Healthcare Blog

JANUARY 19, 2025

CMS Medicare Swing Bed Rules and Regulations for Critical Access Hospitals (CAHs) Critical Access Hospitals (CAHs) are the backbone of rural healthcare, providing essential services to underserved communities. Why Are Medicare Swing Bed Rules So Important to Follow? Provide a framework for proper documentation and billing practices.

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Healthcare It News

SEPTEMBER 9, 2022

The Centers for Medicare and Medicaid Services is inviting patients and their families, providers, clinicians, consumer advocates, healthcare professional associations, individuals serving underserved communities and all CMS stakeholders serving populations facing disparities in health and healthcare to submit public comments by November 4.

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Hall Render

JANUARY 29, 2025

The Centers for Medicare & Medicaid Services (CMS) is reinforcing its emphasis on hospice quality of care and identifying fraud. Hospice surveys are performed before their initial certification for Medicare participation. Identifying Fraud : Detecting practices that jeopardize patient safety or Medicare program integrity.

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HIT Consultant

DECEMBER 3, 2024

Many care settings are required to perform elaborate intake and documentation before even beginning treatment for a patient. The Centers for Medicare & Medicaid Services (CMS) added codes for Digital Mental Health Treatment in its 2025 Medicare Physician Fee Schedules. Automating intake and paperwork.

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Healthcare IT News - Telehealth

JULY 9, 2020

The Centers for Medicare and Medicaid Services has put together further detailed guidance for how healthcare providers should be documenting and reporting electronic clinical quality measures for telehealth encounters.

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Healthcare It News

OCTOBER 31, 2022

Through the secure collection, documentation, reporting, access and use of data across provider types, ONC aims to address health inequities that have their root causes in poverty and racism. They're not limited to using the SDOH standards in ONC's guide in their work, according to the post. THE LARGER TREND.

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Medisys Compliance

DECEMBER 24, 2024

However, billing for teletherapy services can be complex, requiring a deep understanding of coding, documentation, and payer-specific policies. Some of the documentation tips for CPT codes include: Include the start and end time of the session. Document that the service was provided via telehealth, including the platform used (e.g.,

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Healthcare IT News - Telehealth

NOVEMBER 10, 2020

Prepare Now for Anticipated Changes to Medicare and Private Payer Rules. The Centers for Medicare and Medicaid Services (CMS) is expected to issue new rules for telehealth in the release 2021 Physician Fee Schedule later this year. Today, Medicare reimburses for specific services when delivered via live video.

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AIHC

APRIL 18, 2022

Written by: Thomas "Trent" Jackson, BS, CCRS Medicare bad debts present Medicare Part A providers an opportunity to recover reimbursement dollars they otherwise would have missed. Provided that a proper log is kept, total uncollected Medicare co-insurance and/or deductibles can be claimed on the cost report for 65% reimbursement.

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AIHC

MARCH 31, 2025

The "Sunshine Act," officially known as the Physician Payments Sunshine Act, mandates those manufacturers of drugs, medical devices, and biologics report payments and transfers of value to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS).

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Compliance COVID-19 Compliance Officers Medicaid 64

MRO Compliance

JANUARY 16, 2025

To address these gaps, the Centers for Medicare & Medicaid Services (CMS) now mandates the use of FHIR-based APIs for data sharing. For payers, staying ahead of these changes means investing in systems that track documentation and manage disputes efficiently.

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Medisys Compliance

JANUARY 16, 2025

The Centers for Medicare & Medicaid Services (CMS) provides comprehensive behavioral health billing guidelines, which can be overwhelming due to their technical nature and breadth. Providers must ensure that these services meet Medicares criteria for medical necessity.

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Healthcare It News

DECEMBER 6, 2023

Unfortunately, Medicaid does not provide reimbursement for RPM services. As an FQHC, Evara did not qualify for reimbursement from Medicare. "The second item is to have a well thought out and documented rollout plan, with a detailed marketing plan," he continued.

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Medisys Compliance

MARCH 19, 2025

Medicare Coding Overview For practices billing Medicare, it’s crucial to stay updated with the National Correct Coding Initiative (NCCI) edits, which aim to prevent improper payments. Private insurers might have proprietary coding rules or require pre-authorization for a broader range of procedures compared to Medicare.

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Medisys Compliance

JUNE 27, 2022

The Centers for Medicare and Medicaid Services (CMS) has announced a shift in its eligibility criteria for coverage of lung cancer screening using low-dose CT (LDCT), with implementation date of October 3 rd , 2022. CMS Announcement for Revised Coverage. Reduced the eligibility criteria for the reading radiologist.

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Healthcare IT News - Telehealth

SEPTEMBER 20, 2021

"We have seen all too often criminals who engage in health care fraud – stealing from taxpayers while jeopardizing the health of Medicare and Medicaid beneficiaries," said Deputy Inspector General for Investigations Gary L. More than $1.1 billion of that loss involved allegedly fraudulent claims related to telemedicine.

