Healthcare Law Blog

FEBRUARY 3, 2023

Part 521 governing the implementation and operation of effective compliance programs for certain “required providers,” including, now for the first time, Medicaid managed care organizations (MMCOs). [1] New Subpart 521-1: Compliance Programs The adopted regulations represent substantial changes to 18 N.Y.C.R.R.

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Medicaid Medicaid Compliance Overpayments 52

Health Populi

OCTOBER 22, 2021

Holding health care back is the lack of digitization in general, and then the under-investment in user-centered design to engage and then retain patients beyond an initial download or visit to a patient portal. Claims — that’s the paper-based workflow that eats up some of the $billion U.S. It still does.

Electronic Medical Records 174

Electronic Medical Records Health Insurance Medicaid Medicaid 174

HIPAA Journal

AUGUST 10, 2023

Missouri Department of Social Services The Missouri Department of Social Services (DSS) has confirmed that the data of Medicaid recipients was compromised in the recent mass MOVEit hacks by the Clop threat group. It is currently unclear exactly how many Medicaid recipients were affected.

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Medicaid Medicaid Health Insurance HIPAA 52

Healthcare IT Today

JANUARY 5, 2024

The proceeds from the financing will support PursueCare’s ongoing collaborative care initiatives with health systems across 11 states, as well as expansion into value-based care with Medicaid managed care and other health plans. Patients can also seek treatment without a referral by downloading the app from Google Play or the Apple Store.

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FDA Medicaid Medicaid Hospitals 119

Compliancy Group

JANUARY 31, 2025

The attack started when an employee downloaded a malicious file, allowing threat actors to access the health systems servers. Centers for Medicare & Medicaid Services In May 2023, the Clop group exploited a zero-day vulnerability to gain unauthorized access to the networks of 2,500 companies. The damage?

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Ransomware HIPAA Medicare Medicare 52

Provider Trust

SEPTEMBER 12, 2022

In 2006, New York’s Office of the Medicaid Inspector General (OMIG) was established as an independent office within New York State’s Department of Health to combat fraud and abuse in New York State’s Medicaid program. No payments will be for medical care, services and supplies furnished, prescribed, or ordered by an excluded party.

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Medicaid Medicaid Fraud Licensing 52

HIPAA Journal

MAY 23, 2024

The exposed data included names, medical record numbers, Medicaid IDs, dates of birth, gender, race, ethnicity, clinic, and dates of service. The affected medical practices were notified about the data exposure between April 5 and 8, 2024, and individual notifications have been mailed to the affected patients.

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Electronic Medical Records HIPAA Medicaid Medicaid 83

MedTrainer

JULY 28, 2023

Earlier this year, an in-depth OIG investigation resulted in a six-day trial of a former Louisiana health clinic CEO , who was ultimately convicted of Medicaid fraud and sentenced to 82 months in federal prison. Download “Compliance Reports You Can’t Live Without” for OIG reporting templates and tips. What Prompts an OIG Inspection?

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Fraud Compliance Medicaid Medicaid 98

MedTrainer

FEBRUARY 27, 2025

OIG exclusion list monitoring is vital in maintaining compliance with Centers for Medicare & Medicaid Services (CMS) regulations, as well as National Committee for Quality Assurance (NCQA) credentialing standards , among other federal healthcare provisions. Be ready for inspections from OSHA, OCR, CMS, and OIG.

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Compliance Malpractice Fraud Licensing 52

HIPAA Journal

MARCH 10, 2022

The malware was detected on or around August 9, 2021, with the investigation confirming the malware was downloaded onto its systems on July 27, 2021. The malware was removed and unauthorized access to its systems was prevented on August 11, 2021. Dr. Douglas C.

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Ransomware Licensing Health Insurance HIPAA 139

Healthcare IT News - Telehealth

NOVEMBER 11, 2020

Medicaid instituted new guidelines and procedure codes to address this new reality, but the turnaround time to implement these changes was very short. THE PROBLEM. COPE needed to react quickly to the sudden change in the healthcare service delivery model and minimize any negative impact from these changes. ” MARKETPLACE.

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COVID-19 Telemedicine Medicaid Medicaid 150

Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. In 2021, the Patient Access API, which allows patients to download their data through their preferred third-party app, became available to healthcare beneficiaries.

