Compliancy Group

JANUARY 23, 2025

A classic example is Medicare fraud. Providers who bill Medicare for services they did not actually provide and who present the bill with the knowledge that the service was not performed have committed Medicare fraud. Medicare Advantage Matters Medicare Part C is the largest part of Medicare.

Fraud 98

Fraud Medicare Medicare Regulatory Compliance 98

Bill of Health

OCTOBER 19, 2023

The traditional model for post-graduate education for medical students, called residency, is regulated by the Accreditation Council for Graduate Medical Education ( ACGME ) and largely funded by the Center for Medicare Services (CMS). There is an urgent need for Congress to ensure this funding through the Center for Medicare Services.

Nurses 279

Nurses Medicare Medicare Medicaid 279

Healthcare It News

OCTOBER 31, 2022

" Since HL7 pledged to share the standards free of charge under licensing terms, many partnerships and collaborations with both public and private healthcare entities have bloomed.

Licensing 342

Licensing Medicaid Medicaid Health Outcomes 342

Healthcare IT News - Telehealth

APRIL 10, 2020

The Centers for Medicare and Medicaid Services has temporarily suspended several regulations to enable hospitals, clinics and other providers to boost their front-line medical staff during the coronavirus pandemic.

Nurses 216

Nurses Medicare Medicare Licensing 216

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.

Medicare 195

Medicare Medicare Medicaid Medicaid 195

Healthcare IT News - Telehealth

MARCH 18, 2020

On Tuesday, Centers for Medicare and Medicaid Services expanded its Medicare telehealth coverage during the COVID-19 pandemic to enable more patients to get virtual care services from their providers.

COVID-19 217

COVID-19 HIPAA Nursing Homes Medicare 217

Healthcare IT News - Telehealth

JANUARY 25, 2021

According to a press statement from Thompson's office, it would: Eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and establishing the patient’s home as an eligible distant site. This is a common-sense step to make sure our policies keep pace with our technology," he added.

COVID-19 216

COVID-19 Medicare Medicare Telemedicine 216

HIPAA Journal

MARCH 28, 2025

The exposed data included full names, dates of birth, health insurance information, Medicaid/Medicare numbers, and medical information such as medical record numbers, clinical information, provider information, diagnosis/treatment information, and/or prescription information.

Licensing 61

Licensing Health Insurance HIPAA Medicaid 61

Verisys

APRIL 8, 2025

At a minimum, FACIS Level 1M satisfies the requirements of the OIG and CMS (Centers for Medicare & Medicaid Services) by screening providers for exclusions, debarments, disciplinary actions , and related issues. The post What is FACIS? A Guide to the Fraud Abuse Control Information System appeared first on Verisys.

Fraud 52

Fraud Medicaid Medicaid Compliance 52

Healthcare IT News - Telehealth

SEPTEMBER 3, 2020

In his study, Auerswald found that labor market barriers to entry, such as licensing requirements, and technical barriers to entry, such as regulatory approvals and interoperability standards, constitute "the most significant barriers to entrepreneurial entry. But the details of telehealth reimbursement are still unknown.

Licensing 190

Licensing Medicare Medicare Governance 190

Healthcare IT News - Telehealth

APRIL 10, 2019

The illegal kickback scheme allegedly involved companies that received money in exchange for referral of Medicare beneficiaries by medical professionals for back, shoulder, wrist and knee braces that are medically unnecessary. billion in losses. ON THE RECORD. WHAT ELSE TO KNOW. billion in claims and were paid over $900 million.

Fraud 167

Fraud Telemedicine Medicare Medicare 167

Medisys Compliance

DECEMBER 24, 2024

Medicare Reimbursement Medicare covers teletherapy under specific guidelines: Eligible Providers: Includes licensed clinical social workers (LCSWs), clinical psychologists, and other licensed professionals. Understanding payer-specific policies is essential for timely reimbursement.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medicaid Medicaid Medical Billing 59

Verisys

APRIL 3, 2025

Licensure actions Disciplinary actions from state medical boards, like suspensions or revoked licenses. Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Civil judgments Lawsuits that reveal unethical behavior or misconduct.

