Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

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Medicare Medicare Overpayments Overpayment 59

Health Care Law Brief

APRIL 12, 2023

We note, however, that an MA plan may elect to offer, as a Medicare benefit, coverage for post-hospital skilled nursing facility care without a prior qualifying hospital stay that is required under traditional Medicare. If finalized, the amendments would have aligned the Medicare standard with the standard for liability under 31 U.S.C.

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Medicare Medicare Overpayments Overpayment 52

Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. SNF billing compliance refers to the adherence to federal and state regulations governing billing processes for skilled nursing facilities.

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Compliance Medical Billing Outsourcing Medicare Medicare 52

Hall Render

NOVEMBER 25, 2024

Department of Health and Human Services (“HHS”) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (“Nursing Facility ICPG”) for nursing home members of the health care compliance community.

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Nurses Compliance Compliance Officers Medicare 40

HIT Consultant

JANUARY 16, 2023

Julie Stegman, Vice President, Nursing Segment of Health Learning, Research & Practice  at Wolters Kluwer. Nursing education goes to the metaverse: Over the last decade, technology has fundamentally transformed nursing education. Kuldeep Jiwani, SVP of Data Science at HiLabs.

Nurses 98

Nurses FDA Overpayments Overpayment 98

YouCompli

DECEMBER 14, 2022

In this article she looks at specific ways to engage and communicate with Nursing, Physicians, Sales & Marketing, Revenue Cycle, and IT. Nursing represents the largest team in many healthcare organizations, so we must build strong relationships here. In an inpatient setting, nursing is going to be a 24×7 business.

Compliance 52

Compliance Compliance Officers Nurses Overpayment 52

Hall Render

AUGUST 4, 2023

CMS described the increase as a “parity adjustment recalibration,” noting that it had previously overestimated overpayments to nursing homes, which resulted in an unintended reduction in reimbursement in 2023. CMS issued a final rule that will increase payments to SNFs by 4%, or $1.4B, starting in 2024.

Hospitals 40

Hospitals Overpayments Overpayment Nursing Homes 40

YouCompli

MAY 17, 2023

In a previous article, I discussed relationships with operational areas such as Nursing Revenue Cycle, and IT. We further identified overpayments and developed a plan to refund. IQR outcomes affect governmental reimbursements, so issues identified in IQR measure reporting can result in overpayment liability.

Compliance 52

Compliance Compliance Officers Overpayment Overpayments 52

YouCompli

SEPTEMBER 27, 2023

 She also claimed the hospital failed to reimburse payors for overpayment stemming from these improperly coded claims. The providers traveled to skilled nursing and care facilities, where they identified and treated patients with wounds caused by pressure, dermatitis, vascular disease, diabetes, and surgery.

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Compliance Overpayment Overpayments Medicare 52

The Health Law Firm Blog

JUNE 9, 2023

However, if you are a physician, dentist, nurse, mental health counselor, psychologist, pharmacist, physician assistant, nurse [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Nurses Overpayments 52

The Health Law Firm Blog

JULY 26, 2023

However, if you are a physician, dentist, nurse, mental health counselor, psychologist, pharmacist, physician assistant, nurse [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Nurses Overpayments 52

The Health Law Firm Blog

JUNE 27, 2023

However, if you are a physician, dentist, nurse, mental health counselor, psychologist, pharmacist, physician assistant, nurse [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Nurses Overpayments 52

The Health Law Firm Blog

MAY 17, 2023

However, if you are a physician, dentist, nurse, mental health counselor, psychologist, pharmacist, physician assistant, nurse [.] Indest III, J.D.,

Medicare 52

Medicare Medicare Nurses Overpayments 52

Hall Render

APRIL 18, 2022

The Public Health Emergency was extended, CMS proposed a small increase in skilled nursing facility (“SNF”) reimbursement rates and South Carolina is pushing to repeal its certificate of need (“CON”) law. reduction in funds to account for overpayments by CMS in previous years per Modern Healthcare.

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Public Health COVID-19 Overpayment Overpayments 40

Healthcare Law Blog

FEBRUARY 9, 2024

However, ChristianaCare employees – including hospitalists, residents, physician assistants, and nurse practitioners – worked in the NICU alongside Neonatology Associates, and were also providing care to these same patients.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayment 52

Hall Render

DECEMBER 11, 2024

OIGs new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community emphasizes the importance of staff screening and exclusion checks. Under 42 CFR Sec. Under 42 CFR Sec.

Compliance 40

Compliance Licensing Nurses Medicaid 40

AIHC

SEPTEMBER 5, 2023

Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations. This compact does not apply to nurse practitioners (NPs) because they are licensed under state boards of nursing and not medicine.

