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

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

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

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

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

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By Hannah Rahim Many mental health provider directories for private and public insurance plans contain inaccurate or outdated provider information , which creates a misleading illusion of accessible care.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

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

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

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

Kaiser Health News

FEBRUARY 8, 2022

The federal government has penalized 764 hospitals — including more than three dozen it simultaneously rates as among the best in the country — for having the highest numbers of patient infections and potentially avoidable complications. The total amount of the penalties is determined by how much each hospital bills Medicare.

Medicare 128

Medicare Medicare Hospitals COVID-19 128

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. Budget leaders have asked, "How do you really know what the impact on the Medicare population and the Medicare Trust Fund will be?

Medicare 164

Medicare Medicare Governance Medicaid 164

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

HIPAA Journal

SEPTEMBER 29, 2022

The Government Accountability Office (GAO) recently conducted a review of Medicare telehealth services provided during the COVID-19 pandemic, when a waiver was in place that greatly expanded access to telehealth and virtual visits. Between April and December 2019, 5 million Medicare telehealth visits were conducted.

Medicare 74

Medicare Medicare COVID-19 HIPAA 74

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

HIT Consultant

OCTOBER 11, 2024

Neena Patel, MHA, CSM, VP of Client Success at Chordline As population health initiatives for Medicare and Medicaid members pick up steam, one of the biggest obstacles to care transformation remains a lack of trust among healthcare’s key stakeholders. Meanwhile, as the number of seniors aging into Medicare increases, the U.S.

Medicare 98

Medicare Medicare Health Outcomes Medicaid 98

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

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

Hall Render

NOVEMBER 17, 2023

The Centers for Medicare and Medicaid Services (“CMS”) Medicare Advantage final rule for 2024 (“Final Rule”) clarified that Medicare Advantage plans must adhere to the “two-midnight rule” when making coverage determinations for inpatient services. 1395w-22(a) ). d)(2) ).

Medicare 40

Medicare Medicare Hospitals 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. Two potential strategies for implementing these requirements include: 1.

HIPAA 132

HIPAA Compliance Public Health Medicaid 132

Medisys Compliance

JULY 13, 2023

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

Medicare 52

Medicare Medicare Medical Billing Outsourcing Health Outcomes 52

MedTrainer

JUNE 15, 2022

When changes are made to government regulations, they have far-reaching effects. This is the case for proposed changes to the Medicare Shared Savings Program, as they’ll impact ACOs in more ways than one if they’re enacted. Beyond just receiving better care, the ACO helps out Medicare beneficiaries in many other ways.

Medicare 52

Medicare Medicare Medicaid 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.,

Governance 105

Governance Medicaid Medicaid Medicare 105

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

AUGUST 6, 2023

Often, insurance or the government covers part of the healthcare costs, but if a patient doesn’t have healthcare coverage, they will be responsible to reimburse their providers for the entire cost of the care. They are no longer simply a place for aging Medicare and Medicaid patients to live out their final years.

Nursing Homes 98

Nursing Homes Nurses Medicare Medicare 98

Med-Net Compliance

SEPTEMBER 9, 2022

to resolve allegations that they submitted false claims to Medicare and Medicaid. The ophthalmologist was identified by HHS-OIG as one of the top outliers for billing the Medicare program across all medical specialists in West Virginia, far exceeding the average of Medicare claims submitted by his peers.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Medisys Compliance

MAY 20, 2024

Payer type: Private insurance companies, Medicare, and Medicaid have their own reimbursement structures. Payer Websites: Insurance companies and government agencies (Medicare, Medicaid) often publish reimbursement rates on their websites. Stay Informed: Reimbursement rates can change periodically.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Medicare 59

Kaiser Health News

NOVEMBER 11, 2021

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. “You’re not from Medicare,” Heimer told her.

Medicare 145

Medicare Medicare Doctors Fraud 145

Healthcare It News

OCTOBER 25, 2022

With those flexibilities due to sunset 151 days after the federal Public Health Emergency expires, HIMSS is calling on its members to contact their senators and representatives and urge them to extend coverage of telehealth services under Medicare until at least December 31, 2024.

COVID-19 243

COVID-19 Medicaid Medicaid Public Health 243

American Medical Compliance

JANUARY 9, 2024

When someone uses your personal information, such as your name, Social Security number, or Medicare number, to make false claims to Medicare and other health insurers without your consent, it is known as medical identity theft. Educating patients on how to reduce their overall risk helps protect their health information.

Fraud 52

Fraud Medicare Medicare Compliance 52

HIT Consultant

MAY 2, 2023

For decades, the industry lacked a patient-centric approach focused on efficiency, reliability, and accessibility for all populations, especially those enrolled in Medicare Advantage and Medicaid plans. In a recent study , 21% of U.S. adults without access to a vehicle or public transportation skipped needed medical care last year.

Medicaid 96

Medicaid Medicaid Medicare Medicare 96

Healthcare Compliance Blog

JANUARY 14, 2022

million to settle allegations that the company sold custom fabricated shoe inserts to Medicare recipients that did not meet Medicare standards. Custom shoe inserts for diabetic patients can be covered by Medicare and Medicaid. A Florida based diabetic shoe company has agreed to pay over $5.5

Medicare 59

Medicare Medicare Medicaid Medicaid 59

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”). CMS proposed extending enrollee advisory committee requirements to D-SNPs.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Provider Trust

JANUARY 25, 2024

Ensuring the Financial Integrity of HHS Programs In fiscal year (FY) 2022, improper payments within healthcare programs like Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) were estimated at a staggering $131.6 With Medicaid, the challenges are equally formidable.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare Compliance Blog

MARCH 2, 2022

The money laundering scheme involved the submission of false and fraudulent claims to Medicare for medically unnecessary genetic tests and durable medical equipment. Allegedly, between January 2020 and July 2021, the ten Florida defendants referred Medicare beneficiaries for medically unnecessary genetic tests and durable medical equipment.

Medicare 45

Medicare Medicare Fraud Compliance 45

Innovaare Compliance

MARCH 1, 2022

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare IT News - Telehealth

JULY 23, 2020

Without that kind of information, he said, "we're actually sort of groping in the dark." Wolf also pointed out that the recent bloom in telehealth is rooted, in part, in the government's electronic health record incentive program and meaningful use. " Rep. David Schweikert, R-Ariz., " she said.

COVID-19 188

COVID-19 Electronic Medical Records Medicare Medicare 188