Verisys

OCTOBER 8, 2024

– The best resource for monthly healthcare regulatory compliance updates. Compliance Updates: October 2024 Overlook: Licensure Compacts Other Legislation Board Updates Interstate Medical Licensure Compact (IMLC): Pennsylvania has reached a partial implementation of the Interstate Medical Licensure Compact.

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Regulatory Compliance Compliance Licensing Medicaid 52

Compliancy Group

JANUARY 23, 2025

billion in recuperated funds account for federal losses, many cases also involved Medicaid losses at the state level, in which the federal government was instrumental in aiding recovery efforts. Compliancy Group supports healthcare organizations through robust regulatory compliance training and incident reporting tools.

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MedTrainer

JULY 11, 2024

Maintaining regulatory compliance has never been easy, and the pace of change isn’t slowing. In this article, I will share the impact of change on regulatory compliance and a few strategies to reduce disruption. Let’s start by defining regulatory compliance. What Is Regulatory Compliance?

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Compliancy Group

MARCH 19, 2024

Regulatory compliance in healthcare ensures quality care for patients. In this blog, we’ll outline the fundamentals and importance of regulatory compliance in healthcare in the U.S. What Does Regulatory Compliance in Healthcare Involve? name, phone number).

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Regulatory Compliance Compliance US Department of Health and Human Services ACA 52

HIT Consultant

FEBRUARY 7, 2025

Industry Leadership & Adoption: Edifecs’ solutions are trusted by 24 of the top 25 commercial health plans, 32 of the 51 Medicaid programs, and six of the ten largest health systems in the country.

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Regulatory Compliance Compliance Governance Medicaid 52

Medisys Compliance

MARCH 19, 2025

Common challenges such as complicated coding guidelines, the diverse rules set by different payers, and stringent regulatory compliance often lead to billing errors, claim denials, and ultimately, revenue loss. Medicaid: Medicaid billing often involves navigating state-specific rules and regulations, which can add complexity.

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American Medical Compliance

MARCH 6, 2025

Fraud, Waste, and Abuse (FWA) remain critical challenges in the healthcare industry, impacting patient care, financial integrity, and regulatory compliance. It strictly prohibits intentional payments – whether monetary or in-kind – in exchange for referrals or securing business under programs like Medicare and Medicaid.

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Fraud Medicare Medicare Compliance 52

HIT Consultant

OCTOBER 15, 2024

Recent data from the Centers for Medicare & Medicaid Services (CMS) indicates that patients treated at home experience lower mortality rates and fewer complications compared to those receiving traditional inpatient care. Global Reach and Regulatory Compliance Vivalink supports HaH programs not only in the U.S.

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Hospitals Patient Satisfaction Regulatory Compliance FDA 98

HIT Consultant

FEBRUARY 9, 2023

Czekai, MPH, VP of Strategic Partnerships at Cohere Health The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. LinkedIn – [link].

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HIT Consultant

JANUARY 19, 2025

Technology is changing the game by offering innovative means to address the challenges of content management, quality assurance, regulatory compliance, translation and beyond.

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Medicare Medicare Due Diligence Regulatory Compliance 52

Medisys Compliance

APRIL 8, 2025

Experience with Insurance Companies and Credentialing: A reliable billing partner should have experience working with Medicare, Medicaid, and commercial insurance payers. Conclusion Psychiatric billing services are essential for ensuring accurate claims processing, timely reimbursements, and regulatory compliance.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Compliance HIPAA 59

Verisys

MARCH 6, 2025

Supporting Healthcare Compliance Healthcare facilities must comply with a myriad of legal and regulatory standards set by accreditation bodies that oversee general medical practices, including the maintenance of quality provider data.

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Compliance Licensing Doctors Malpractice 52

Healthcare IT Today

FEBRUARY 26, 2025

Perhaps most concerning is that between 25% and 33% of out-of-state Medicaid claims are never filed due to enrollment complications. Regulatory compliance represents a third crucial area where collaboration delivers significant value.