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Electronic Medical Records Doctors Governance Medicaid 117

Medval Compliance Blog

MARCH 18, 2022

The Centers for Medicare & Medicaid Services (CMS) will be hosting an overview of the new “Go Paperless” feature available in the Medicare Secondary Payer Recovery Portal (MSPRP) on Thursday, April 13 at 1:00 pm ET. The webinar will feature opening remarks and a presentation, followed by a question and answer session.

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Medicare Medicare Medicaid Medicaid 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. Learn More About NPIs When Did NPI Numbers Begin?

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Fraud HIPAA Medicare Medicare 97

Medval Compliance Blog

FEBRUARY 8, 2022

The Centers for Medicare & Medicaid Services (CMS) announced yesterday that it will be hosting a Workers’ Compensation Medicare Set-Aside (WCMSA) webinar next Thursday, February 17, 2022 at 1:00 pm ET. Check back following the webinar for a recap, where we will share key takeaways and highlights from the session.

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Medicare Medicare Medicaid Medicaid 52

HIT Consultant

NOVEMBER 10, 2021

– Downloads of medical apps increased 65% last year. Centers for Medicare and Medicaid Service (CMS) approved dozens of new telehealth services last year, and payers are beginning to offer virtual-first health plans, where patients first see a virtual provider before making an in-person appointment.

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COVID-19 Telemedicine Medicaid Medicaid 105

MedTrainer

MAY 21, 2024

The Centers for Medicare and Medicaid Services (CMS) defines behavioral health as the emotions and behaviors that affect your overall well-being. It generally refers to mental health and substance use disorders, life stressors and crises , and stress-related physical symptoms.

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Compliance Medicaid Medicaid HIPAA 52

HIPAA Journal

JANUARY 30, 2023

Tennant, MA The full schedule for the event can be downloaded here – HIPAA Summit Schedule (PDF). The pre-conference basic training day is included in the basic HIPAA Summit registration and includes 8 training sessions, followed by a HIPAA Workforce Training Faculty Q&A.

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US Department of Health and Human Services HIPAA Compliance Medicaid 81

AIHC

FEBRUARY 7, 2024

Medicaid policies on this issue vary from state to state. Download the 1-Page “ A Framework for Defining Telehealth ” Fact Sheet. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”. It covers billing, Federal Medicare policies and State Medicaid policies.

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HIPAA Medicaid Medicaid Telemedicine 59

Natalia Mazina

JULY 20, 2022

Our firm has prepared policies and procedures (and patient notices) that comply with the above requirements, available for download here. Many Medicaid programs have similar restrictions. Basically, California law mirrors Part D requirements.

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Medicaid Medicaid Medicare Medicare 52

MedTrainer

MAY 7, 2024

Download Now UnitedHealthcare Provider Enrollment Guidelines UnitedHealthcare requires that credentialiers ensure all providers meet standard credentialing criteria to become a healthcare professional in its network. Easily assign multiple enrollments to staff, update statuses, and prioritize.

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Malpractice Licensing Medicaid Medicaid 52

HIT Consultant

FEBRUARY 27, 2024

When it comes to clinical policies that a typical state Medicaid publishes, on average, there are more than 5,000 documents that a clinician must first sample and then evaluate for relevancy. Each relevant section must be read before deciding if it applies to very specific rules and edits.

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Medicaid Medicaid Compliance 111

HIPAA Journal

DECEMBER 31, 2022

You can download a complaint form , complete it, send it to OCR by mail or as an email attachment. Consequently, it is not possible to report a HIPAA violation anonymously via the OCR Complaints Portal. There are Other Ways of Filing a Complaint with OCR. The Complaints Portal is not the only way to file a complaint with OCR.

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HIPAA Medicaid Medicaid Medicare 98

Provider Trust

SEPTEMBER 29, 2022

A 49-year-old Brownsville, TX man named Fernando Mendez was taken into custody in early September after being charged with defrauding Medicaid. From August 2021 to February 2022, Mendez provided patient assessments and evaluations and ordered treatments and prescriptions, all while billing Medicaid for his services.

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Licensing Fraud Medicaid Medicaid 52

MedTrainer

MAY 29, 2024

The interactive PDF is available through the Texas Department of Insurance, but providers or credentialers can easily download a pre-filled application from CAQH — the format changes slightly per payer, but it includes almost the same information as any other “standard” application. Primary Source Verification.

