Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. This article covers the essentials of SNF billing compliance, including processes, guidelines, exclusions, and practical tips for providers.

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Healthcare IT News - Telehealth

AUGUST 30, 2021

In 2017, the health system – which has 100 continuing care locations, including home care, hospice, PACE programs and senior living facilities – was in a bind, facing double-digit hospital readmissions of 16% across its high-risk Medicare population. THE PROBLEM. Trinity needed to reduce readmissions to single digits.

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Medisys Compliance

OCTOBER 1, 2022

Navigating through the complex medicare guidelines can be a complex and overwhelming task, however, here is the good news, the entire process is merely about using the right CPT codes. However, one needs to be careful while billing as Medicare follows strict rules and regulations for time increments. The Concept of Medicare Coverage.

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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. We are one of the first pediatric health systems to go live with what the telemedicine industry has chosen to call virtual nursing.

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Telemedicine Nurses Regulatory Compliance COVID-19 192

Medisys Compliance

NOVEMBER 27, 2024

Medicare covers certain podiatry services, but billing for them requires strict adherence to guidelines to ensure compliance and maximize reimbursement. What Does Medicare Cover for Podiatry Services? Routine Foot Care Exceptions: Medicare covers routine foot care (e.g., nontraumatic amputation of a foot).

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Healthcare Law Blog

OCTOBER 27, 2022

On October 21, 2022, the Centers for Medicare and Medicaid Services (CMS) announced changes to its Special Focus Facility (SFF) program, including new steps to address nursing home facilities that fail to graduate from the SFF program in a timely manner, or “yo-yo” back into non-compliance after graduating from the SFF program.

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Nursing Homes Medicaid Medicaid Nurses 96

Hall Render

NOVEMBER 25, 2024

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.

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Nurses Compliance Compliance Officers Medicare 40

Healthcare Blog

OCTOBER 31, 2024

Compliance with regulations is only possible when all clinical and non-clinical staff members have the proper training and support. Maintain Regulatory Compliance Non-compliance with just one regulation can put patients’ health and organizational operations at risk. Experts predict a shortage of almost 79,000 nurses by 2025.

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Hall Render

SEPTEMBER 22, 2023

In 2023, nursing homes have seen increased citations by surveyors for noncompliance tied to their pre-dispute, binding agreements for binding arbitration with their residents. When used appropriately, these agreements can streamline conflict resolution processes, but operators must tread carefully to ensure compliance with the regulations.

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Nursing Homes Nurses Compliance Medicaid 73

Healthcare Blog

AUGUST 23, 2023

It is critical for an organization to have strategies for promoting ethical behavior in healthcare compliance. Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization.

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Compliance Nurses Regulatory Compliance Medicaid 73

Healthicity

NOVEMBER 1, 2022

Medicaid Fraud Control Units.

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Health Law RX

SEPTEMBER 14, 2021

Medicare and Medicaid certified facilities will be required to ensure that their employees are vaccinated for COVID-19, the Centers for Medicare & Medicaid Services (CMS) announced on September 9, 2021. The Interim Final Rule will apply to any healthcare facility receiving Medicare or Medicaid reimbursement. The OSHA ETS.

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MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

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Healthcare IT News - Telehealth

AUGUST 25, 2020

"The FCC COVID-19 Telehealth Program will enable Parker to reduce patient face-to-face encounters in the nursing home and the possible impact of COVID-19, reduce PPE, and minimize staff burden." Parker serves medically complex and severely immunocompromised, frail elderly patients requiring intense skilled nursing and medical care.

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MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

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Med-Net Compliance

AUGUST 18, 2022

An Indiana provider of skilled nursing and long-term care services has agreed to pay $5,591,044.66 to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program. The complaint alleged that the provider had engaged in conduct to defraud the Medicare program. to the United States.

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Nursing Homes US Department of Health and Human Services Nurses Medicare 59

Med-Net Compliance

OCTOBER 27, 2022

A federal jury convicted a licensed Illinois psychologist of defrauding Medicare over the course of several years by causing the submission of fraudulent claims for psychotherapy services he never provided. Issue: It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

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Nursing Homes Fraud US Department of Health and Human Services Nurses 59

Healthcare IT News - Telehealth

SEPTEMBER 15, 2021

Over the years, while digital technology was quickly advancing, telehealth had a relatively low adoption rate due to poor reimbursement rates and regulatory challenges when it came to patient privacy and HIPAA compliance. According to CMS.gov , CMS is expanding access to telehealth services with Medicare.

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Telemedicine COVID-19 Medicare Medicare 192

AIHC

SEPTEMBER 3, 2024

Celebrating the Healthcare Compliance Officer The American Institute of Healthcare Compliance is recognizing healthcare Compliance Officers – hats off to you! The primary goal of a compliance officer is to mitigate risk. This involves investigating complaints and conducting internal auditing and monitoring for compliance.

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Compliance Officers Compliance Fraud Medicare 52

Med-Net Compliance

AUGUST 3, 2022

A Pennsylvania nursing home will pay $819,640 to settle claims that it provided medically unnecessary rehabilitation therapy to residents to maximize revenue, and without prioritizing clinical needs. overbilled federal healthcare programs such as Medicare for therapy services provided; (b)?billed provisions of the False Claims Act.

