Fierce Healthcare

JULY 31, 2023

The federal government is seeking to improve quality of life for both people with dementia and their caregivers through a new model called Guiding an Improved Dementia Experience, or GUIDE. | CMS and HHS will test an alternative payment system for individuals with dementia to better assist patients and caregivers.

Payment Systems 52

Payment Systems Governance 52

Healthcare IT Today

SEPTEMBER 19, 2024

However, alongside technological advancements, government support, the transition to value-based care, and effective coordination among healthcare teams play equally important roles in the widespread adoption of HaH initiatives. In the U.S.,

Hospitals 99

Hospitals Governance Telemedicine Payment Systems 99

HIT Consultant

MARCH 30, 2023

The chain integrates seamlessly with the broader Solve.Care ecosystem and adds to the full-stack digital healthcare platform that simplifies the healthcare experience for all stakeholders which include individuals and families, doctors and care providers, employers, insurance providers, government agencies, and more.

Payment Systems 96

Payment Systems Compliance Licensing Doctors 96

Symplr

JUNE 5, 2023

As the backbone of health care documentation and payment systems, this is a critical thing to get right. Healthcare is a highly regulated industry and there are multiple code sets that are under the purview of different government agencies. Old codes are deleted or replaced. And, code descriptors are revised.

Payment Systems 52

Payment Systems Governance Compliance 52

Medisys Compliance

MARCH 14, 2023

Wound Care Reimbursements in Various Healthcare Settings Inpatient Hospital Wound care in an inpatient hospital setting is reimbursed through the Diagnosis-Related Group (DRG) payment system. The MPFS is a payment system that reimburses healthcare providers for services rendered to Medicare patients in an outpatient setting.

Payment Systems 52

Payment Systems Medical Billing Medicare Medicare 52

Electronic Health Reporter

MAY 17, 2018

Many government rules have been written to address the […]. Federal healthcare organizations, such as CMS, have spent billions of dollars over the years trying to bridge the gap between medical data and quality patient care with interoperability requirements and data integration, the mesh used to try and bridge the gap.

Governance 87

Governance Payment Systems Hospitals 87

YouCompli

FEBRUARY 22, 2023

This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). However, there are certain circumstances when Medicare, for example, will reimburse additional amounts beyond the prospective payment rate.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

HIT Consultant

OCTOBER 29, 2024

To rectify this, the Centers for Medicare & Medicaid Services (CMS) introduced the Inpatient Prospective Payment System. In the late 20th century, when the fee-for-service version of healthcare grew in popularity, inpatient costs started increasing. As efforts to control those prices ensued, yet other cost areas began to rise.

Payment Systems 98

Payment Systems Medicaid Medicaid Medicare 98

HIT Consultant

APRIL 21, 2022

. – The data CMS uses to account for real inflation in the cost of labor and other expenses is unlikely to reflect reality and produce an accurate payment update for the FY 2023 IPPS rule, due this spring. CMS is expected to release proposed rules for the Inpatient Prospective Payment System (IPPS). PINC AI™ Data Analysis.

Hospitals 52

Hospitals COVID-19 Payment Systems Medicaid 52

Healthcare IT Today

MAY 9, 2024

healthcare system does not provide universal coverage and there is a mix of publicly-financed government coverage and privately-financed health coverage. Some 40% of U.S. adults owe money related to medical or dental care.

Patient Satisfaction 84

Patient Satisfaction Payment Systems Compliance Governance 84

Health Populi

JULY 6, 2018

This report defines quality as, “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and consistent with current professional knowledge.”

Health Outcomes 83

Health Outcomes Doctors Payment Systems Governance 83

Healthcare IT Today

AUGUST 14, 2022

Health Payment Systems, Inc. Government service consultant Maximus named Jason Tone as Senior Vice President of Technology and Consulting Services for Healthcare. Social service platform Unite Us hired Raffaelle Breaks to serve as Chief Product Officer ; she previously led digital transformation efforts at American Express.

Nurses 84

Nurses COVID-19 Hospitals Payment Systems 84

Healthcare IT Today

NOVEMBER 15, 2023

Medicare launched a payment system for in-home treatment during the pandemic, and now more than 200 hospitals have been approved by Medicare for the service. Benefit use is defined by the Medicare Advantage programs to include their own benefits and benefits offered by government programs. offering in-home treatment.

