AIHC

DECEMBER 27, 2024

13] Beyond Federal law, state laws and Title IX policies that govern teaching hospitals at associated universities address consent. This provides a straightforward definition of consent as it applies specifically to intimate areas of the body defined by the policy as breasts, buttock, groin, or genitals. [14]

Informed Consent 98

Informed Consent Bioethics ADA Medical Personnel 98

Healthcare It News

MARCH 18, 2022

Fortunately, government, investors and startups are working together to close some of these care gaps. By some definitions the digital health field lost almost 70% of its market cap, or $180 billion. Not only is this population difficult to manage for the existing care system, it is even harder for startup entrants.

Medicaid 362

Medicaid Medicaid COVID-19 Telemedicine 362

MRO Compliance

AUGUST 8, 2024

The Role of Clinical Data Registries According to the latest information from the Centers for Medicare and Medicaid Services (CMS), 90% of payments are now linked to value, with 40% flowing through alternative payment models (APMs), showing the shift towards more cost-effective care driven by data from registries.

Patient Satisfaction 147

Patient Satisfaction Medicare Medicare Medicaid 147

Healthcare Law Blog

AUGUST 3, 2022

is a reminder that the government will use the FCA to target medical device manufacturers for off-label use of medical devices, even where healthcare providers have decided the use is safe and effective. The government is attempting to prove materiality using Medicare’s coverage requirement that procedures must be “reasonable and necessary.”

Governance 52

Governance FDA Medicare Medicare 52

Healthcare IT News - Telehealth

SEPTEMBER 9, 2024

Meanwhile, the American Telemedicine Association is pleading with the Centers for Medicare and Medicaid Services for expanded flexibilities and further guidance on payment and coverage. counties have internet speeds below the FCC's definition of "broadband." The government must take the lead. with broadband.

Telemedicine 190

Telemedicine Licensing Health Outcomes Governance 190

Healthcare Law Today

DECEMBER 15, 2022

The case asks whether the government has authority to dismiss an FCA suit after initially declining to proceed with the action, and if so, what standard would apply. Petitioner-Relator Polansky is a doctor and former consultant for Executive Health Resources (EHR), a company that submits claims to Medicare on behalf of health care providers.

Governance 52

Governance Doctors Medicare Medicare 52

YouCompli

MARCH 22, 2023

The second type is typically called quantitative or definitive drug testing. According to the OIG, prior error rate testing has suggested an improper payment rate of almost 30% for Medicare. The overpayment rate for definitive drug testing for 22 or more drug classes was over 71%.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

Healthcare IT Today

MAY 13, 2024

Providers not using certified EHR may face downward payment adjustments to their Medicare reimbursements in the affected payment year. Governance and Monitoring: Set up a governance model to monitor compliance. Non-compliance with predictive DSI requirements may result in penalties or loss of certification.

Compliance 122

Compliance Governance Medicare Medicare 122

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Refining Definition for Fully Integrated and Highly Integrated D-SNPs (§§ 422.2

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIPAA Journal

NOVEMBER 4, 2022

Warner suggests the only way to improve healthcare cybersecurity rapidly is through a collaborative effort involving the public and private sectors, with the federal government providing overall leadership. The program would standardize coverage elements and provide incentives for insurance companies to adopt them.

HIPAA 135

HIPAA Governance FDA Medicaid 135

Healthcare IT Today

OCTOBER 20, 2023

Previous articles covered the definition, collection, sharing, and use of SDoH. Food Aid Federal government food programs expanded significantly during the COVID-19 crisis. Clara Lambert, director of financial navigation, points out that out-of-pocket costs keep rising, reaching $8,300 per year now for Medicare Advantage.

COVID-19 132

COVID-19 Medicaid Medicaid Doctors 132

Healthcare Law Blog

APRIL 13, 2022

However, in all states, the NSA governs disputes relating to air ambulance services, not state law. Federal law governs disputes relating to out-of-network services provided by air ambulance providers. Background of the NSA. AB 72 also limits the enrollee’s cost-sharing amount to the enrollee’s in-network rate.

Governance 52

Governance Medical Billing Licensing Medicare 52

AIHC

FEBRUARY 17, 2025

There are also self-reporting mechanisms in place to report overpayments on the OIG website ( Self-Disclosure ) and Self-Referral Disclosure for voluntary self-reporting of overpayments on the Centers for Medicare and Medicaid Services (CMS) website. The list of terms and definitions used throughout are below for reference.