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COVID-19 Telemedicine Informed Consent Compliance 59

Redox

APRIL 29, 2019

As healthcare starts to understand more about what people expect, we need to keep in mind the pervasive role that technology plays in everyone’s lives and that our doctors and nurses don’t check their personal experiences at the door.

Doctors 40

Doctors Overpayment Overpayments Health Insurance 40

CMS.gov

NOVEMBER 16, 2018

These improper payments may be overpayments or underpayments and do not necessarily represent expenses that should not have occurred. Skilled nursing facility corrective actions resulted in a $1.04 The skilled nursing facility improper payment rate decreased from 9.33 The home health improper payment rate decreased from 58.95

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Medicare Medicare Overpayment Overpayments 20

The Health Law Firm Blog

MARCH 14, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.]

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Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

JANUARY 12, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. The deal was signed on July 11, 2022, but wasn’t publicly [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

DECEMBER 19, 2022

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law On August 24, 2022, managed healthcare company, Centene Corporation, agreed to pay $19 million to the State of Washington to settle fraud allegations. Centene owns and operates Sunshine State Health Plan, d/b/a Sunshine Health, in Florida. In addition, [.].

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Fraud Medicaid Medicaid Overpayments 52

The Health Law Firm Blog

OCTOBER 18, 2022

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law The nation's largest Medicaid insurer, Centene, has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. The deal was signed on July 11, 2022, but wasn’t publicly [.].

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

APRIL 19, 2024

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]

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Malpractice Overpayments Overpayment Licensing 52

The Health Law Firm Blog

AUGUST 24, 2023

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law Florida's Agency for Health Care Administration (AHCA) has come under fire for failing to make Medicaid final orders accessible to the public. On April 11, 2023, an attorney asked a Florida appeals court to revive her suit against [.]

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Medicaid Medicaid Overpayments Overpayment 52

The Health Law Firm Blog

JANUARY 24, 2023

By George F. Indest III, J.D., Board Certified by The Florida Bar in Health Law In a possibly precedent-setting case, on November 9, 2022, for the first time, an appeals court in New Jersey ruled that plaintiffs in medical malpractice cases do not need an affidavit of merit to file claims against a [.]

Malpractice 52

Malpractice Overpayments Overpayment Licensing 52

Hall Render

JUNE 22, 2022

Skilled Nursing. This latter claim is hard to fathom given the history of reimbursement updates over the last few years as well as the recent pandemic, record inflation and a significant home health staffing crisis which has driven up employee pay, especially for nurses, which have all contributed to increased costs. Discipline.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’ million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

FEBRUARY 23, 2024

And lawmakers are trying to help. ’ and highlights community partnerships in newly released Annual Report MARYLAND Baltimore jury awards $1.5M

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Nursing Homes Nurses Hospitals Medicaid 40

Hall Render

APRIL 26, 2024

New California rule aims to limit health care cost increases to 3% annually UC San Diego Health operations deal with California hospital slows to crawl Kaiser reports data breach affecting 13.4M area health system chief leaving for post in Florida Supreme Court will not hear D.C. biotech’s patent infringement appeal A D.C.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Medicaid 40

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

OCTOBER 7, 2022

10 states with the largest decreases to travel nurse pay. How tight nursing home capacity is bottlenecking hospital operations. Judge orders Anthem to face lawsuit over alleged Medicare overpayments. Investigators found high rates of bed sores and extended isolation among Providence nursing home patients, leading to $310K fine.

COVID-19 40

COVID-19 Nurses Nursing Homes Hospitals 40

Hall Render

APRIL 19, 2024

to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M Can lawmakers do anything about it? hospital cost review board a bandage for rising costs?

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Hall Render

JANUARY 19, 2024

Did it work? Workers at another D.C.

Nursing Homes 40

Nursing Homes Nurses COVID-19 Hospitals 40

Hall Render

NOVEMBER 10, 2023

Million to Settle Kickback Allegations Florida nursing home staffing changes opposed Leapfrog Group releases safety grades for Central Florida hospitals. Million to Settle Kickback Allegations Florida nursing home staffing changes opposed Leapfrog Group releases safety grades for Central Florida hospitals. See who got an A.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

AUGUST 26, 2022

CMS bulletin presses states on Medicaid nursing home spending. CMS informational bulletin urges steps for improving health outcomes in nursing homes. Tie nursing home Medicaid payments to care quality, CMS tells states. Alabama Baptist universities address nursing shortage. Compliance with Oct. CALIFORNIA. in net income.

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

MARCH 15, 2024

NATIONAL 3 things to expect from the pharmaceutical supply chain in 2024 Absence of AI hospital rules worries nurses American Academy of Dermatology votes to keep its diversity policies after anti-DEI proposal Are digital health partnerships replacing M&A?

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40