HIT Consultant

JANUARY 19, 2025

For Medicare Advantage Organizations (MAOs), the summer months have historically been defined by the high stakes, tight turnarounds and document management challenges of the Annual Enrollment Period (AEP). Sohail Malik, VP, Healthcare Solutions, Messagepoint, Inc.

Medicare 52

Medicare Medicare Due Diligence Regulatory Compliance 52

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?

Regulatory Compliance 52

Regulatory Compliance Compliance Compliance Officers Hospitals 52

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).

Regulatory Compliance 52

Regulatory Compliance Compliance US Department of Health and Human Services ACA 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. Staying informed about payer-specific bulletins and updates is crucial for avoiding denials.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

McBrayer Law Blog

FEBRUARY 23, 2022

More > Tags: Audit , Centers for Medicare & Medicaid Services , CMS , COVID-19 , Healthcare Compliance Issues , Medicaid , Medicare , regulatory compliance. Just as the pandemic may finally be easing, federal focus on use of COVID-19 resources promises to increase healthcare providers’ stress.

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COVID-19 Compliance Regulatory Compliance Medicaid 97

YouCompli

NOVEMBER 30, 2022

Additionally, we are subject to regulatory guidance from our Medicare Administrative Contractor. Some examples: Institute a standardized regulatory compliance process . Gain visibility into enterprise-wide regulatory compliance. Track compliance activities with regulations at the departmental level.

Regulatory Compliance 52

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

MedTrainer

MAY 12, 2021

The Hidden Benefits of Regulatory Compliance in Healthcare. With its maddening complexities and time- and resource-consuming demands, regulatory compliance is thought to be the plague of any thriving business. But what is compliance in healthcare? Fact: Regulatory Compliance in Healthcare is an Advantage.

Regulatory Compliance 40

Regulatory Compliance Compliance HIPAA Medical Personnel 40

MRO Compliance

APRIL 11, 2024

That’s why providers need to understand which path is best for them when it comes to partnering with an eCQM / Medicare CQM for direct Electronic Health Record (EHR) connection or using QRDA-1 for data uploads. Accurate reporting not only safeguards against penalties but also maximizes shared savings and reimbursement.

Regulatory Compliance 147

Regulatory Compliance Medicare Medicare Compliance 147

Verisys

DECEMBER 29, 2024

Healthcare organizations and insurance companies rely on credentialing to ensure patient safety, regulatory compliance, and minimize liability risks. 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

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. By staying vigilant, you help protect Medicare enrollees, preserve the integrity of the Medicare Program, and safeguard the Medicare Trust Fund.

Fraud 52

Fraud Medicare Medicare Compliance 52

Medisys Compliance

APRIL 8, 2025

CMS Guidelines The Centers for Medicare & Medicaid Services (CMS) plays a significant role in laboratory billing. Conclusion Accurate laboratory coding is fundamental for the financial health and regulatory compliance of any clinical laboratory.

Medical Billing Outsourcing 52

Medical Billing Outsourcing COVID-19 Medical Billing Medicare 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. “It Global Reach and Regulatory Compliance Vivalink supports HaH programs not only in the U.S.

Hospitals 98

Hospitals Patient Satisfaction Regulatory Compliance FDA 98

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

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].

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

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

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.

Compliance 52

Compliance Licensing Doctors Malpractice 52

Hall Render

DECEMBER 30, 2024

On November 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance under QSO-25-09-ALL, updating Core Appendix Q of the State Operations Manual regarding findings of immediate jeopardy. Removal of Culpability : The updated guidance removes culpability from the immediate jeopardy determination process.

Medicaid 40

Medicaid Medicaid Nursing Homes Medicare 40

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

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.

Licensing 52

Licensing Compliance Nurses Malpractice 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. Key details about the Preclusion List : It applies only to Medicare Advantage items and services or Part D drugs for Medicare beneficiaries.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Physician Credentialing Company

DECEMBER 20, 2024

Medicare guidelines should be checked if you are billing this payer. 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.

Medical Billing 52

Medical Billing Compliance Malpractice Regulatory Compliance 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

Compliancy Group

APRIL 17, 2024

Office of Inspector General (OIG) in the Department of Health and Human Services (DHHS) oversees efforts in the healthcare sector to identify, reduce, and prevent incidents of fraud, waste, and abuse of funds from programs like Medicare. Findings from OIG audits can identify compliance areas needing improvement.

Compliance Officers 52

Compliance Officers Compliance Medicare Medicare 52

Medisys Compliance

DECEMBER 30, 2024

Regulatory Compliance: Staying updated with HIPAA regulations, ICD-10 codes, and payer-specific guidelines can be challenging. Billing companies ensure compliance, reducing legal and financial risks. Learn more about the CMS Billing Guidelines for Medicare billing.

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Medical Billing Services Medical Billing Medical Billing Outsourcing Regulatory Compliance 59

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. Medicare opt out.

Medicare 52

Medicare Medicare Regulatory Compliance Medicaid 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. Medicare Beneficiary Identifier (MBI) has been replaced with Enrollee ID.

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare Compliance 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

Healthcare IT Today

DECEMBER 17, 2023

Business process management company Sagility launched its Utilization Management as a Service offering , which aims to help providers with CMS regulatory compliance. Pennsylvania-based WellSpan Health selected Arcadia data analytics to supports its Medicare Shared Savings Program.

Hospitals 95

Hospitals Nurses Compliance Regulatory Compliance 95

MedTrainer

AUGUST 30, 2023

Medicare Advantage (Part C). Medicare Advantage plans are managed care plans offered by private insurance companies as an alternative to traditional Medicare (Parts A and B). MCOs need to comply with various regulations and requirements to operate effectively — and ensure they meet the standards set forth by regulatory bodies.

Compliance 52

Compliance Regulatory Compliance Medicaid Medicaid 52

Compliancy Group

OCTOBER 16, 2024

Some compliance officers turn to free resources like the Department of Health and Human Services (HHS) risk assessment tool to assess their organizational compliance and risk, while others use spreadsheets or software. Risk management refers to identifying, avoiding, and mitigating the factors contributing to healthcare non-compliance.

Compliance 52

Compliance Compliance Officers Fraud Regulatory Compliance 52

Compliancy Group

APRIL 23, 2024

Furthermore, when an OIG measurement of compliance program effectiveness uncovers unethical behavior or costly errors, a liability judgment can fall on the board of directors, not just the compliance officer. The CIA outlines the organization’s obligations for correcting wrongdoing and improving corporate compliance measures.

Compliance 59

Compliance Compliance Officers Regulatory Compliance Medicare 59

HIT Consultant

JANUARY 26, 2023

The Improving Seniors’ Timely Access to Care Act mandates the adoption of electronic PA for Medicare Advantage (MA) plans and requires plans to offer greater policy transparency, approval rates, and rationale for denials. It is time for intelligent utilization management, beginning with prior authorization. LinkedIn – [link].

Regulatory Compliance 52

Regulatory Compliance Medicare Medicare 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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Medicaid Medicaid Medicare Medicare 52

Healthcare IT Today

JUNE 29, 2023

However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. Medicare Certification ASCs must sign a contract with Medicare and meet its Conditions for Coverage (CFC) to be paid. ASCs must also meet Medicare’s Conditions for Coverage.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

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.

FDA 97

FDA Compliance Regulatory Compliance Medicaid 97

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.

Compliance 52

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