Fraud 52

Fraud Compliance Overpayments Overpayment 52

Hall Render

OCTOBER 22, 2024

Effective October 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) introduced significant updates to the CMS-855A form , specifically requiring a new Skilled Nursing Facility (“SNF”) Attachment for every SNF. Additionally, SNFs structured as trusts must disclose all trustees.

Medicare 40

Medicare Medicare Nurses Medicaid 40

Hall Render

APRIL 6, 2022

Turning to the present case, in Safeway , the relator alleged that the defendant engaged in the submission of false claims to the government when it “reported its ‘retail’ price for certain drugs as its ‘usual and customary’ price.” Guidance Must Be Truly Authoritative and Must Come from An Actual Authority. Practical Takeaways.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Hall Render

DECEMBER 20, 2023

Finalized Revisions to Form CMS-855A For SNFs, the aforementioned data would be reported by completing the Form CMS-855A Medicare enrollment application (“CMS-855A” or “Form”). For NFs, the data would be reported via means prescribed by the applicable state Medicaid agency.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

Health Law Advisor

AUGUST 14, 2023

2] This means, in most cases, that Medicare beneficiaries must now come to a physician practice’s office location to pick up their DME – including IUCs – when the DME items are furnished and billed by physicians or their practices. The IOAS exception does NOT apply.

COVID-19 52

COVID-19 Medicare Medicare Public Health 52

HIT Consultant

NOVEMBER 15, 2022

The growing number of promising but expensive treatments present a challenge – to governments, caregivers, insurance companies, and ordinary citizens. Payers, including insurance companies and government agencies, cannot help but look at the bottom line. And for decades, no definitive answer or policy has been found.

Governance 98

Governance Medicare Medicare Hospitals 98

McGuire Wood

JULY 5, 2022

Founded in 2001, the company solutions, designed for government-sponsored health plans, are designed to support member interactions, compliance and Medicare processes. Under the terms of the definitive merger agreement, the firm will acquire all outstanding shares of Convey common stock, representing an enterprise value of about $1.1

Medicare 52

Medicare Medicare Governance Compliance 52

Healthcare Law Today

JANUARY 11, 2023

The government alleged that, between April 2014 and April 2019, Jet Medical introduced devices into interstate commerce that were misbranded under the Federal Food, Drug and Cosmetic Act (FDCA) because Jet Medical did not obtain approval or clearance from the U.S. Food and Drug Administration (FDA) prior to distribution.

FDA 59

FDA Governance Medicare Medicare 59

American Medical Compliance

MARCH 15, 2024

Furthermore, it prohibits knowingly submitting false or false claims to Medicare, Medicaid, or other federally funded healthcare programs. HIPAA regulations govern the use, disclosure, and safeguarding of protected health information (PHI) by covered entities and their business associates.

Compliance 105

Compliance Fraud HIPAA Health Insurance 105

Healthcare IT Today

OCTOBER 18, 2023

Data can be spotty, according to Eye, who says for instance that data from Centers for Medicare & Medicaid Services (CMS) often lacks racial identifications. The service pulls together the profiles maintained by facilities and local governments and combines relevant information to display to providers.

Doctors 132

Doctors Public Health Medicare Medicare 132

HIT Consultant

JULY 16, 2024

But this is an outdated and manifestly untrue statement that relies on a very limited definition of “internet.” Because Medicaid is jointly funded by state and federal governments, there’s no standard approach to prioritizing or implementing technology reimbursement. Or so the argument goes.

Medicaid 105

Medicaid Medicaid Health Insurance Health Outcomes 105

HIPAA Journal

MAY 12, 2023

The term “continuity of care” has various definitions. Some definitions imply care is continuous within the same healthcare organization (or Organized Health Care Arrangement), while others extend the definition to multiple healthcare settings. 42 CFR Part 2).

HIPAA 63

HIPAA Compliance Health Services Administration Medicare 63

The Digital Health Corner

JUNE 14, 2017

One early definition of Artificial Intelligence (AI) in medicine (1984) was “…the construction of AI programs that perform diagnosis and make therapy recommendations. Today a broader definition may be applied: “the simulation of human intelligence processes by machines, especially computer systems. Artificial Intelligence (AI).