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Medicaid Medicaid Malpractice Licensing 52

AIHC

FEBRUARY 7, 2024

Medicaid policies on this issue vary from state to state. Download the 1-Page “ A Framework for Defining Telehealth ” Fact Sheet. Centers for Medicare & Medicaid Services (CMS) offers a 17-page PDF: “ Telehealth for Providers: What You Need to Know ”. It covers billing, Federal Medicare policies and State Medicaid policies.

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HIPAA Medicaid Medicaid Telemedicine 52

MedTrainer

JANUARY 12, 2024

Here are some of the key organizations involved in regulating healthcare compliance: Centers for Medicare & Medicaid Services (CMS): CMS is a federal agency within the U.S. Department of Health and Human Services responsible for administering and regulating healthcare programs such as Medicare and Medicaid.

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Compliance Fraud Medicaid Medicaid 52

Healthcare Law Blog

NOVEMBER 2, 2023

According to the Congressional Research Service, which analyzed data from the Centers for Medicare & Medicaid Services (“CMS”) National Health Expenditure Accounts (“NHEA”) on the personal health expenditures for LTSS by payer, in 2021, an estimated $467.4 billion was spent on LTSS. This represents 13.2% of LTSS spending. [5]

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Nursing Homes Medicaid Medicaid Medicare 52

MedTrainer

MAY 29, 2024

One of the newest changes that impacts medical credentialing services in Oklahoma is a major change to SoonerCare, the state’s Medicaid program. Ensuring the provider’s CAQH profile is up to date, and if the provider will also be enrolling in SoonerCare, Oklahoma’s Medicaid program, you’ll want to ensure the provider has a profile.

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Licensing Medicaid Medicaid Malpractice 52

MedTrainer

JANUARY 30, 2024

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). Download Now The post Healthcare Compliance Certification Is Within Your Reach appeared first on MedTrainer.

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Compliance Compliance Officers Fraud Medicaid 52

MedTrainer

MAY 16, 2024

Download the Ultimate List of Training Requirements for Ambulatory Surgery Centers to see a full list of federal and accreditation training requirements for ASC staff broken down by role, with the applicable standard, CMS violation category, and frequency. Staff should review the requirements for their specific state to remain in compliance.

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Compliance HIPAA Health Insurance Medicaid 52

MedTrainer

MAY 10, 2024

1, 2024 , mental health counselors can enroll with Medicare as part of The Centers for Medicare and Medicaid Services ( CMS ) plan to bring approximately 400,000 marriage and family therapists (MFT) and mental health counselors (MHC) into their network. Effective Jan.

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Licensing ACA Medicare Medicare 52

MedTrainer

MAY 6, 2024

Download Now Aetna Provider Enrollment Guidelines Aetna requires that all providers meet standard credentialing criteria to become a healthcare professional in its network. Download our guide – Tools to Conquer Provider Enrollment – for valuable tips on speeding up the time from credentialing to enrollment approval.

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Licensing Malpractice Health Insurance Medicaid 52

MedTrainer

FEBRUARY 7, 2025

Regular audits from regulatory bodies such as the Centers for Medicare & Medicaid Services (CMS) or the Health Resources and Services Administration (HRSA) are a necessary part of operating in the healthcare industry. Download a ready-to-use and customizable Code of Conduct.

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Compliance Fraud Medicaid Medicaid 52

MedTrainer

APRIL 11, 2024

Download Now Culture of Collaboration Developing a culture of compliance within healthcare extends beyond meeting legal obligations; it is a cornerstone for delivering safe, ethical, and top-tier care. Get tips and tricks for effective compliance training.

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Compliance Officers Compliance Medicaid Medicaid 52

Healthcare Law Blog

AUGUST 11, 2022

The FQHC served predominantly low-income individuals [3] including Medicare and Medicaid beneficiaries and offered telehealth services to its patients through a telehealth application, which could be downloaded onto a smartphone. . The Arrangement. OIG Analysis. The Federal Anti-Kickback Statute.

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Medicare Medicare COVID-19 Medicaid 52

YouCompli

SEPTEMBER 18, 2024

According to the Centers for Medicare and Medicaid Services (CMS), TPE’s goal is to facilitate quick improvement and enable MACs to work with providers to identify specific errors and correct them. TPE is designed to help providers and suppliers reduce claim denials and appeals through one-on-one help.

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