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Regulatory Compliance Compliance Hospitals Medicaid 52

Verisys

MARCH 6, 2025

Further, the failure of a hospital to verify a practitioners qualifications can have a direct impact on patient safety, regulatory compliance, and the operational success of healthcare organizations. Why Provider Credentialing Matters Without proper credentials, healthcare workers cannot practice in their field.

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Verisys

APRIL 3, 2025

As a centralized hub of critical practitioner data, the NPDB serves as a powerful ally in provider credentialing , helping hospitals, medical boards, and institutions verify backgrounds, track malpractice claims, and ensure regulatory compliance. What Is the National Practitioner Data Bank (NPDB)?

Malpractice 52

Malpractice Licensing Compliance Hospitals 52

AIHC

APRIL 22, 2025

When individuals report unsafe care, fraudulent billing, privacy violations, or ethical concerns, they help ensure accountability, uphold regulatory compliance, and safeguard patient welfare.

Compliance 52

Compliance HIPAA Compliance Officers Fraud 52

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

MedTrainer

JANUARY 21, 2025

Understanding the OIG Exclusion List The OIG maintains the List of Excluded Individuals/Entities (LEIE), which provides comprehensive information to the healthcare industry on those currently excluded from participating in Medicare, Medicaid, and any other federal healthcare programs.

Compliance 52

Compliance Fraud Regulatory Compliance Medicare 52

Healthcare Blog

JANUARY 19, 2025

However, the success of swing bed programs hinges on strict adherence to Medicare Swing Bed Rules , a set of regulations established by the Centers for Medicare & Medicaid Services (CMS) to ensure compliance and optimize patient care. As CMS regulations evolve, staying ahead of compliance requirements will be crucial.

Medicare 52

Medicare Medicare Compliance Nurses 52

Medisys Compliance

APRIL 8, 2025

Key Guidelines for Laboratory Coding Accurate laboratory coding requires adherence to specific guidelines from various regulatory bodies and payers. CMS Guidelines The Centers for Medicare & Medicaid Services (CMS) plays a significant role in laboratory billing.

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Medical Billing Outsourcing COVID-19 Medical Billing Medicare 52

MedTrainer

JULY 29, 2024

These tools make it easier for healthcare organizations to maintain a culture of compliance, adapt to evolving industry standards, and ensure that all staff members are consistently informed and compliant. Corporate Compliance vs. Regulatory Compliance Corporate compliance and regulatory compliance are not the same thing.

Compliance 52

Compliance US Department of Health and Human Services Regulatory Compliance Compliance Officers 52

HIT Consultant

AUGUST 3, 2022

Medicaid reimbursement, which comprises the largest share of nursing home reimbursement, has not kept pace, resulting in SNFs and medical providers assuming the burden of those costs. . A Regulatory compliance and survey process both distract and often assault a beaten-up staff and push people out of service to the facilities.

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Nursing Homes Nurses COVID-19 Medicaid 98

Physician Credentialing Company

DECEMBER 20, 2024

In case of suspicion of non-compliance, claims can be rejected, and even healthcare facilities may have serious implications. Medicare and Medicaid allow non-credentialed providers to get reimbursement but under strict rules. These are true examples that show the importance of regulatory compliance.

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 52

Verisys

NOVEMBER 30, 2022

Maintaining compliance and safeguarding against fraud and abuse in today’s changing healthcare landscape can be challenging. organizations that receive any funds from Medicare, Medicaid, TRICARE, or other federal programs cannot afford to employ individuals or entities excluded from even one program. 38 Medicaid Sanctions.

Medicare 52

Medicare Medicare Regulatory Compliance Medicaid 52

Verisys

FEBRUARY 3, 2025

Ensuring compliance with healthcare regulatory compliance standards is essential to maintaining operational efficiency and delivering quality care. This includes verifying qualifications, submitting proof of malpractice insurance , and ensuring compliance with all healthcare regulatory compliance standards.

