Bill of Health

APRIL 13, 2022

The COVID-19 Public Health Emergency (PHE) expires at the end of this week, with Department of Health and Human Services (HHS) Secretary Xavier Becerra expected to renew the PHE once more to extend through mid-July. This policy improves coverage and helps reduce churn , which is associated with poor health outcomes.

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Medicaid Medicaid COVID-19 Public Health 147

Modern Healthcare

MARCH 31, 2023

The Centers for Medicare and Medicaid Services estimates health insurance companies will see a 3.32% increase in Medicare Advantage revenue next year.

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Medicare Medicare Health Insurance Medicaid 80

Bill of Health

JUNE 15, 2023

By Laura Dolbow Merck recently filed a lawsuit that challenges the constitutionality of the Medicare price negotiation program created by the Inflation Reduction Act. Merck argues that this form of price regulation charts a “ radical new course ” for Medicare that violates the Takings Clause of the Fifth Amendment.

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Medicare Medicare Medicaid Medicaid 195

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

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Medicaid Medicaid Compliance COVID-19 100

Compliance Now

AUGUST 10, 2023

As background, according to federal Health Insurance Portability and Accountability Act (HIPAA) rules, individuals have 60 days from losing CHIP and Medicaid eligibility to elect coverage under their group plan. The real potential of this number growing daily is what has prompted the Agencies to issue this “request.”

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Medicaid Medicaid Compliance COVID-19 100

HIT Consultant

NOVEMBER 8, 2021

Jessica Altman, Pennsylvania’s insurance commissioner sums it up well : “When we talk about bringing something back to state control, that is a real narrative that can appeal to both sides of the aisle. There is nothing political about making health insurance more affordable.”.

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Health Insurance Medicaid Medicaid Governance 98

Fierce Healthcare

APRIL 23, 2024

Medicaid managed care plans and the Children’s Health Insurance Program (CHIP) will be subject to new wait time standards and quality ratings requirements, the Centers for Medicare & Medicaid S | CMS defended implementing stronger rules over nursing home staffing as well as explained its thoughts behind Medicaid access and managed care rules.

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Nursing Homes Nurses Medicaid Medicaid 116

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.

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Medicaid Medicaid Ransomware Health Insurance 90

Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Fraud Medicare Medicare US Department of Health and Human Services 52

Kaiser Permanente

JANUARY 1, 2022

Medicaid and the Children’s Health Insurance Program (CHIP) have served as critical supports to children, pregnant women, parents, seniors, and individuals with disabilities – covering 80 million individuals during the COVID-19 pandemic. Since February 2020, Medicaid enrollment has grown sharply to cover an additional 9.9

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Medicaid Medicaid Medicare Medicare 92

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.

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Medicaid Medicaid Health Insurance COVID-19 64

Center for Health Insurance Reform

DECEMBER 6, 2023

This week, the Centers for Medicare & Medicaid Services (CMS) is spotlighting how the Marketplaces can serve LGBTQI+ individuals, a community that has historically faced discriminatory barriers to health insurance and health care.

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Health Insurance Medicaid Medicaid Medicare 98

Health Populi

JUNE 26, 2023

People love being health-insured, but their negative experiences with health plans create serious burdens on patients-as-consumers. The 2023 Kaiser Family Foundation Survey of Consumer Experiences with Health Insurance updates our understanding of and empathy for insured peoples’ Patient Administrative Burdens (PAB).

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Health Insurance Doctors COVID-19 Medical Billing 62

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”).

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Medicare Medicare COVID-19 Medicaid 98

Health Care Law Brief

FEBRUARY 2, 2024

While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5 billion in Medicaid investments over the next three years. Services will be delivered via a two-tiered system.

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Medicaid Medicaid Medicare Medicare 52

HIPAA Journal

AUGUST 10, 2023

Four more entities have confirmed they were affected by the mass hacks of the MOVEit Transfer file transfer solution and had protected health information stolen. It is currently unclear exactly how many Medicaid recipients were affected. The DSS said all Missouri Medicaid recipients are being notified about the breach as a precaution.

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Medicaid Medicaid Health Insurance HIPAA 52

Healthcare Law Blog

JANUARY 20, 2023

To add uniformity to this practice, CMS codified this flexibility in the 2016 Medicaid and Children’s Health Insurance Plan (CHIP) managed care final rule by authorizing coverage for “In Lieu of Service or Settings” (ILOS). [i] ILOSs must advance the objectives of the Medicaid program.

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Medicaid Medicaid Medicare Medicare 52

Center for Health Insurance Reform

MARCH 7, 2022

Health insurers reported healthy earnings during the fourth quarter of 2021, thanks in large part to publicly funded programs Medicare and Medicaid. CHIR's Megan Houston reviewed earnings reports for nine major insurers and reports on the key market trends in the health insurance industry.

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Governance Health Insurance Medicaid Medicaid 97

Healthcare It News

DECEMBER 16, 2022

The Medicaid and CHIP Access to Prescription Digital Therapeutics Act seeks to expand care options that can help improve health outcomes and quality of life for those facing barriers to healthcare. The act would also define "prescription digital therapeutic" in Medicaid and allow U.S. WHY IT MATTERS. THE LARGER TREND.

