MedTrainer

JANUARY 30, 2024

What types of healthcare facilities are required by the government to have a compliance program? In this blog, we’ll outline what types of healthcare facilities are required by the government to have a compliance program and why compliance is crucial for both healthcare organizations and the agencies that support them.

Governance 52

Governance Compliance Nursing Homes Medicaid 52

AIHC

SEPTEMBER 25, 2024

There is value in learning from another organization’s lessons publicly posted by a government authority, such as the Department of Justice (DOJ), Centers for Medicare & Medicaid Services (CMS), the HIPAA enforcement agency, the Office of Civil Rights (OCR) or the Federal Bureau of Investigations (FBI).

Fraud 52

Fraud Compliance Compliance Officers Licensing 52

HIT Consultant

NOVEMBER 9, 2023

Director of Healthcare Strategy, LexisNexis Risk Solutions During the peak of the Covid-19 pandemic, over 10 million Americans enrolled in Medicaid – nearly a 14% increase from the beginning of 2020. A month before the public health emergency ended on May 11, 2023, 87 million individuals were enrolled in Medicaid.

Medicaid 64

Medicaid Medicaid Health Insurance COVID-19 64

HIPAA Journal

JULY 31, 2023

a government services contracting company, has announced in a Securities and Exchange Commission (SEC) filing that hackers exploited a zero-day vulnerability in Progress Software’s MOVEit Transfer solution in May 2023 and accessed the protected health information (PHI) of between 8 and 11 million individuals.

Governance 77

Governance Medicare Medicare Ransomware 77

HIPAA Journal

JUNE 8, 2023

The Iowa Department of Health and Human Services has announced there have been three separate breaches of the protected health information of Iowa Medicaid recipients in the past two months – two hacking incidents and an impermissible disclosure, all three of which involved third-party contractors.

Medicaid 87

Medicaid Medicaid Ransomware Health Insurance 87

MRO Compliance

JUNE 1, 2022

Information You Need to Know about a HEDIS Audit from Revenue Cycle Experts. Below we explore some common questions about HEDIS and review important information your team should know now and in the future. Below we explore some common questions about HEDIS and review important information your team should know now and in the future.

Medicare 130

Medicare Medicare Compliance Medicaid 130

Compliancy Group

JUNE 28, 2024

On June 24, 2024, the Department of Health and Human Services (HHS) released a final rule establishing disincentives for healthcare providers who have engaged in information blocking. Information blocking is a practice by a provider that is likely to interfere with the access, exchange, or use of electronic health information (EHI).

Medicare 59

Medicare Medicare Hospitals HIPAA 59

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. To become a provider for Ohio Medicaid, you must first enroll in the Ohio Medicaid program. Here are the steps of provider enrollment for Ohio Medicaid: Provider Enrollment for Ohio Medicaid 1.

Medicaid 52

Medicaid Medicaid Licensing Medical Billing Outsourcing 52

HIPAA Journal

NOVEMBER 17, 2022

Caroline Cook, Privacy Consultant, GDH Government Consulting Services, has shared her thoughts. I then left acute care and began a career as a Privacy Consultant, obtaining three different certifications as an information privacy professional. I’m a Privacy Consultant employed by GDH Government Consulting Services.

Governance 92

Governance HIPAA Compliance Nursing Homes 92

Med-Net Compliance

NOVEMBER 2, 2022

Massachusetts Attorney General Maura Healey announced that her office’s Medicaid Fraud Division recovered more than $71 million during the most recent federal fiscal year, which ended on September 30. The AG’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state’s Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Compliance 59

Hall Render

AUGUST 22, 2023

The Fourth Circuit recently held that providers may not defend a False Claims Act (“FCA”) lawsuit by arguing that eligibility requirements violate the Medicaid Act. the government alleged a clinical pharmacy manager for a Tennessee Walgreens falsified twelve different patients’ medical records between January 2015 and June 2016.

