Compliancy Group

FEBRUARY 12, 2025

Using the ICPG to Maintain an Effective Compliance Program The Centers for Medicare & Medicaid Services (CMS) has issued participation requirements for nursing facilities in the Medicare and Medicaid programs (Requirements of Participation or ROPs). The ICP covers the areas listed below.

Nurses 52

Nurses Compliance Medicare Medicare 52

Modern Healthcare

APRIL 10, 2023

The fiscal 2024 Medicare inpatient prospective payment system proposed rule from the Centers for Medicare and Medicaid Services also includes new safety and health equity provisions.

Payment Systems 86

Payment Systems Hospitals Medicare Medicare 86

Medisys Compliance

JULY 19, 2024

Introduction The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. Expanded Telehealth Services One of the most notable changes in Medicare/Medicaid billing for behavioral health is the expanded coverage for telehealth services.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HealthIT Answers

OCTOBER 30, 2023

Deadlines: The Centers for Medicare & Medicaid Services would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines: The post Upcoming MIPS Important Dates and Deadlines appeared first on Health IT Answers.

Payment Systems 69

Payment Systems Medicaid Medicaid Medicare 69

Healthcare IT News - Telehealth

SEPTEMBER 25, 2020

The American Telemedicine Association was among several groups this week that submitted comments to the Centers for Medicare and Medicaid Services regarding the 2021 Physician Fee Schedule proposed rule. THE LARGER TREND.

COVID-19 146

COVID-19 Telemedicine Medicare Medicare 146

HealthIT Answers

JANUARY 16, 2025

The Centers for Medicare & Medicaid Services has posted new 2025 Merit-based Incentive Payment System (MIPS) resources to the QPP Resource Library. The post Now Available: 2025 MIPS Resources appeared first on Health IT Answers.

Payment Systems 59

Payment Systems Medicaid Medicaid Medicare 59

Electronic Health Reporter

JANUARY 15, 2019

The 340B Drug Pricing Program was created in 1992 to give safety net providers — those that deliver a significant level of both healthcare and other health-related services to the uninsured, Medicaid, and other vulnerable populations — discounts on outpatient drugs to “stretch scare federal resources as […].

Medicaid 107

Medicaid Medicaid Payment Systems Medicare 107

HealthIT Answers

JANUARY 31, 2024

The Centers for Medicare & Medicaid Services opened data submission for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2023 performance year of the Quality Payment Program. Data can be submitted and updated until 8:00 p.m. ET on April 1, 2024.

Payment Systems 59

Payment Systems Medicaid Medicaid Medicare 59

HIT Consultant

OCTOBER 30, 2023

The impact on eligible hospitals would be the loss of 75 percent of the annual market basket increase; for CAHs, payment would be reduced to 100 percent of reasonable costs instead of 101 percent.

Medicare 98

Medicare Medicare Payment Systems Hospitals 98

HealthIT Answers

DECEMBER 16, 2022

The Centers for Medicare & Medicaid Services would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines: The post Reminder: Upcoming MIPS Important Dates and Deadlines appeared first on Health IT Answers.

Payment Systems 52

Payment Systems Medicaid Medicaid Medicare 52

HealthIT Answers

OCTOBER 3, 2022

The Centers for Medicare & Medicaid Services would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines in 2022. The post Upcoming MIPS Important Dates and Deadlines appeared first on Health IT Answers.

Payment Systems 52

Payment Systems Medicaid Medicaid Medicare 52

Healthcare IT Today

JANUARY 8, 2025

Outsourcing will pivot to a more surgical, targeted strategy, focusing on high-impact, specialized areas like revenue integrity, underpayment recovery, and the more commonplace out-of-state Medicaid and small balance recovery work where RCM outsourcing supplements streamlined, automation-empowered teams instead of replacing them.

Hospitals 87

Hospitals Payment Systems Licensing Medicaid 87

HealthIT Answers

NOVEMBER 11, 2022

Centers for Medicare & Medicaid Services has issued final rules on the 2023 Physician Fee Schedule and the 2023 End-Stage Renal Disease Prospective Payment System. They include updates and policy changes that will take effect January 1.

Payment Systems 52

Payment Systems Medicaid Medicaid Medicare 52

Healthcare IT Today

DECEMBER 31, 2020

To further support clinicians during the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) has extended the deadline for COVID-19 related 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception applications to February 1, 2021.

COVID-19 52

COVID-19 Payment Systems Medicaid Medicaid 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

Healthcare IT Today

SEPTEMBER 19, 2024

However, the Centers for Medicare and Medicaid Services (CMS) took an important step to accelerate the adoption of the model in the U.S. where healthcare systems have traditionally operated under a fee-for-service framework, there’s a growing interest in exploring and implementing value-based care models. In the U.S.,

Hospitals 96

Hospitals Governance Telemedicine Payment Systems 96

Medisys Compliance

FEBRUARY 9, 2024

Hospital Outpatient Prospective Payment System (OPPS) Updates OPPS is a payment system used by Medicare to reimburse hospitals for outpatient services, including some wound care procedures. The Centers for Medicare & Medicaid Services (CMS) issues annual updates to the OPPS payment rates and co-payment amounts.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Payment Systems Medical Billing Medicare 59

Medisys Compliance

APRIL 25, 2024

MACRA replaced the previously used Sustainable Growth Rate (SGR) formula for Medicare physician payments. Advanced Alternative Payment Models (APMs): These models encourage collaboration between providers and offer the potential for higher shared savings if specific quality and cost goals are met.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Medicare Medicare 64

Healthcare IT Today

NOVEMBER 12, 2023

Health Payment Systems selected Madaket Health to manage its provider directory and roster requirements for No Surprises Act compliance. Community care provider Wider Circle tapped ApolloMed to support Enhanced Care Management for Medicaid members in California.