Malpractice 52

Malpractice Regulatory Compliance Licensing Compliance 52

Verisys

APRIL 1, 2025

When the Centers for Medicare and Medicaid Services ( CMS ) Medicare Preclusion List went into effect in 2019, it added restrictions on Medicare payments to certain providers. If someone is enrolled in both Medicare and Medicaid and sees a precluded provider, who is responsible for payment? What is the CMS Preclusion List?

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Medicare Medicare Medicaid Medicaid 52

MedTrainer

AUGUST 30, 2023

Medicaid Managed Care. Some state Medicaid programs contract with managed care organizations to provide healthcare services to eligible beneficiaries. These plans follow managed care principles to control costs and improve care coordination for Medicaid recipients.

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Compliance Regulatory Compliance Medicaid Medicaid 52

Provider Trust

OCTOBER 29, 2024

“Our joint solution will also drive even greater efficiencies for provider groups, while further reducing administrative costs and significantly improving turnaround times.” About ProviderTrust ProviderTrust was founded in 2010 with a mission to create safer healthcare for everyone through OIG and state Medicaid exclusion monitoring.

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Regulatory Compliance Licensing Medicaid Medicaid 52

Innovaare Compliance

JUNE 8, 2023

The Centers for Medicare & Medicaid Services (CMS) has released new audit protocol changes for Medicare and Medicaid plans. These changes are significant and will have a major impact on Medicare and Medicaid plans. Increased use of data analytics: CMS will be using data analytics more extensively in its audits.

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Healthcare IT Today

JUNE 7, 2023

However, it seems that the protracted regulatory promulgation process that preceded the publication of HTI-1 was not used by ONC to push back various deadlines originally included in the proposed rule, resulting in suggested timelines that would be insufficient to complete sizable development work.

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Verisys

JANUARY 8, 2024

This type of audit is essential in the healthcare industry for several reasons: Regulatory Compliance It ensures that the healthcare organization complies with various federal and state laws and regulations. Compliance with state-specific healthcare laws and regulations is also assessed.

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Compliance Regulatory Compliance Health Insurance Medicaid 52

Total Medical ComplianceHIPAA

JANUARY 11, 2024

These screenings search through various databases containing records of individuals or organizations barred from participating in Medicaid, Medicare, or other federal/state healthcare programs due to fraud, abuse, or other offenses. Why is Sanction Screening Vital Under HIPAA?

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HIPAA Malpractice Regulatory Compliance Compliance 52

Compliancy Group

JANUARY 17, 2024

The OIG Work Plan, sometimes referred to as “the Work Plan” or “the Plan,” is an essential tool in securing and maintaining healthcare regulatory compliance for patient safety, privacy, and quality care.

US Department of Health and Human Services 52

US Department of Health and Human Services Regulatory Compliance Compliance Regulations Compliance 52

Innovaare Compliance

APRIL 29, 2022

The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of program audits in February 2022. Multiple Medicare Advantage Prescription Drug Plans (MAPDs) have already received notification of their selection. CMS anticipates a total of 25 plan organizations to be audited in this cycle.

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Regulatory Compliance Medicare Medicare Compliance 52

Medisys Compliance

MARCH 7, 2024

Our team of experienced professionals utilizes cutting-edge technology and industry expertise to streamline processes, maximize reimbursements, and ensure regulatory compliance. MDS offers comprehensive billing solutions tailored to meet the unique needs of each client.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Regulatory Compliance COVID-19 59

HIT Consultant

JULY 24, 2024

The company’s AI practices are guided by standards from the Centers for Medicare & Medicaid Services (CMS) and the National Institutes of Standards and Technology (NIST).

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Regulatory Compliance Compliance Officers Compliance Medicaid 52

Healthcare Blog

AUGUST 23, 2023

Strategies Healthcare Organizations Can Use to Promote Ethical Behavior in Compliance Ensuring ethical practices in healthcare compliance is essential to corporate health and the integrity of your organization. Use the following strategies to promote ethical behavior in regulatory compliance. 2022, December 5).

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