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The healthcare industry has rapidly evolved, and with that, the need for a reliable and comprehensive provider sanction and exclusion database became increasingly apparent. Verisys introduced the Fraud Abuse Control Information System (FACIS) to meet this growing need in 1993. Initially, FACIS aggregated data from licensing boards, the Office of Inspector General (OIG), and other select federal databases.
Two of the most significant healthcare compliance risks are medical coding and billing. Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. This is why selecting appropriate medical codes is essential for operating and being reimbursed compliantly.
The following is a guest article by Bill Young, Director of Healthcare & Life Sciences at SYSTRAN Keeping patient data confidential and secure remains a major healthcare challenge today, more than 25 years after the introduction of the 1996 Health Insurance Portability & Accountability Act or HIPAA. HIPAA is regulatory guidance to ensure Patient Health Information (PHI) is protected in specific entities, mainly healthcare facilities, and healthcare admin support institutions, for the tra
As the healthcare landscape continues to evolve, regulatory compliance has become a critical aspect of ensuring patient privacy, safety, and overall quality of care. Healthcare organizations and professionals must navigate complex regulations to comply with various legal requirements. Let’s look into the world of healthcare regulatory compliance, exploring its importance as well as the role of regulatory compliance software, consulting, and certification.
Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health
AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!
By Lee Spiegel , Compliance Director, MZQ Consulting By October 13, 2023, plan sponsors that offer prescription drug coverage must provide notices of creditable or non-creditable coverage to Medicare-eligible individuals. While plan sponsors are typically responsible for providing these notices by October 14 th every year, this year’s notice is due by October 13 th because the 14 th falls on a Saturday.
Disregard your Health Insurance Portability and Accountability Act obligations at your own risk. That’s the stark warning covered entities and business associates should take away from a recent settlement entered into by the nation’s largest publicly operated health plan and the U.S. Department of Health and Human Services’ Office for Civil Rights.
Grand Blanc, Mich.-based McLaren Health Care said it has experienced a ransomware attack shortly after a ransomware gang took credit for it, The Record reported Sept. 29.
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Health Care Compliance Brief brings together the best content for health law & compliance professionals from the widest variety of industry thought leaders.
Grand Blanc, Mich.-based McLaren Health Care said it has experienced a ransomware attack shortly after a ransomware gang took credit for it, The Record reported Sept. 29.
Today, everything is digital, accessible, and readily available at your fingertips or at the click of a button. This is why it’s absolutely crucial to safeguard personal data. This is especially true in healthcare settings, where patient confidentiality is paramount. To address this concern, HIPAA and the Privacy Act were established to protect individuals’ privacy rights.
Compliance never takes a break – not even on National Compliance Officer Day. As Carl approached the cake he requested for the occasion, he couldn't help but feel a sense of duty, a commitment to upholding justice, even in the sweetest of moments. Carl wanted to make sure there were no non-compliant slices – bigger vs. smaller slices, pieces with more frosting than others, etc.
In today’s digital landscape, data security is of utmost importance. With the ever-increasing number of cyber threats, organizations must take proactive measures to protect sensitive information and maintain the trust of their customers. One such measure is SOC 2 compliance, a widely recognized standard that demonstrates an organization’s commitment to safeguarding data.
Kaiser Permanente’s novel labor approach allowed for decades of stability, but over a dozen sources familiar with the situation said fractured relationships are straining current negotiations.
Based on comprehensive survey data from diverse healthcare providers, the 2025 HIPAA Benchmark Report delivers actionable intelligence for modern compliance programs. This report examines how organizations are restructuring HIPAA Privacy Programs to address emerging regulatory requirements. Through analysis of staffing models, program operations, and breach management protocols, it provides a clear picture of current best practices.
Kentucky ranks fifth in the U.S. for adults with hypertension, many of whose condition is not controlled. Untreated high blood pressure increases the risk of heart attack, stroke and other serious health problems. THE PROBLEM The traditional approach of seeing a patient in the office, prescribing medication, advising them on lifestyle changes to make, having them check their blood pressure at home and report back, has fallen short, said Dr.
By P.F. Anderson and LaTeesa James PubMed special queries are master search strategies on common, important, but challenging health topics, which are usually peer-reviewed. Disability certainly qualifies as a common, important health topic that is challenging to search – and yet, no PubMed special query exists for it. This oversight is concerning. Put simply, it’s important that disability as a topic is easily identifiable in the scholarly record.
Boston Children's Hospital recently announced its plans to transition to a unified Epic electronic health record. Similar to Salt Lake City-based Intermountain Health and Pittsburgh-based UPMC , Boston Children's – which currently uses both Epic and Cerner PowerChart – says it plans to make the migration to a single Epic platform across all its care sites in 2024.
Hospices acquired by private equity firms and publicly traded companies shift their operational strategies toward maximizing profits, the new study in JAMA Network Open suggests.
Every health care provider that accepts federal payments must screen for excluded providers. Use this sample Exclusion Screening Checklist and Compliance Policy to evaluate and improve your organization’s compliance with the law. Payments from Medicare, Medicaid, and TriCare trigger screening requirements that may extend to employees, contractors, volunteers, board members, and network providers.
Various capabilities have been incorporated into modern patient portals, including chatbots and digital twins, to maximise their potential for improving the patient experience. However, it may take a while for hospitals to apply the newer large language models to their patient portals. In the session " Patient portal integration for enhanced hospital operations ," Dr Roel Bolt, CMIO, Franciscus Hospital discussed the evolution and innovation of patient portals.