Medicare 124

Medicare Medicare Hospitals Compliance 124

MedTrainer

JANUARY 12, 2024

Healthcare compliance is the process of following the laws, regulations, and ethical standards that govern the healthcare industry. Medicare and Medicaid (1960s): The introduction of government-funded healthcare programs brought about increased scrutiny and regulation. What is Healthcare Compliance?

Compliance 52

Compliance HIPAA Telemedicine ACA 52

Healthcare IT Today

OCTOBER 21, 2024

The following is a guest article by Ashay Thakur, VP of Data Strategy at Cedar Gate Technologies The traditional fee-for-service (FFS) payment model has dominated the healthcare industry’s payment systems for decades. About Ashay Thakur Ashay Thakur is the VP of Data Strategy at Cedar Gate Technologies.

Payment Systems 75

Payment Systems HIPAA Governance Hospitals 75

HIT Consultant

AUGUST 28, 2023

When you join two businesses that have different payment systems and procedures in place, and different staffs for overseeing them, you’re likely to experience disruptions and struggle to keep AP efficient. But mergers and acquisitions can lead to major headaches for AP processes.

Payment Systems 103

Payment Systems Compliance Medicaid Medicaid 103

AIHC

NOVEMBER 15, 2022

The government expects hospitals to be compliant as there has been ample time to prepare for its implementation and to comply with the requirements. In 2019, the federal government finalized a rule requiring hospitals to disclose the prices they negotiate with insurers. How is the Government Monitoring for Noncompliance?

Hospitals 52

Hospitals US Department of Health and Human Services Compliance Governance 52

Health Law Attorney

DECEMBER 18, 2020

The Centers for Medicaid & Medicare Services ( CMS ) recently released the 2021 Outpatient Prospective Payment System ( OPPS ) and Ambulatory Surgical Center ( ASC ) Final Rule, which may be accessed here. CMS Administrator Seema Verma indicated there would be less micromanagement from the government regarding such decisions.

Medicare 40

Medicare Medicare COVID-19 Payment Systems 40

Hall Render

NOVEMBER 14, 2024

The governing body is responsible for assuring that this is done as part of their oversight responsibilities set forth in 42 CFR § 484.105(a). HHAs are already required by 42 CFR § 484.105 to document, in writing, the services that they furnish. 100–07), as needed.

Payment Systems 40

Payment Systems Medicare Medicare Medicaid 40

Compliancy Group

JUNE 28, 2024

These disincentives withhold money that a provider might have earned under certain federal government incentive or “bonus” programs. For CAHs, payment will be reduced to 100 percent of reasonable costs instead of 101 percent. The 2024 rule provides a different penalty for provider information blocking.

Medicare 59

Medicare Medicare Hospitals HIPAA 59

CMS.gov

OCTOBER 2, 2018

However, while medical technology is developing at a rapid pace, Medicare’s payment systems haven’t always been as quick to change. It’s no secret that the government often moves more slowly than private industry — some of our payment policies haven’t been updated in decades.

Medicare 44

Medicare Medicare Payment Systems FDA 44

The Digital Health Corner

APRIL 28, 2017

This type of payment system shifts the ROI of digital technology from one based on revenue generation to cost savings. In fact arguments for consolidation are based on the promise of improved cheaper care. This has yet to be demonstrated (in healthcare or any other industry).

Hospitals 60

Hospitals ACA Patient Satisfaction Payment Systems 60

Medisys Compliance

JUNE 20, 2022

If a patient receiving home infusion therapy is also under a home health plan of care and receives a visit that is unrelated to the administration of the home infusion drug, then payment for the home health visit would be covered under the Home Health Prospective Payment System (HH PPS) and billed on the home health claim.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Redox

DECEMBER 4, 2020

Immunization information systems (IIS) have received special focus as part of government health initiatives (Meaningful Use 1 and 2), so every state has one or more: More accurate information about the number of distinct IIS in the US: [link] — Lisa Bari (she/her/hers) (@lisabari) November 17, 2020. Return of the MU).