Medicaid 40

Medicaid Medicaid Governance Fraud 40

Healthcare Law Blog

OCTOBER 2, 2023

The government buys billions of dollars in healthcare-related goods and services every year, and no government procurement is perfect. If the answer is “yes”—or even “maybe”—healthcare companies may file a bid protest at the Government Accountability Office (“GAO”) or the U.S. B-417836, 2020 CPD ¶ 47 ( Nov. 2021 CPD ¶ 325 (Nov.

Governance 52

Governance Department of Veterans Affairs Medicaid Medicaid 52

Healthcare Compliance Blog

APRIL 27, 2022

A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds. 29, 2018.

Medicaid 59

Medicaid Medicaid Compliance Governance 59

Healthcare Compliance Blog

JANUARY 24, 2022

On January 19, 2022, the Massachusetts Medicaid Fraud Division announced that in calendar year 2021, more than $55 million was recovered from individuals and entities who defrauded the state. The Attorney General’s Medicaid Fraud Division investigates and prosecutes providers who defraud the state Medicaid program, MassHealth.

Fraud 59

Fraud Medicaid Medicaid Nursing Homes 59

Bill of Health

DECEMBER 6, 2023

By Hannah Rahim Many mental health provider directories for private and public insurance plans contain inaccurate or outdated provider information , which creates a misleading illusion of accessible care. The Consolidated Appropriations Act of 2023 requires Medicaid plans to publish and update accurate and searchable provider directories.

Governance 147

Governance Medicaid Medicaid Medicare 147

Hall Render

DECEMBER 20, 2023

For NFs, the data would be reported via means prescribed by the applicable state Medicaid agency. Public Posting of Data CMS finalized the Proposed Rule’s requirement that the information provided per Section 1124(c) of the Act be publicly available within one year of the Final Rule.

Nurses 40

Nurses Medicaid Medicaid Medicare 40

Healthcare It News

JULY 11, 2024

The second version of ONC's Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing and Public Health Interoperability rule, or HTI-2, is designed to support the data exchange needs of patients, providers, payers and public health agencies.

US Department of Health and Human Services 237

US Department of Health and Human Services Public Health COVID-19 Governance 237

Healthcare It News

OCTOBER 31, 2022

The pilot, funded under a cooperative agreement by the Office of the National Coordinator for Health IT (ONC) and Health Level Seven International (HL7), focuses on applying FHIR Gravity social risk terminology – to exchange information. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org.

Licensing 296

Licensing Medicaid Medicaid Health Outcomes 296

Provider Trust

MARCH 16, 2022

Exclusions are administrative actions that are placed upon an individual or entity by HHS OIG, a state agency or Medicaid Fraud Control Unit (MFCU), or by one of the many agencies associated with SAM.gov. Additionally, there are varying, disparate State Medicaid exclusions sources that require periodic screening.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

JULY 18, 2024

Physician practices, burdened with updating information across multiple platforms, contribute to the problem. The Impact: Patients can face delays in care due to incorrect contact information. National Standards: Establishing national standards for how provider information is exchanged could be a less disruptive solution.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Bill of Health

JANUARY 23, 2024

Medicaid pays for more than 40% of births in the U.S., Examining efforts at the federal and state level, I highlight three options, leveraging Medicaid as a policy lever. In the past, when individuals were Medicaid-eligible due to pregnancy, federal law required states to provide coverage for at least 60 days postpartum.

Medicaid 113

Medicaid Medicaid Patient Satisfaction Health Insurance 113

Healthcare IT News - Telehealth

JANUARY 23, 2023

We spoke with the HIMSS government relations team for their thoughts on those priorities and more in 2023 and beyond. HIMSS will "use the next two years to gather additional data to inform both Congress and CBO on either the cost of avoidance or the cost control aspects," said Leary.

Medicare 164

Medicare Medicare Governance Medicaid 164

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

HIPAA Journal

APRIL 29, 2024

A Portland, ME-based accounting and consulting firm has recently reported a data breach to the Maine Attorney General that involved the personal information of 1,107,354 individuals. A vendor was engaged to conduct a review of the affected files, and that process was completed on April 2, 2024.

