MRO Compliance

OCTOBER 31, 2024

If you’re participating in the Merit-based Incentive Payment System ( MIPS ) or MIPS Value Pathways ( MVPs ), you’ve likely encountered a familiar scenario: you review your estimated MIPS score in your dashboard, only to find that months later, when CMS releases the final score, the numbers don’t quite add up.

Medicare 147

Medicare Medicare Payment Systems 147

Compliancy Group

APRIL 2, 2025

Whether you’re working with a small medical office or a large practice, you can meet compliance requirements by focusing on the parts of the site that specifically handle Protected Health Information (PHI). Focus on Specific Parts of the Website for Compliance Picture the website for your local dental office.

HIPAA 52

HIPAA Compliance Payment Systems 52

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. CJ Wolf, MD, M.Ed.

Nurses 52

Nurses Overpayments Overpayment Compliance 52

Healthcare It News

MAY 2, 2024

"We pledge to do everything in our power to fix their system or underwrite their cashflow, simple as that," he already promised in his opening testimony. While much of the claims and payment system functionality has been restored, according to an April 29 letter from the American Hospitals Association to Senators Ron Wyden, D-Ore.,

US Department of Health and Human Services 342

US Department of Health and Human Services HIPAA Ransomware Governance 342

MRO Compliance

SEPTEMBER 3, 2024

Using this data, registries encompass quality initiatives and improved patient outcomes alongside support for Merit-based Incentive Payment System (MIPS) reporting requirements.

Payment Systems 147

Payment Systems Governance 147

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?

Compliance 52

Compliance HIPAA Telemedicine ACA 52

MRO Compliance

SEPTEMBER 3, 2024

Using this data, registries encompass quality initiatives and improved patient outcomes alongside support for Merit-based Incentive Payment System (MIPS) reporting requirements.

Payment Systems 130

Payment Systems Governance 130

YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Price increases can sometimes result in inappropriate outlier payments. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS).

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

Compliancy Group

SEPTEMBER 20, 2024

The plaintiffs in the Change Healthcare class action lawsuit also include providers who allege that payment systems were unavailable due to the data breach. As a result, the providers could not submit insurance claims and receive payments. You can monitor Change Healthcare class lawsuit developments by clicking here.

Ransomware 105

Ransomware HIPAA Compliance Payment Systems 105

Healthcare IT Today

JANUARY 18, 2025

Read more… 2025 Predictions: Healthcare Regulations and Compliance. We may also see the emergence of a true compliance certification framework. Empowering specialty care, addressing complex comorbidities, and personalizing patient education should help, the experts in our community said.

Payment Systems 53

Payment Systems Compliance Telemedicine Hospitals 53

Medisys Compliance

FEBRUARY 16, 2025

As providers navigate this new landscape, understanding the implications of VBC on medical billing is crucial to ensuring compliance, efficiency, and financial stability. This transition is reshaping medical billing, placing a greater emphasis on patient outcomes rather than service volume.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Patient Satisfaction Payment Systems 59

Healthcare IT News - Telehealth

JUNE 27, 2023

"Additionally, we see around 30 readings per patient per month on average, meaning we have a high level of compliance among our patients," she added. Impressively, 34 patients have graduated from the program so far, meaning their blood pressure has been controlled. Enterprise Taxonomy:

Doctors 166

Doctors Payment Systems Compliance 166

HIT Consultant

MARCH 30, 2023

Trust and compliance measures are built-in to overcome barriers to adoption, such as requiring a Proof-of-Competency and a healthcare license or certification from validators. Care.Chain also introduces new healthcare computing primitives with the introduction of ZK (Zero-Knowledge) verifiable runtime for events.