Public Health 52

Public Health Governance Doctors Medicare 52

C&M Health Law

AUGUST 3, 2023

According to the OIG, actors accepted by OIG into the SDP who cooperate with OIG during the self-disclosure process will pay lower damages than would normally be required in resolving a government-initiated investigation.

Fraud 52

Fraud HIPAA Governance Compliance 52

AIHC

NOVEMBER 29, 2023

In 1983 Medicare shifted to the inpatient Prospective Payment System (PPS) and DRGs (Diagnostic Related Groups) and only paying a limited number of days to the hospital regardless of the actual length of stay. These different Acts initiated the testing of alternate forms of delivering care and payment methodologies.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare IT Today

JUNE 29, 2023

Medicare Payment Resources CMS implemented an Ambulatory Payment Classification-based payment methodology in 2008. Visit the Medicare payment resources page on the ASCA website to learn about the changes that CMS has made to the payment system and ensure that your ASC is paid appropriately.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

Redox

OCTOBER 12, 2023

Primarily, CMS covers AI reimbursement with AI-specific Current Procedural Terminology (CPT) codes created by the American Medical Association CPT Editorial Panel or by establishing New Technology Add-on Payments (NTAPs) for AI devices.

FDA 69

FDA Medicare Medicare Hospitals 69

Health Blawg

JANUARY 16, 2019

Remember, this is the federal government, so getting almost halfway through the throat-clearing phase of fleshing out an idea in about six months or so really is a sprint.) healthcare “system.” Hey, coordinated care is a good idea. ” (Let’s just say here that the jury is still out. We can all agree on that.

HIPAA 60

HIPAA Fraud Governance Payment Systems 60

Health Blawg

JANUARY 16, 2019

Remember, this is the federal government, so getting almost halfway through the throat-clearing phase of fleshing out an idea in about six months or so really is a sprint.) healthcare “system.” Hey, coordinated care is a good idea. ” (Let’s just say here that the jury is still out. We can all agree on that.

HIPAA 60

HIPAA Fraud Governance Payment Systems 60

Health Care Law Brief

JULY 25, 2023

2] In addition to these priorities, OIG also explained how it “may evaluate allegations and prioritize investigations based in part on the volume of claims relating to the same (or similar) conduct by the same actor.” [3]

HIPAA 52

HIPAA Payment Systems Compliance Licensing 52

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment.

Medicare 52

Medicare Medicare Payment Systems Governance 52

AIHC

NOVEMBER 29, 2023

In 1983 Medicare shifted to the inpatient Prospective Payment System (PPS) and DRGs (Diagnostic Related Groups) and only paying a limited number of days to the hospital regardless of the actual length of stay. These different Acts initiated the testing of alternate forms of delivering care and payment methodologies.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Physician Credentialing Company

OCTOBER 25, 2024

Medicare and Medicaid may have different payment systems from those of the private health insurance plans. Session notes should be formed as per rules and regulations set by the government and payers. Appealing Denied Claims When an Insurance Claim is rejected, healthcare providers have the right to appeal.

Licensing 52

Licensing Medical Billing Telemedicine Medicare 52

Hall Render

NOVEMBER 25, 2024

The Nursing Facility ICPG provides that, even if an entity makes an isolated billing error, the entity still has an obligation to repay the overpayment to the government to avoid False Claims Act liability, as explained in the GCPG. It is intended only to assist nursing facilities in evaluating and mitigating their own particular risk areas.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

HIPAA Journal

MARCH 29, 2024

Department of State has confirmed that there is a reward of up to $10 million for information leading to the identification or location of any individual linked to the ALPHV/Blackcat ransomware group, their affiliates, or links to a foreign government under the Rewards for Justice (RFJ) program.

Ransomware 99

Ransomware US Department of Health and Human Services HIPAA Hospitals 99

Fierce Healthcare

JULY 6, 2023

Days after the Biden administration proposed hundreds of millions in 2024 pay cuts for home health providers, an industry association is suing the government over similar adjustments at the heart o | The National Association for Home Care and Hospice alleges that CMS "arbitrarily and capriciously" set payment adjustments in the Home Health (..)

Payment Systems 105

Payment Systems Medicare Medicare Governance 105