Public Health 94

Public Health Payment Systems Medicare Medicare 94

Medisys Compliance

AUGUST 4, 2022

Proposed ESRD Payment System. This rule also proposes an update to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year (CY) 2023. Direct nursing services include registered nurses, licensed practical nurses, technicians, social workers, and dietitian.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Payment Systems Medicare 59

Hall Render

MARCH 4, 2025

SNF services covered by the Medicare Part A Skilled Nursing Prospective Payment System (PPS) payment are not designated health services (DHS) for purposes of the PSL. Nursing Facility ICPG and Physician Self-Referral Law The federal physician self-referral law (PSL) at Section 1877 of the Social Security Act , 42 U.S.C.

Compliance 52

Compliance Nursing Homes Nurses Medicare 52

HIT Consultant

APRIL 21, 2022

What You Should Know: – Centers for Medicare & Medicaid Services’ (CMS) payment adjustments did not adequately address hospitals increased costs for FY 2021, according to new data from Premier. 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

The Health Law Firm

AUGUST 30, 2013

Board Certified by The Florida Bar in Health Law On August 2, 2013, the Centers for Medicare and Medicaid Services (CMS) released the 2014 Inpatient Prospective Payment System (IPPS) Final Rule (the 2014 IPPS Final Rule). Leider, J.D., The Health Law Firm and George F. Indest III, J.D.,

Hospitals 40

Hospitals Payment Systems Medicaid Medicaid 40

Medisys Compliance

APRIL 18, 2022

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. Many states are taking advantage of Medicaid program flexibility and federal financing to implement APMs in a variety of ways. Types of Alternative Payment Models.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

Healthcare Law Blog

FEBRUARY 1, 2023

On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). One thing that is certain, CMS can expect further challenges to its RADV audit methodology. See also Ratanasen v.

Medicare 105

Medicare Medicare Overpayments Overpayment 105

Hall Render

JULY 7, 2022

On June 30, 2022, the Centers for Medicare & Medicaid Services (“CMS”) released proposed regulations (“Proposed Rule”) addressing the Conditions of Participation (“CoPs”) that a provider will need to meet to qualify as an REH. This facility payment will be adjusted each year by the annual hospital market basket update factor.

Hospitals 70

Hospitals Payment Systems Medicare Medicare 70

HIT Consultant

JULY 25, 2024

What You Should Know: – Avenda Health , a pioneer in AI-powered prostate cancer care, announced today that the Centers for Medicare & Medicaid Services (CMS) has assigned a national payment rate for its prostate cancer mapping technology, Unfold AI.

Medicare 52

Medicare Medicare Payment Systems Medicaid 52

Medisys Compliance

APRIL 11, 2024

However, it’s important to note that MFT and MHC services furnished to residents of skilled nursing facilities (SNFs) remain subject to consolidated billing under the SNF prospective payment system (PPS). Telehealth Considerations Telehealth has become an increasingly important aspect of mental healthcare delivery.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Healthcare IT Today

MARCH 12, 2023

Health Payment Systems announced that PayMedix increases cash yield for healthcare organizations as much as 9.5%. Maryland HIE CRISP is expanding availability of its Medicaid Redetermination Notification project to all interested providers in the state. Higher education virtual health platform Timely MD ranked No.

Telemedicine 75

Telemedicine Medicaid Medicaid Payment Systems 75

Healthcare IT Today

AUGUST 13, 2023

Practice management vendor Practice Better launched Practice Better Payments , a fully integrated payment system. Sales The Iowa Department of Health and Human Services chose HHS Technology Group and Noridian Healthcare Solutions to build its Medicaid provider management system.

US Department of Health and Human Services 75

US Department of Health and Human Services Doctors Telemedicine Payment Systems 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

Healthcare IT Today

NOVEMBER 15, 2023

The technique involves finding data from public sources such as Centers for Medicare & Medicaid Services (CMS). 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. offering in-home treatment.

Medicare 120

Medicare Medicare Hospitals Compliance 120

HIT Consultant

NOVEMBER 2, 2021

In 2010, the Affordable Care Act ushered in a new era for Medicaid Modularity, an approach anchored by breaking down large, monolith systems into smaller, more nimble and self-contained modules that can de-risk healthcare delivery and unlock innovation. Prior to SAS, he was the Chief Information Officer of Arkansas Medicaid.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

C&M Health Law

DECEMBER 23, 2022

The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). Most of the Proposed Rule’s provisions will be effective on January 1, 2026. Our initial takeaways are summarized below.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

HIT Consultant

JULY 15, 2024

– The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining changes to Medicare payments under the Physician Fee Schedule (PFS) for services furnished and other Medicare Part B issues on or after January 1, 2025. RFI on additional payment policies recognizing advanced primary care services.

Medicare 52

Medicare Medicare Payment Systems Medicaid 52

AIHC

JANUARY 28, 2022

Medicare Uncompensated Care Payments & DSH Hospitals' charity care and bad debt, together known as uncompensated care, is used to calculate disproportionate-share hospital payments. LTCHs are paid under the Long-Term Care Hospital Prospective Payment System (LTCH PPS).

Medicare 40

Medicare Medicare Hospitals Payment Systems 40

YouCompli

FEBRUARY 22, 2023

Price increases can sometimes result in inappropriate outlier payments. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS).

Compliance 52

Compliance US Department of Health and Human Services Overpayment Overpayments 52