Payment Systems 96

Payment Systems Compliance Licensing Doctors 96

Healthcare IT Today

JUNE 29, 2023

Each ASC is responsible for ensuring that they are in compliance with the numerous statutes and regulations that are in place at both the state and federal levels. However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. ASCs must also meet Medicare’s Conditions for Coverage.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

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. On November 20, 2024, the Office of Inspector General (“OIG”) for the U.S.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

HIT Consultant

MAY 31, 2023

Healthcare operations, or the nonclinical processes that help keep hospitals and health systems running, are one area where software investments can provide significant value. Health system decision-makers must ensure that new software investments simplify their existing operations and provide a return on investment (ROI).

Hospitals 98

Hospitals Regulatory Compliance Compliance Payment Systems 98

Healthcare IT Today

NOVEMBER 14, 2022

Employees on employer-sponsored plans also now have to deal with multiple invoices from different providers for deductibles and other payments. In fact, according to data from Health Payment Systems (HPS), the average U.S. family can expect to receive approximately 125 pieces of mail each year related to health care billing.

Medical Billing 105

Medical Billing Payment Systems Health Insurance HIPAA 105

HIT Consultant

JANUARY 6, 2025

Instead, these payment options are seamlessly embedded into the institutions payment system. Some providers such as the Cleveland Clinic use embedded verification for remote patient authentication, particularly for telemedicine, ensuring that the patient accessing services is verified for privacy and regulatory compliance.

Telemedicine 52

Telemedicine Regulatory Compliance Payment Systems Medical Billing 52

Healthcare IT Today

NOVEMBER 15, 2023

Jackleen Samuel, president and CEO, says that they analyze patient demographics, clinical information, and process indicators such as medication compliance and service utilization. The system tries to measure whether patients are learning more about their illness, and are becoming more comfortable with their physicians.

Medicare 124

Medicare Medicare Hospitals Compliance 124

Medisys Compliance

JULY 19, 2024

Understanding these updates is crucial for behavioral health providers to ensure compliance, maximize reimbursements, and continue delivering high-quality care. Documentation and Compliance With the changes in billing, there is an increased emphasis on accurate documentation and compliance.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

MRO Compliance

OCTOBER 23, 2023

This transformation aims to enhance patient care quality and better align ACO reporting with the Quality Payment Program (QPP) Merit-Based Incentive Payment System (MIPS). These organizations received concessions from CMS to serve as early adopters and test the system.

Payment Systems 130

Payment Systems Medicare Medicare 130

Healthcare IT Today

NOVEMBER 12, 2023

Health Payment Systems selected Madaket Health to manage its provider directory and roster requirements for No Surprises Act compliance. Healthcare management services company Care About selected Innovaccer for population health management.

Public Health 97

Public Health Payment Systems Medicare Medicare 97

Medisys Compliance

MARCH 14, 2023

Wound Care Reimbursements in Various Healthcare Settings Inpatient Hospital Wound care in an inpatient hospital setting is reimbursed through the Diagnosis-Related Group (DRG) payment system. The MPFS is a payment system that reimburses healthcare providers for services rendered to Medicare patients in an outpatient setting.

Payment Systems 52

Payment Systems Medical Billing Medicare Medicare 52

Healthcare IT Today

MAY 9, 2024

Healthcare providers, technology companies, and regulated lenders can collaborate to drive digital transformation and financing accessibility while meeting regulatory and compliance standards and protecting the patient’s financial well-being. Some 40% of U.S. adults owe money related to medical or dental care.

Patient Satisfaction 84

Patient Satisfaction Payment Systems Compliance Governance 84

Medisys Compliance

APRIL 25, 2024

MACRA replaced the previously used Sustainable Growth Rate (SGR) formula for Medicare physician payments. Advanced Alternative Payment Models (APMs): These models encourage collaboration between providers and offer the potential for higher shared savings if specific quality and cost goals are met.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medicare Medicare 64

HIT Consultant

AUGUST 28, 2023

When you join two businesses that have different payment systems and procedures in place, and different staffs for overseeing them, you’re likely to experience disruptions and struggle to keep AP efficient. Compliance issues : Fines, penalties, or audit notes related to AP errors mean that AP is not being managed efficiently.