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Nursing Homes Nurses Medicare Medicare 59

Healthcare Compliance Blog

JANUARY 25, 2022

A Missouri woman who had previously pled guilty to Medicare and Medicaid fraud was sentenced in Federal Court to three years imprisonment and ordered to pay $7,620,779 in restitution. The DME companies would then submit the reimbursement claims to Medicare and Medicaid. General Legal Duties and Antitrust Laws.

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Med-Net Compliance

AUGUST 16, 2022

Five individuals and two for-profit skilled nursing facilities (SNFs) in Pennsylvania were indicted on charges of conspiracy to defraud the United States and related healthcare fraud charges. Billing Medicare or Medicaid for services that were not provided is fraudulent activity that is often punishable by fines and imprisonment.

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Health Care Performance

AUGUST 25, 2022

We summarize enforcement trends and deliver the latest compliance and HIPAA developments to your inbox with our Monthly Compliance News Report. Read MPA’s News Report to stay current with compliance news and developments. The OIG's audit report of nursing home life safety and emergency preparedness noncompliance.

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Compliance Nursing Homes HIPAA Fraud 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

Health Law RX

NOVEMBER 22, 2023

Department of Health and Human Services (the OIG) recently released an updated General Compliance Program Guidance document (GCPG). The GCPG discusses general compliance risks and compliance considerations. The GCPG discusses general compliance risks and compliance considerations. Other Compliance Considerations.

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MedTrainer

SEPTEMBER 20, 2023

Watch this one-demand webinar for insider tips straight from seasoned compliance surveyors. Examples of covered entities include health plans, clearinghouses, and certain health care providers including but not limited to: doctors, clinics, psychologists, dentists, chiropractors, nursing homes, and pharmacies. Accreditation.

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Medicaid Medicaid Medicare Medicare 97

Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

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MedTrainer

JANUARY 30, 2024

Healthcare compliance is a critical part of any organization’s business model. The professionals who manage compliance are the front lines of preventing medical errors, deterring fraud, and staying in good standing with federal payers like the Centers for Medicare and Medicaid Services (CMS).

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Compliance Compliance Officers Fraud Medicaid 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.

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Nurses Medicare Medicare Medicaid 102

Healthcare Law Blog

MAY 11, 2023

The Department of Health and Human Services Office of Inspector General (OIG) recently announced changes to its process for informing healthcare industry stakeholders of new or updated Compliance Program Guidance (CPG). Historically, sector-specific CPG has been published in the Federal Register.

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Compliance Fraud Nurses Medicare 52

Hall Render

OCTOBER 31, 2022

The Centers for Medicare & Medicaid Services (“CMS”) has retooled guidance it armed surveyors with regarding how to survey skilled nursing facilities for compliance with the CMS staff vaccine requirements. Key Surveyor Guidance Revisions. Enforcement. Surveyor Review. Vaccination Enforcement – Flexibility.

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Provider Trust

JULY 17, 2023

In our recent webinar, ProviderTrust’s Chief Compliance Officer, Donna Thiel, shared her expertise and valuable feedback from the 2023 HCCA Compliance Institute. Watch the Webinar During the Keynote Speech at the HCCA Compliance Institute this year, Office of Inspector General (OIG) Christi A.

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Compliance Nursing Homes Nurses Fraud 52

AIHC

NOVEMBER 12, 2024

These revisions resulted from recent articles, media reports, and concerns from nurses, some physicians, and medical students opposing these exams. [3],[4] About the Author Gabriella Neff , RHIA, CHA, CHC, CHRC, CHPC is a Research Compliance Officer for H. OCR recently issued an FAQ focusing on this right. [6]

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Healthcare IT Today

NOVEMBER 22, 2022

The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. They also look to flag “items and services that have high national error rates and are a financial risk to Medicare.” Meanwhile, Medicare also has a Fee for Service Recovery Audit Program. Tricare and Medicare).

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Overpayments Overpayment Medicare Medicare 111

Med-Net Compliance

NOVEMBER 8, 2022

On November 3, 2022, the OIG released the results of a recent inspection of a nursing home by the Texas Health and Human Services (HHS) Office of Inspector General Audit and Inspections Division (OIG Inspections). OIG inspectors recommended the facility develop a process to collect this data and post the information as required.

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Nursing Homes Nurses US Department of Health and Human Services Licensing 59

Healthcare IT Today

NOVEMBER 15, 2023

The technique involves finding data from public sources such as Centers for Medicare & Medicaid Services (CMS). Jackleen Samuel, president and CEO, says that they analyze patient demographics, clinical information, and process indicators such as medication compliance and service utilization. offering in-home treatment.

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Compliancy Group

SEPTEMBER 16, 2024

Office of Inspector General (OIG) enforces the General Compliance Program Guidance. In November, updates for 2024 appeared in the OIG General Compliance Program Guidance, including recommendations for Medicare, nursing facilities, and other industry-specific entities.

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