Bill of Health

SEPTEMBER 25, 2024

In short, the conflict hinges on the definition of what it means to be “entitled to supplemental security income (SSI) benefits.” DSH payments are administered as part of the Medicare program.

Medicare 100

Medicare Medicare Medicaid Medicaid 100

Healthcare IT News - Telehealth

SEPTEMBER 3, 2020

Centers for Medicare and Medicaid Services to extend administrative flexibility around greater portability of licensure for telehealth service providers. "States and the federal government should work to harmonize definitions and regulations (e.g., But the details of telehealth reimbursement are still unknown.

Licensing 165

Licensing Medicare Medicare Governance 165

Healthcare IT News - Telehealth

JUNE 26, 2020

"It is definitely helpful to have someone there who understands technology who can troubleshoot with you," said A. " McBride and other panelists noted that before the COVID-prompted changes from the Centers for Medicare and Medicaid Services, Northwell was not seeking reimbursement for MTT services.

COVID-19 199

COVID-19 Telemedicine Medicaid Medicaid 199

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 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.

Patient Satisfaction 175

Patient Satisfaction Nurses Medicare Medicare 175

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.

Nurses 102

Nurses Medicare Medicare Medicaid 102

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

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.

Medicare 52

Medicare Medicare Compliance Medicaid 52

Healthcare IT News - Telehealth

OCTOBER 14, 2021

" Key to moving forward will be a delivery model through the Centers for Medicare and Medicaid Services Innovation Center that will enable testing and implementation of a long-term advanced care at home framework. "We're going to need to have a few different ways of measuring this." "There's no vanity here.

Hospitals 171

Hospitals Public Health COVID-19 Patient Satisfaction 171

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.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

HIT Consultant

JUNE 26, 2024

What You Should Know: – The Rise Fund, the multi-sector strategy of TPG’s global impact investing platform, today announced it has signed definitive documentation to lead an investment of over $200 million in Foodsmart, the leading telenutrition provider and food benefits management platform in the US.

Health Outcomes 105

Health Outcomes Medicaid Medicaid Medicare 105

Innovaare Compliance

JUNE 30, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Chapter 5 and under Definitions in Chapter 12, EOC) Lengthy explanation for requesting exceptions to the formulary (Sections 6.2, Section 2.1 Chapter 9, EOC) A monthly cap of $35.00 and Section 3.2,

Medicare 52

Medicare Medicare Compliance Medicaid 52

Healthcare IT News - Telehealth

APRIL 24, 2020

The Alliance for Integrated Care of New York (AICNY) oversees the healthcare needs of roughly 6,200 dually eligible Medicare and Medicaid beneficiaries with intellectual and developmental disabilities (IDD). Many AICNY beneficiaries reside in group homes and use Federally Qualified Community Health Centers. THE PROBLEM. MARKETPLACE.

Telemedicine 173

Telemedicine COVID-19 Medicaid Medicaid 173

Healthcare Law Blog

DECEMBER 27, 2022

The Centers for Medicare and Medicaid Services (“CMS”) has issued a proposed rule which would amend the existing regulations for reporting and returning identified overpayments (the “Proposed Rule”). UnitedHealthcare challenged the current Overpayment Rule in litigation. [1]

Overpayments 98

Overpayments Overpayment Medicare Medicare 98

Healthcare Law Blog

JANUARY 20, 2023

To add uniformity to this practice, CMS codified this flexibility in the 2016 Medicaid and Children’s Health Insurance Plan (CHIP) managed care final rule by authorizing coverage for “In Lieu of Service or Settings” (ILOS). [i] ILOSs must advance the objectives of the Medicaid program. ILOSs must be medically appropriate.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT News - Telehealth

FEBRUARY 3, 2022

The highest rates of telehealth visits were among Medicaid and Medicare users, along with Black patients and those earning less than $25,000 a year. For instance, lawmakers in New Hampshire this past year sought to exclude audio-only care from the definition of telemedicine.

Telemedicine 152

Telemedicine COVID-19 Health Insurance Medicaid 152

Healthcare IT News - Telehealth

JUNE 14, 2024

RPM was initially recognized in 2019 by the Centers for Medicare and Medicaid Services through a small set of codes for remote physiologic monitoring services, enabling clinicians to seek reimbursement for gathering data from patients through certain medical devices outside the hospital setting.

Medicare 144

Medicare Medicare Nursing Homes Hospitals 144

HIT Consultant

JULY 15, 2024

– The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining changes to Medicare payments under the Physician Fee Schedule (PFS) for services furnished and other Medicare Part B issues on or after January 1, 2025.

Medicare 52

Medicare Medicare Payment Systems Medicaid 52

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

Healthcare IT Today

OCTOBER 20, 2023

Previous articles covered the definition, collection, sharing, and use of SDoH. Another source of fresh foods for low-income people is FarmboxRx , often available through Medicaid and Medicare Advantage programs as part of SNAP or Healthy Food Card benefits. I’ll finish with a look at some specific areas of intervention.