Patient Satisfaction 87

Patient Satisfaction Hospitals FDA Governance 87

HIT Consultant

MARCH 28, 2023

Now is the time for employers, healthcare organizations, and governments to invest in supporting unpaid caregivers in a sustainable way. The Centers for Medicare & Medicaid Services ( CMS ) even has a Caregiver Support Group, which acknowledges the impact of caregiving on one’s own well-being.

Medicaid 98

Medicaid Medicaid Medical Billing Medicare 98

Compliancy Group

JUNE 28, 2024

Provider information blocking can take place as a result of a provider’s deliberate actions or policies that prevent ePHI (the definition of EHI includes ePHI) from being lawfully shared or used for HIPAA-authorized purposes. What Are Examples of Provider Information Blocking? Provider information blocking can occur in less obvious ways.

Medicare 59

Medicare Medicare Hospitals HIPAA 59

Health Populi

OCTOBER 17, 2019

While two-thirds of consumers say they understand their insurance coverage, only one-half of them can correctly answer questions about the definition of premiums and deductibles. That’s in addition to what Americans had already saved into Medicare. Add patients to that definition. Given that the average savings in a U.S.

Health Insurance 61

Health Insurance Medicare Medicare Governance 61

Healthcare IT Today

FEBRUARY 15, 2024

Sarah Carroll, Senior Vice President, Center for Care Transformation at AVIA Health Medicaid and Medicare have become one of the biggest quiet crises in health systems today. US hospitals regularly lose $100B annually on Medicaid and Medicare patients but continue to chase higher-margin commercial patients to drive toward profitability.

Medical Device Industry 130

Medical Device Industry Medicaid Medicaid Nurses 130

HIT Consultant

JANUARY 14, 2025

Lastly, possibly good intentions with definite unintentional consequences, which can be said about the ACA, because the government did fully contemplate the impact of the legislation. Final thought ask anyone using Medicare for their opinion or those who travel from other countries to the US for treatment.

ACA 52

ACA Governance Medicare Medicare 52

Healthcare Law Today

JANUARY 2, 2023

As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. For example, in a 2015 case, DOJ attorneys stated in a court conference, “[T]his is not a question. Healthfirst, Inc. ,

Overpayments 52

Overpayments Overpayment ACA Medicare 52

Verisys

DECEMBER 29, 2024

The Centers for Medicare & Medicaid Services (CMS) oversees the issuance and regulation of NPI numbers, ensuring providers meet accountability standards. This requirement improves the efficiency and quality of Medicare, Medicaid, and other state and federally funded healthcare programs.

HIPAA 52

HIPAA Fraud Health Insurance Medicare 52

Health Populi

OCTOBER 28, 2019

Cost concerns are playing into peoples’ perspectives on health care reform proposals, with a majority of survey respondents saying they’d be more likely to vote for a candidate that would support expanding private health insurance reforms versus scrapping commercial insurance for a Medicare for All proposal. health care system model.

Single Payer Health Care 54

Single Payer Health Care Medical Billing Health Care Reform Governance 54

Provider Trust

MAY 17, 2022

In this post, we’ll break down the definition of healthcare vendors and summarize the most important and impactful laws and regulations that apply to vendors and the healthcare organizations that contract with them. Which regulations govern vendor compliance? So what does that mean for your healthcare organization’s compliance program?

Compliance 52

Compliance Medicare Medicare Due Diligence 52

Healthcare IT Today

DECEMBER 20, 2023

They streamline the often complex requirements definition and test case development processes by providing industry-specific, predefined implementation assets. With the goal to have all Medicare payments processed through value-based care by 2030, the clock is ticking for providers to manage these data challenges head-on.

Compliance 93

Compliance Regulatory Compliance COVID-19 Hospitals 93

Compliancy Group

JANUARY 3, 2024

When auditing claims, medical records, and financial documentation, it is essential to incorporate guidance based on the following questions: Are all codes for services and supplies correct?

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

Hall Render

NOVEMBER 18, 2022

On November 2, 2022, CMS announced revisions to the Calendar Year 2023 Payment Policies that impact Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare and Medicaid Provider Enrollment Policies (“CY 2023 PFS Final Rule”). New Definitions.

Nurses 40

Nurses Nursing Homes Medicare Medicare 40