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Medisys Compliance

JULY 19, 2024

Introduction The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. Expanded Telehealth Services One of the most notable changes in Medicare/Medicaid billing for behavioral health is the expanded coverage for telehealth services.

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Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology.

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AIHC

APRIL 22, 2025

For compliance professionalsparticularly those working in environments regulated by Medicare, Medicaid, HIPAA, and federal contractsit is essential to understand the scope and implications of whistleblower protections under current U.S. The technician files a complaint under both the FCA and state labor law.

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HealthIT Answers

APRIL 22, 2025

Nay helped her apply for Medicaid and food assistance and obtain copies of her birth certificate and other identification documents needed to apply for housing assistance. The post Talent Tuesday: Montana Examines Ways To Ease Health Care Workforce Shortages appeared first on Health IT Answers.

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Medisys Compliance

JANUARY 23, 2025

Will Medicare Stop Paying for Telehealth in 2025? One of the pressing questions for healthcare providers is whether Medicare will continue reimbursing telehealth services in 2025. The good news is that Medicare has extended many telehealth flexibilities initiated during the COVID-19 Public Health Emergency (PHE) through March 2025.

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Medical Billing Outsourcing Medicare Medicare Medical Billing 59

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. Of course, amending plan documents to reflect the changes is also necessary.

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Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. Of course, amending plan documents to reflect the changes is also necessary.

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Medicaid Medicaid COVID-19 Compliance 100

Total Medical Compliance Resources

APRIL 16, 2025

The monitoring results must be documented and kept according to local and state regulations. Several regulatory agencies, including the Joint Commission and Centers for Medicare and Medicaid mandate documentation. The sterilizer gauges or displays are observed for each of these parameters and those results are documented.

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MRO Compliance

JULY 12, 2023

Accurate, properly documented, interoperable patient data is required to achieve CMS’s goal for 100 percent of Medicare (and the majority of Medicaid) beneficiaries to be enrolled in some type of accountable, or value-based, care arrangement by 2030.

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HIT Consultant

APRIL 15, 2025

Founder and Chief Executive Officer of RimidI The care management code updates in the 2025 Final Physician Fee Schedule from Centers for Medicare & Medicaid Services (CMS) could have far-reaching implications for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Lucienne Marie Ide, M.D.,

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Healthcare IT News - Telehealth

OCTOBER 27, 2020

The Centers for Medicare and Medicaid Services announced earlier this month , for example, that it would add 11 virtual services to its reimbursement list during the COVID-19 public health emergency – following in the footsteps of its earlier flexibilities for virtual care.

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Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The final rule codifies long-awaited regulations first proposed by CMS in 2018.

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Medicare Medicare Overpayment Overpayments 98

Hall Render

MARCH 27, 2025

The Centers for Medicare & Medicaid Services (CMS) has given surveyors additional rules and updates to allow surveyors to assess and cite violations of the regulations on nursing homes with admission agreements that create prohibited third-party guarantee of resident payments.

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AIHC

NOVEMBER 12, 2024

Teaching hospitals need to establish guidelines addressing this matter, while medical schools should revise their curriculum to encourage a culture where healthcare providers and trainees consistently obtain and appropriately document informed consent from patients before conducting any sensitive examinations.

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Medisys Compliance

APRIL 15, 2025

Here are some key factors contributing to this evolution: Time-Consuming Processes: Managing the complete billing cycle, from accurate documentation and coding to claim submission and follow-up, demands significant time that could be better spent on patient care. Medical billing companies in USA stay up-to-date on these ever-changing rules.

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Healthcare IT News - Telehealth

SEPTEMBER 2, 2021

Department of Justice announced this week that a Florida laboratory owner had pleaded guilty for his role in a $73 million Medicare kickback scheme. The scheme, as outlined in court documents, exploited COVID-19-era amendments to telehealth restrictions. WHY IT MATTERS. ON THE RECORD.

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COVID-19 Medicare Medicare Public Health 165

Healthcare It News

JANUARY 4, 2022

"The adoption of hospital-at-home programs across the country has been rapid, with nearly 200 hospitals participating in the Centers for Medicare and Medicaid Services’ Acute Hospital Care at Home program in only a year since its launch," said Majmudar.

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American Medical Compliance

OCTOBER 25, 2024

The healthcare industry is highly regulated, with various laws such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH), and the Medicare and Medicaid Services (CMS) regulations shaping operations.

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Compliance Fraud Compliance Framework HIPAA 105

Medisys Compliance

FEBRUARY 24, 2025

Factors influencing reimbursement include the payer type ( Medicare , Medicaid, commercial insurance), geographic location, and specific contract agreements. Session start and end times: Meticulously document the precise start and end times. Accurate rate assessment is vital for effective group therapy billing.

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Medical Billing Outsourcing Medical Billing Medical Billing Services Medicaid 59

Hall Render

NOVEMBER 1, 2024

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.

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Verisys

FEBRUARY 3, 2025

A well-organized checklist can simplify this process and help avoid delays caused by missing or incomplete required documents. Understanding Medical Credentialing Healthcare credentialing ensures that both the professional credentials and the necessary documentation are verified.

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