COVID-19 132

COVID-19 Medicaid Medicaid Doctors 132

Medisys Compliance

FEBRUARY 20, 2023

Healthcare providers often get confused about the appropriate use of modifiers GA, GX, GY, and GZ while billing Medicare. GA modifier indicates that an Advance Beneficiary Notice (ABN) is on file and allows the provider to bill the patient if not covered by Medicare. Medicare does not pay for all health care costs.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Verisys

NOVEMBER 8, 2023

The NPI improves the Medicare and Medicaid programs, other federal and private health programs, and the overall effectiveness and efficiency of the healthcare industry by simplifying administration and enabling the efficient electronic transmission of health information. Providers also need an NPI to enroll in Medicare.

Fraud 97

Fraud HIPAA Medicare Medicare 97

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. Hall Render blog posts and articles are intended for informational purposes only.

Medicare 40

Medicare Medicare Nurses Medicaid 40

Healthcare IT Today

MARCH 1, 2023

Reporting), paying close attention to data quality Perform custom analysis of disparate healthcare and information systems data, interpret results, and make recommendations about data collection methods, metrics definitions and evaluation methods to pertinent decision makers, based on analytic findings Create and maintain high-quality documentation (..)

Healthcare information Technology 142

Healthcare information Technology Medicaid Medicaid Health Outcomes 142

Hall Render

APRIL 6, 2022

The relator alleged that these programs and subsequent reporting of the retail price, and not the discounted price, violated Medicare Part D’s requirement that a pharmacy must report the usual and customary price charged for the drugs. This footnote originated as a footnote in a memorandum issued by CMS in October of 2006.

Medicare 72

Medicare Medicare Medicaid Medicaid 72

Innovaare Compliance

AUGUST 24, 2023

Medicare Advantage plans (MAO) have been increasingly popular with Medicare eligible beneficiaries enrolling 51% of the eligible population in 2023 taking in $454 billion (or 54%) in Medicare spending. MLR measures the percentage of premium income and Medicare payments a Sponsor pays for medical claims.

Medicare 52

Medicare Medicare Fraud Medicaid 52

Innovaare Compliance

JUNE 17, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Chapter 5 and under Definitions in Chapter 12, EOC) Lengthy explanation for requesting exceptions to the formulary (Sections 6.2, Section 2.1 Chapter 9, EOC) A monthly cap of $35.00 and Section 3.2,

Medicare 40

Medicare Medicare Compliance Medicaid 40

C&M Health Law

OCTOBER 18, 2023

Section 504 covers all health care and human services programs and activities funded by HHS, from providers, like hospitals and doctors that accept Medicare or Medicare, to state child welfare programs, as well as Medicare Advantage Plans, and Medicaid Managed Care Plans.

ADA 98

ADA COVID-19 Medicare Medicare 98

Healthcare IT News - Telehealth

NOVEMBER 11, 2024

While there are privacy, security and regulatory expectations (for example, the Joint Commission, Centers for Medicare and Medicaid Services , private insurance) for telemedicine programs, there is not yet an official group evaluating or designating maturity levels for these programs.

Telemedicine 192

Telemedicine Nurses Regulatory Compliance COVID-19 192

C&M Health Law

JANUARY 18, 2023

On January 4, in its most recent effort to expand federal support for addressing health-related social needs (HRSNs), the Centers for Medicare & Medicaid Services (CMS) issued guidance to clarify an existing option for states to address HRSNs through the use of “in lieu of” services and settings policies in Medicaid managed care.

Medicaid 52

Medicaid Medicaid Federal Policy Health Outcomes 52

Jane Sarashon

MARCH 29, 2023

” Start with the definition set forth in the report: that techquity is the “intentional design and deployment of technology both to advance health equity and to avoid depending existing systemic inequities and health disparities.”

Medicaid 103

Medicaid Medicaid Health Outcomes Medicare 103

Healthcare IT News - Telehealth

JUNE 17, 2020

advocated for two particular policy changes to be made permanent: the originating site rule, allowing physicians to be reimbursed for telehealth appointments wherever a patient is located, including a patient's home, and the expansion of Medicare- and Medicaid-reimbursable telehealth services. Lamar Alexander, R-Tenn.,

US Department of Health and Human Services 179

US Department of Health and Human Services Telemedicine COVID-19 Doctors 179

HIT Consultant

JULY 24, 2022

Patients in rural areas, those with Medicare and Medicaid, and those struggling with social determinants of health (SDOH) that prevent access to preventive care and screening, often experience difficulties finding a provider knowledgeable about appropriate PAD assessments too. It also would establish a PAD education program in the U.S.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Innovaare Compliance

OCTOBER 6, 2022

Annual Election Period (AEP) is about two weeks away when Medicare Advantage Prescription Drug Plans (MAPD) will be signing up new enrollees by the thousands. According to the Centers for Medicare & Medicaid Services (CMS), enrollment in MAPD keeps rising. However, such allowance is not extended beyond March 31, 2023.

Medicare 52

Medicare Medicare Compliance Public Health 52

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

Hall Render

SEPTEMBER 10, 2024

On July 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its calendar year 2025 Medicare Physician Fee Schedule (“MPFS”) proposed rule (“Proposed Rule”), to implement certain payment updates effective January 1, 2025.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Health Care Law Brief

APRIL 12, 2023

On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The SRFs include low-income subsidy, dual eligibility (meaning eligible for Medicare and Medicaid) and disability.

Medicare 52

Medicare Medicare Overpayments Overpayment 52