By Ashley Shew Far too often, when people write and talk about technology and disability, stories are deeply shaped by ableism. Often when devices are painted as “solving the problem of disability” or “empowering disabled people,” they suggest that being disabled is itself a problem, and that people should try to be as nondisabled as possible. But pretending to be nondisabled is not a great way to live — to be in hiding or denial, to not give your body and mind the rest they deserve, to hurt you
The Southwest Rural Health Research Center has identified mental health concerns and addiction as the first and second most important priorities for rural health stakeholders, according to a May 2023 policy brief. With a chronic shortage of mental healthcare providers in rural areas, there is a significant lack of access to this much-needed care for those who reside there.
The Congressional Budget Office report estimated the Center for Medicare and Medicaid Innovation, which was created in part to reduce spending, will increase net federal spending by $1.3 billion from 2021 through 2030.
Payroll compliance is a cornerstone of business success, yet for small and midsize businesses, it’s becoming increasingly challenging to navigate the ever-evolving landscape of federal, state, and local regulations. Mistakes can lead to costly penalties and operational disruptions, making it essential to adopt advanced solutions that ensure accuracy and efficiency.
Homelessness is a complex and challenging phenomenon, not just in the U.S. but across its neighbor to the north: It has been estimated that anywhere from 100,000 to 300,000 individuals experience homelessness in a given year in Canada, with more than 35,000 individuals experiencing homelessness on any given night in the country. THE PROBLEM The increasing economic pressures faced by people across all levels of society – combined with other recent public health disruptions, such as the pand
By Joshua A. Halstead As a disabled person who relies on speech recognition software to complete a range of daily writing tasks (from emails to book chapters), I am no stranger to the universe of voice assistants, having cut my teeth on Dragon Dictate in the ’90s. Though I’m used to the software knowing my voice, that it now knows my location is uncanny.
The Transcarent platform integrates directly through the care pathway of each of the 10 health systems it is partnering with, including scheduling and pre- and post-care, support services and same-day payment for providers. WHY IT MATTERS Transcarent says the ecosystem will provide the employees of national self-insured employers with faster access to verified high-quality digital or in-person care, higher-quality care, and affordable and predictable costs with full transparency.
Healthcare communication has evolved from handwritten notes and paper charts to digital tools like EHRs, telemedicine, and AI-powered platforms. This blog explores how these advancements improve patient outcomes, streamline care delivery, and enhance provider collaboration. Learn about the role of mobile health (mHealth) apps, secure messaging, and social media in bridging communication gaps.
Within two years of digital transformation, Catholic Medical Center, one of the largest medical institutions in South Korea, gained capabilities to provide personalised care powered by big data and AI. In-Young Choi, professor and head of the Catholic Information Convergence Institute at CMC, shared their journey in the session, " Personalised care with hospital big data and digital health technology.
By Chorong Park The intersection of ableism, ageism, technoableism , and metaeugenics reduce the accessibility and quality of health care for elders with disability experience. They struggle with health care technology that is not built with their user profile in mind. Similarly, assistive technologies are focused on “normalizing” them to “improve” their abilities.
Dr. Richard Tytus of Hamilton, Ontario, is a medical professional with extensive experience in delivering and promoting virtual healthcare. He has been providing telemedicine long before the COVID-19 pandemic. He is a clinic owner and part of a family health team of approximately 30 medical professionals and allied health workers. THE PROBLEM "My journey into telemedicine was sparked by a genuine concern for a subset of patients facing physical or psychological barriers to accessing healthc
A small Iowa pharmacy is accusing CVS Caremark of forcing independent pharmacies to sign one-sided contracts in order to stay in its network and continue dispensing drugs for its millions of covered lives.
In healthcare, where patient data protection is paramount, effective vendor risk management isn't just good business—it's essential for maintaining compliance and trust. This comprehensive guide helps healthcare compliance professionals navigate the complexities of third-party vendor relationships in an increasingly interconnected healthcare environment.
Employed women have as much as $15.4 billion more a year than men in out-of-pocket healthcare expenses, despite largely buying the same health insurance products, according to new findings published this week by Deloitte.
By Hannah van Kolfschooten and Mirko Faccioli There are currently over 12 million cancer survivors in Europe. Due to improving cancer screening methods and medical treatment, this number is expected to grow every year. Former cancer patients often face multiple forms of discrimination throughout their lives. Many commercial companies make long-term cancer survivors “ pay twice ” – while having similar life expectancies as their peers, they are denied access to key services because of their forme
Home hospitalisation, tech-enabled preventive care, and genomic data-driven personalised care are some of the emerging trends in care in the Asia-Pacific region. Dr Deok-Hyun Han, Vice CMIO of Samsung Medical Center, Oscar Lee, professor and vice superintendent of China Medical University Hospital, Low Cheng Ooi, associate professor and CTO of Sheares Healthcare, and Dr Mohammad Adib Khumaidi, president of the Indonesian Medical Association, sat together in the closing panel discussion " Th
Let's discuss the trusty pager—an old favorite that’s losing its shine in hospitals and clinics. While once a staple in hospitals and clinics, pagers now present significant limitations that hinder rather than facilitate communication among healthcare professionals. Healthcare professionals are constantly on the move, and they need communication tools that can keep up with their fast-paced lives.
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