessary: Used for the proper function of the website
Performance/Analytics: Used for monitoring website traffic and interactions
Compliance isn’t just a box to check—it’s a vital responsibility that safeguards patient well-being and protects organizations from significant financial losses. A powerful way to ensure this is through regular compliance audits. This is to confirm that staff are properly trained in compliance protocols.
The feds have set new deadlines for compliance with Medicaid renewal requirements given widespread enrollment concerns during the unwinding. | The feds have set new deadlines for compliance with Medicaid renewal requirements given widespread enrollment concerns during the unwinding.
In just the first three quarters of 2024, 155 providers have been added to the Texas Health and Human Services Commission Medicaid exclusion list. Over 4 million people in Texas are covered by Medicaid, and the Texas OIG exclusion list provides protection for each of them, as well as for healthcare facilities.
Add in the complexities of Medicare and Medicaid, and it can feel overwhelming. This article will explore how outsourcing cardiology billing for Medicare and Medicaid can streamline your operations, boost revenue, and free you to focus on delivering exceptional cardiac care. Does Medicaid Cover Cardiology?
Use this sample Exclusion Screening Checklist and Compliance Policy to evaluate and improve your organization’s compliance with the law. Payments from Medicare, Medicaid, and TriCare trigger screening requirements that may extend to employees, contractors, volunteers, board members, and network providers.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
The Electronic Healthcare Network Accreditation Commission and The CARIN Alliance have partnered to bring both the CARIN Code of Conduct and EHNAC’s criteria review process to health plans, health systems, EHR vendors and others for reporting to the Centers for Medicare & Medicaid Services on their data practices and privacy protections.
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.
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.
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.
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.
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.
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.
It may seem a little early to do some spring cleaning, but not when it comes to compliance! It’s that time of the year to check your records for 2023 compliance deficiencies and set your organization up for success in 2024. Release of Industry-Specific Compliance Program Guidance (ICPG) is anticipated in 2024.
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.
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
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.
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.
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 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.
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.
Three independent clinical laboratories, their owner and holding company, an additional independent clinical laboratory and its owner, two laboratory marketing companies, and a Massachusetts physician have been charged in connection with Medicaid fraud, money laundering, and kickbacks involving urine drug tests?that
The Centers for Medicare & Medicaid Services (CMS) issued a new report Tuesday detailing total complaints related to the No Surprises Act and Affordable Care Act compliance. | A new CMS report outlines the types of No Surprises Act complaints resolved by the federal agency since June 30.
The HHS Office for Civil Rights announced on Tuesday that during the coronavirus pandemic it will use discretion when enforcing HIPAA-compliance for telehealth communications tools. WHY IT MATTERS. and Google G Suite Hangouts Meet. THE LARGER TREND.
We organize all of the trending information in your field so you don't have to. Join 26,000+ users and stay up to date on the latest articles your peers are reading.
You know about us, now we want to get to know you!
Let's personalize your content
Let's get even more personalized
We recognize your account from another site in our network, please click 'Send Email' below to continue with verifying your account and setting a password.
Let's personalize your content