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Medicaid Medicaid COVID-19 Health Outcomes 192

Compliancy Group

MARCH 8, 2023

are missing out on most of these opportunities because their names are on the HHS OIG (Health and Human Services, Office of Inspector General) Medicare Exclusion List. How do people end up on the Medicaid Exclusion List, what are the consequences of being on the list, and can you ever get off the list?

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Medicare Medicare Fraud HIPAA 52

Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). This option is available for five years and ends on March 31, 2027.

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Medicaid Medicaid ACA Public Health 52

Bill of Health

OCTOBER 17, 2024

Finally, SB 1120 limits the degree to which health insurers can use AI to determine medical necessity for member health care services. SB 1223 amended the California Consumer Privacy Act of 2018 to include neural data as sensitive personal information, whose collection and use companies can be directed to limit.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

HIPAA Journal

NOVEMBER 12, 2024

The affected systems contained information such as names, addresses, dates of birth, billing and claims information, health insurance claims information, diagnoses, medications, test results, x-ray images, and other treatment information. Passwords were reset and policies and procedures have been reviewed.

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Health Insurance Fraud Licensing HIPAA 59

Health Law RX

FEBRUARY 21, 2024

The Centers for Medicare & Medicaid Services (CMS) has revised certain payment policies under the Medicare physician fee schedule, and updated provider and supplier enrollment regulations. CMS recently published a final rule (the Final Rule ) effective January 1, 2024.

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Medicare Medicare Licensing Compliance 52

Healthcare IT News - Telehealth

OCTOBER 21, 2020

Data released this past week from the Centers for Medicare and Medicaid Services show that more than 34.5 million services were delivered via telehealth in Medicare and in the Children's Health Insurance Program from March through June. As of June 2020, said CMS, more than 91.8 ON THE RECORD.

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Medicaid Medicaid Medicare Medicare 208

Bill of Health

MARCH 27, 2024

Billing medical insurance for Spravato involves codes for both drug delivery and supervision because treatment requires administration of the drug (using the intranasal spray) and a monitoring period of at least 2 hours at a certified treatment center. Spravato is covered by Medicare Part B , which pays 80% of expenses.

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FDA Medicare Medicare Health Insurance 203

MedTrainer

SEPTEMBER 20, 2023

This means your organization must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you want to obtain or retain CMS certification in order to be reimbursed by services provided to patients with a Medicare/Medicaid health plan, you must comply with HIPAA rules and regulations.

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Medicaid Medicaid Medicare Medicare 97

Health Populi

JUNE 18, 2021

with employer-sponsored health insurance worry that a major health event in their household could lead to bankruptcy, according to research gathered by West Health and Gallup in Business Speaks: The Future of Employer-Sponsored Insurance. Health Populi’s Hot Points: U.S. One-half of U.S.

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ACA Health Insurance Medicaid Medicaid 139

HIPAA Journal

APRIL 29, 2024

Berry, Dunn, McNeil & Parker, LLC (BerryDunn) provides health data analytics services to healthcare providers, health insurers, and government regulatory and healthcare policy agencies and its clients provide BerryDunn with personal and health data to allow the firm to perform its contracted services.

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Health Insurance Health Analytics HIPAA Medicaid 107

Center for Health Insurance Reform

MARCH 31, 2022

In the proposed Notice of Benefit and Payment Parameters for 2023, the Centers for Medicare & Medicaid Services asked for feedback on how to promote health equity through ACA marketplace operations and plan certification standards.

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ACA Health Insurance Medicaid Medicaid 94

Center for Health Insurance Reform

DECEMBER 19, 2022

On December 9, the Centers for Medicare and Medicaid Services announced the membership of the Advisory Committee on Ground Ambulance and Patient Billing, as required by the No Surprises Act (NSA).

Health Insurance 81

Health Insurance Medicaid Medicaid Medicare 81

The Health Law Firm Blog

APRIL 15, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

Physician Credentialing Company

SEPTEMBER 19, 2024

Therefore, it is necessary to verify the legitimacy of all providers’ credentials before enrolling them in health insurance plans. Some health insurance companies allow providers to bill on their NPI numbers under the supervision of senior physicians. How Long Does It Take To Get Credentialed With Medicare?

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Malpractice Medicare Medicare Medicaid 52

HIT Consultant

MARCH 8, 2022

The steep incline in unemployment and fears that millions of people would lose their health coverage drove the declaration of the national public health emergency (PHE) on January 31, 2020. Under the PHE, states must keep Medicaid enrollees continuously covered, irrespective of their circumstances. .

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Public Health Medicaid Medicaid COVID-19 98

The Health Law Firm Blog

MARCH 25, 2024

Board Certified by The Florida Bar in Health Law On February 16, 2024, a Parkland, Florida, man agreed to plead guilty to organizing a Medicare fraud scheme worth $110 million. By: George F. Indest III, J.D., The federal prosecution is taking place in the U.S. District Court for the District of Massachusetts.

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Fraud Medicare Medicare Telemedicine 52

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report.

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Medicare Medicare Licensing Health Insurance 52

HIPAA Journal

AUGUST 14, 2023

The Colorado Department of Health Care Policy and Financing , which oversees the state’s Medicaid program and the Child Health Plan Plus (CHP+) program, was also affected. The Indiana Family and Social Services Administration has recently confirmed that the state Medicaid enrollment broker, Maximus Health Services Inc.,

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Medicaid Medicaid HIPAA Health Insurance 86