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

Healthcare IT News - Telehealth

OCTOBER 5, 2022

how streamlined licensing and credentialing can help with the psychiatrist shortage. How can telehealth, combined with streamlined licensing and credentialing, help solve the nation's current psychiatrist shortage? Telehealth, however, does so directly and immediately. More than three-quarters of U.S.

Licensing 194

Licensing Telemedicine Nursing Homes Hospitals 194

Verisys

DECEMBER 29, 2024

Credentialing services perform this verification by contacting primary sources, such as medical schools and licensing boards, to confirm the physician’s education and qualifications. Without proper credentialing, physicians cannot apply for privileges, bill for services, or receive reimbursement from Medicare and other payers.

Malpractice 52

Malpractice Licensing Regulatory Compliance Hospitals 52

Healthcare IT News - Telehealth

JUNE 3, 2020

He noted the moves by the Centers for Medicare and Medicaid Services to reimburse providers for services and allow telehealth care between states , and the relaxed HIPAA regulations around technology use , as important contributors to the uptick in telehealth availability. Telehealth in the long term.

Telemedicine 213

Telemedicine COVID-19 HIPAA Medicare 213

Verisys

MARCH 6, 2025

The Centers for Medicare and Medicaid Services (CMS) Regulates reimbursement policies and ensures healthcare organizations adhere to the standards necessary to participate in federal healthcare programs. Imagine a healthcare system caught up in fraudulent billing, submitting false claims to Medicare. link] The HIPAA Journal.

Compliance 52

Compliance HIPAA Licensing Governance 52

Compliancy Group

APRIL 25, 2024

Maintaining Medicare compliance and avoiding legal and financial repercussions requires Medicare compliance training for employees at all organizational levels. Examples of Medicare fraud include billing for unrendered services and using a billing code or a service that’s more expensive than what a patient received.

Fraud 59

Fraud Medicare Medicare Compliance 59

Verisys

FEBRUARY 10, 2025

At Verisys, we specialize in credentialing and license monitoring , offering industry-leading data accuracy and real-time insights. Verisys Licensure : Comprehensive Credentialing & Monitoring Covers all license types across all U.S.

Licensing 40

Licensing Compliance Medicaid Medicaid 40

Healthcare IT News - Telehealth

JULY 28, 2020

More than 100 physician groups, led by the American Medical Association, told the Centers for Medicare and Medicaid Services in no uncertain terms this past week that, while they supported temporary regulatory relaxations in response to COVID-19, they were strongly opposed to certain rules changes being made permanent. WHY IT MATTERS.

COVID-19 202

COVID-19 Public Health Nurses Medicare 202

Verisys

MARCH 6, 2025

Credentialing involves a detailed review of a provider’s qualifications, including their: Education Work experience Certifications Licenses Professional standing This process ensures that patients see professionals who are properly trained and certified to provide the level of care they require.

Licensing 52

Licensing Compliance Nurses Malpractice 52

Healthcare IT News - Telehealth

SEPTEMBER 9, 2024

Meanwhile, the American Telemedicine Association is pleading with the Centers for Medicare and Medicaid Services for expanded flexibilities and further guidance on payment and coverage. Licenses that allowed physicians to practice across state lines and provided reimbursement parity due to the pandemic have now expired.

Telemedicine 188

Telemedicine Licensing Health Outcomes Governance 188

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

Medicare 52

Medicare Medicare Licensing Compliance 52

Healthcare IT News - Telehealth

OCTOBER 2, 2020

The simplification or alignment of provider licensing, credentialing and enrollment protocols with respect to telehealth across states, state Medicaid plans and Medicaid managed care organizations. Enable the HHS to expand telehealth in Medicare during all future emergencies and disasters; among other provisions. this summer.

US Department of Health and Human Services 167

US Department of Health and Human Services COVID-19 Medicaid Medicaid 167

Healthcare IT News - Telehealth

AUGUST 30, 2021

In 2017, the health system – which has 100 continuing care locations, including home care, hospice, PACE programs and senior living facilities – was in a bind, facing double-digit hospital readmissions of 16% across its high-risk Medicare population. THE PROBLEM. Trinity needed to reduce readmissions to single digits.