Payment Systems 103

Payment Systems Compliance Medicaid Medicaid 103

Healthcare IT Today

FEBRUARY 2, 2024

This quote lies at the heart of integrity, a powerful concept that applies equally critically in the healthcare payments environment as it does in daily life. In adopting pre-payment systems, the synergy between payers and providers is paramount.

Payment Systems 78

Payment Systems Overpayments Overpayment Medical Billing 78

Compliancy Group

OCTOBER 5, 2023

One of these incentives is the Merit-Based Incentive Payment System, or MIPS, program. Modernize Your Compliance Using automated compliance software compliance is a breeze. Become Compliant × Modernize Your Compliance Find Out More! The MIPS rules for 2023 are discussed below. Please Wait.

HIPAA 52

HIPAA Medicare Medicare Compliance 52

HIT Consultant

FEBRUARY 9, 2023

A lack of regulatory compliance, network and technical vulnerabilities, unencrypted information, unsecured mobile devices, and weak credentials all play a part in putting a healthcare organization at risk for a data breach. Paul Banco, CEO of etherFAX    How secure is your data? How Can a Data Breach Be Prevented?

Regulatory Compliance 52

Regulatory Compliance Due Diligence Compliance Compliance Framework 52

Medisys Compliance

AUGUST 4, 2022

Proposed ESRD Payment System. This rule also proposes an update to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year (CY) 2023. Direct nursing services include registered nurses, licensed practical nurses, technicians, social workers, and dietitian.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Payment Systems Medicare 59

Medisys Compliance

FEBRUARY 9, 2024

Hospital Outpatient Prospective Payment System (OPPS) Updates OPPS is a payment system used by Medicare to reimburse hospitals for outpatient services, including some wound care procedures. The Centers for Medicare & Medicaid Services (CMS) issues annual updates to the OPPS payment rates and co-payment amounts.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Payment Systems Medical Billing Medicare 59

Symplr

JUNE 5, 2023

As the backbone of health care documentation and payment systems, this is a critical thing to get right. Codes are constantly evolving. New codes are added. Old codes are deleted or replaced. And, code descriptors are revised.

Payment Systems 52

Payment Systems Governance Compliance 52

AIHC

NOVEMBER 15, 2022

Compliance is mandatory. However, a low compliance level among hospitals would compromise the operational effectiveness of this regulation. Understanding hospitals’ compliance status to the regulation has important implications for its enforcement effort and effectiveness assessment. So, exactly what is this all about?

Hospitals 52

Hospitals US Department of Health and Human Services Compliance Governance 52

Medisys Compliance

NOVEMBER 21, 2023

With Medicare Part A serving as a primary payer for many residents, understanding the intricate landscape of SNF billing is crucial to ensure proper reimbursement and compliance. Accurate and timely billing is a fundamental aspect of financial success for Skilled Nursing Facilities (SNFs), particularly when it comes to optimizing SNF billing.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medicare Medicare Medical Billing 59

Hall Render

MARCH 1, 2023

During the Dispute Period, Covered Recipients may use CMS’ Open Payments system to formally dispute any information they believe is incorrect. If a Covered Recipient fails to dispute data reported in the system during the Dispute Period, the information will be published on June 30 th as originally reported.

Hospitals 40

Hospitals Payment Systems Nurses Medical Device Industry 40

Hall Render

FEBRUARY 14, 2025

424.527(a) in the “Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update” final rule to address this issue. Ensure Compliance Before Reactivating: Providers seeking reactivation should conduct a thorough internal audit before submitting their application. CMS finalized new 42 CFR Sec.

Medicare 52

Medicare Medicare Compliance Payment Systems 52

AIHC

JANUARY 28, 2022

For more information on filing compliance cost reports, attend the Medicare Cost Report Camp in March 2022 presented by KraftCPAs and sponsored by the American Institute of Healthcare Compliance. LTCHs are paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS).

Medicare 40

Medicare Medicare Hospitals Payment Systems 40