Health Insurance 101

Health Insurance Health Analytics HIPAA Medicaid 101

HIT Consultant

OCTOBER 22, 2024

Making HPH-CPGs a Condition of Participation (CoP) for CMS : The Centers for Medicare & Medicaid Services (CMS) could require adherence to HPH-CPGs as a condition for participating in Medicare and Medicaid programs. He has been dedicated to the healthcare information technology and information management industry for over 30 years.

HIPAA 132

HIPAA Compliance Public Health Medicaid 132

HIT Consultant

JUNE 26, 2023

signed a Letter of Intent with CRISP Shared Services to participate in a health data interoperability pilot program that will lay the foundation for OHIT’s Health Information Exchange in the Territory. Virgin Islands (USVI) Governor Albert Bryan Jr. Why It Matters OHIT Director Michelle M.

US Department of Health and Human Services 52

US Department of Health and Human Services Local Policy Governance Medicaid 52

Health Law Advisor

AUGUST 30, 2023

In a decision that significantly levels the field for providers, the District Court ruled in part for the provider plaintiffs and in part for the Government in the TMA III ruling. The Centers for Medicare & Medicaid Services (“CMS”) responded to the ruling by temporarily suspending all Federal (i.e., Earlier this month, the U.S.

Governance 105

Governance Medicaid Medicaid Medicare 105

Verisys

FEBRUARY 8, 2024

The bill requires the board to post an online statement directing the public to contact the board for more information concerning a formal name change. Federal regulations require Medicaid to enroll an Ordering, Referring, and Prescribing (ORP) practitioner as a participating provider for services billable to the Medicaid program.

Regulatory Compliance 52

Regulatory Compliance Compliance Licensing Nurses 52

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

Fraud 103

Fraud Medicaid Medicaid Doctors 103

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

AIHC

MARCH 12, 2024

Written by the AIHC Education Department This article provides an overview of how the media and government are reacting to the potential of artificial intelligence (AI) and potential threats associated with this advanced technology. A Government-Commissioned Report Released February 2024 The U.S.

Ransomware 59

Ransomware Governance Compliance HIPAA 59

Hall Render

FEBRUARY 10, 2023

North Carolina legislators are considering a Medicaid expansion bill that includes a repeal of its CON law. Higher interest rates have resulted in fewer government and non-profit health care providers going to market to place debt. Hall Render blog posts and articles are intended for informational purposes only.

Medicaid 40

Medicaid Medicaid Hospitals Governance 40

Verisys

OCTOBER 8, 2024

Additional Gateway Profile information can be located on the Alabama Board of Pharmacy website under each license type. These rules and regulations govern the process for the safe provision of regulated natural medicine services. PA HB 2560 Disclaimer: This information has been gathered from a variety of sources.

Regulatory Compliance 52

Regulatory Compliance Compliance Licensing Medicaid 52

Hall Render

JUNE 20, 2022

Is housing health care and should Medicaid pay the rent? States are using Medicaid programs to cover rent, security deposits and furniture per The New York Times. State and local governments are stepping up to save facilities on the brink of closure. Senior housing facilities continue to struggle financially.

Medicaid 40

Medicaid Medicaid Hospitals Nurses 40

Healthcare It News

OCTOBER 25, 2022

"We have expanded access to care and kept people safe with telehealth services," said Tom Leary, senior vice president and head of government relations at HIMSS. has the highest maternal mortality rate when compared with other countries with similar wealth.

COVID-19 243

COVID-19 Medicaid Medicaid Public Health 243

Verisys

FEBRUARY 14, 2024

Governance, Risk Management, and Compliance (GRC) in healthcare is an integrated approach that helps healthcare organizations manage their overall governance, enterprise risk management, and comply with regulatory requirements in a cohesive and aligned manner. What is healthcare data governance? What is GRC in Healthcare?

Governance 52

Governance Compliance Regulatory Compliance Compliance Framework 52

HIT Consultant

JULY 17, 2023

Cessation of PHE telehealth, prescribing, and mental health access exceptions could impact the Medicaid population the most. Twenty-one percent of Medicaid enrollees have mild, moderate, or severe SUD, compared to 16% of commercially insured individuals. And as of the latest data, 7.3% And as of the latest data, 7.3%

Public Health 98

Public Health Medicaid Medicaid Electronic Medical Records 98