Patient Satisfaction 195

Patient Satisfaction Nurses Medicare Medicare 195

Medisys Compliance

DECEMBER 30, 2024

It is commonly used to treat: Depression Anxiety disorders Insomnia Post-traumatic stress disorder (PTSD) Obsessive-compulsive disorder (OCD) Chronic pain management Providers delivering CBT often include psychiatrists, psychologists, clinical social workers, and licensed therapists. Key Components of CBT Billing 1.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Medicare Medicare 59

Verisys

APRIL 3, 2025

In traditional credentialing, healthcare organizations manually collect and verify information from licensing boards, medical schools, and past employersa process that can take a significant amount of time to complete. Automated credentialing isnt just about cutting down paperworkits about getting qualified providers to patients faster.

Licensing 52

Licensing Malpractice Compliance Nurses 52

Healthcare IT News - Telehealth

DECEMBER 17, 2021

Department of Justice announced this past Friday that it had charged four people, one of whom is a licensed physician, in an international telehealth fraud and kickback scheme. WHY IT MATTERS.

Fraud 175

Fraud Telemedicine Nurses Licensing 175

HIPAA Journal

FEBRUARY 16, 2022

The system contained patients’ names, birth dates, insurance card numbers, driver’s license numbers, and copies of patients’ insurance cards and driver’s licenses. The attackers compromised FCHC’s old dental system which contained the PHI of patients who had received dental services prior to August 31, 2020.

Ransomware 130

Ransomware Hospitals Licensing HIPAA 130

Healthcare IT Today

NOVEMBER 22, 2022

The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. They also look to flag “items and services that have high national error rates and are a financial risk to Medicare.” Meanwhile, Medicare also has a Fee for Service Recovery Audit Program. Tricare and Medicare).

Overpayments 107

Overpayments Overpayment Medicare Medicare 107

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. He was also ordered to pay $557,000 in restitution to Indiana Medicaid and Medicare. As such, providers should prioritize billing compliance.

Fraud 40

Fraud Compliance Medicaid Medicaid 40

Verisys

APRIL 3, 2025

Data inaccuracies: A misspelled name, incorrect license number, or missing documentation might seem minor, but they can lead to license and certification rejections, compliance violations, and delayed insurance reimbursementspotentially causing financial and operational headaches.

US Department of Health and Human Services 52

US Department of Health and Human Services Licensing Compliance Malpractice 52

The Health Law Firm Blog

OCTOBER 5, 2023

Board Certified by The Florida Bar in Health Law Do you have a medical, pharmacist, counselor, or nursing license in more than one state? Do you have a license in more than one profession? By George F. Indest III, J.D., Have you been notified that an investigation has been opened against your professional [.]

Licensing 52

Licensing Nurses Medicaid Medicaid 52

Healthcare IT News - Telehealth

JUNE 5, 2020

In addition, the group called for lasting changes to an array of process rules that enable nurse practitioners and physician assistants to practice atop their license, with remote supervision, while physicians are freed up to care for the most acute patients. ON THE RECORD. " Twitter: @MikeMiliardHITN.

COVID-19 156

COVID-19 Licensing Public Health Nurses 156

MRO Compliance

JUNE 1, 2022

HEDIS (Healthcare Effectiveness and Data Information Set) is part of a review process for Medicare Advantage plan quality measures. Depending on the score of a health plan, payers may receive considerable Medicare financial incentives if a score exceeds a certain level. HEDIS audits are important for Medicare and Medicaid health plans.

Medicare 130

Medicare Medicare Compliance Medicaid 130

Healthcare IT News - Telehealth

SEPTEMBER 16, 2022

With the COVID-19 pandemic – especially thanks to an expansion of Medicare telehealth benefits during the public health emergency – driving increased use of virtual psychiatric care, many behavioral health providers ventured into telemedicine and onboarded digital telehealth platforms. " THE LARGER TREND.

COVID-19 166

COVID-19 HIPAA Telemedicine Licensing 166

Verisys

MARCH 6, 2025

For example, requiring all names to follow a “Last Name, First Name” format and license numbers to be entered uniformly can prevent mismatches.

Compliance 52

Compliance Licensing Doctors Malpractice 52