Readiness Rounds

OCTOBER 3, 2023

The Tightening Grip of CMS Regulations 2. What You Can Do Today to Reduce Regulatory Findings Photo: iStock Signature In today's healthcare landscape, hospitals are facing increasing pressure from accrediting organizations like The Joint Commission and DNV. Headlines: 1. Key Takeaways 5.

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Regulations Performance improvement Patient Safety Hospitals 52

Advanced Data Systems

JULY 19, 2022

Whether your patient population currently consists mostly of Medicare patients or only a portion, it’s imperative to stay on top of regulations and updates that the government issues regarding healthcare coverage. With that in mind, here’s a look at proposed Medicare fee schedule changes that are anticipated for 2023.

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Medicare Regulations Healthcare 77

HIT Consultant

APRIL 17, 2024

What You Should Know: Wolters Kluwer Health , a leading provider of healthcare information and analytics, has introduced a new weapon in the fight against potential financial penalties for Medicare Advantage Organizations (MAOs) – the Regulatory Audit Module.

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Medicare Regulations Medicaid Healthcare 52

Healthcare It News

MAY 31, 2023

They also said clinicians reported needing more formal training on how to communicate more effectively over a virtual platform and about state regulation. Regulations that varied widely also affected their use of telehealth platforms. Andrea Fox is senior editor of Healthcare IT News.

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Telemedicine Primary Care Regulations Doctors 299

Healthcare It News

OCTOBER 4, 2022

The Electronic Healthcare Network Accreditation Commission and The CARIN Alliance have partnered to bring both the CARIN Code of Conduct and EHNAC’s criteria review process to health plans, health systems, EHR vendors and others for reporting to the Centers for Medicare & Medicaid Services on their data practices and privacy protections.

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Healthcare It News

OCTOBER 13, 2023

Social determinants of health – the food, shelter and security attributes of patients that exist outside of care settings – contribute disproportionate risks for disease, hospital readmissions and a lack of access to quality healthcare among vulnerable populations, including people on Medicare. Like what you hear?

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Accountability Population Health Regulations Medicare 230

Briggs Healthcare

JULY 12, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare Transmittal 12123 was posted July 11, 2023. FUNDING : For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. GENERAL INFORMATION A.

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Medicare Regulations Healthcare 52

HIT Consultant

MARCH 28, 2022

The COVID-19 pandemic feels like a once-in-a-lifetime event for those of us involved in healthcare, but the patterns of how the crisis affected our industry feel familiar. I believe the COVID-19 pandemic represents the same type of watershed moment in healthcare that finally inspires a historically stagnant industry to change for the better.

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Healthcare Regulations Patient Experience Medicaid 138

Briggs Healthcare

DECEMBER 2, 2021

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare. CMS posted QSO-22-04-ALL the afternoon of December 2, 2021. Between the two of them, these injunctions cover all states, the District of Columbia and the US Territories. CMS has appealed both of these decisions, and has filed motions for stays of these orders.

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Medicaid Medicare Regulations Healthcare 97

Lexis Nexis

DECEMBER 14, 2023

The healthcare industry has been adapting to rapid changes especially since the COVID-19 pandemic started. As the world has generally returned to the new normal, healthcare industry players are looking to a more proactive approach and to take advantage of the momentum the pandemic provided as they think forward about the future.

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Healthcare Urgent Care Life Sciences Regulations 52

HIT Consultant

APRIL 1, 2024

Key Allegations The lawsuit alleged that TRG engaged in improper billing practices related to radiology services provided to hospitals and other healthcare providers across the country. The government alleges that TRG radiologists did not adequately review these drafts before finalizing the reports sent to healthcare providers.

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Quality of Care Regulations Federal Healthcare Healthcare Providers 97

Sheppard Health Law

JANUARY 26, 2023

BACKGROUND The Proposed Rule is the latest in a long line of federal legislation and rulemakings governing the conscience rights of healthcare providers and entities. Medicaid and Medicare The Balanced Budget Act of 1997, Public Law 105–33, 111 Stat.

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Healthcare Federal Healthcare Medicaid Regulations 105

Briggs Healthcare

MAY 4, 2023

This final rule will also codify regulations implementing section 118 of Division CC of the Consolidated Appropriations Act, 2021, section 11404 of the Inflation Reduction Act, and includes provisions that will codify existing sub-regulatory guidance in the Part C, Part D, and PACE programs.

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Medicare Regulations Nursing Primary Care 40

Briggs Healthcare

JANUARY 31, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare Today (January 30, 2023), the U.S. Under this program, CMS identifies improper risk adjustment payments made to Medicare Advantage Organizations (MAOs) in instances where medical diagnoses submitted for payment were not supported in the beneficiary’s medical record.

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Medicare Accountability Regulations Medicaid 40

Lexis Nexis

FEBRUARY 14, 2024

One of your many jobs is to convince potential new members that your plan offers the best options for their healthcare and wellness needs. But what if strategic healthcare marketing could make the process easier, messaging more targeted, and attracting new members more successful? The healthcare industry is unlike any other.

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Healthcare Regulations Medicaid Medicare 52

Etactics

APRIL 12, 2024

I recently entered a job that revolves around the healthcare industry. My point in beginning with this is that I write weekly blogs about healthcare and human resources and I STILL find myself getting pretty confused on all the different components that come into play with medical billing. What is Medicare ? Back to the basics.

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Healthcare Medicaid Doctors Medicare 52

Briggs Healthcare

MARCH 3, 2022

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare. This Medicare Payment Systems educational tool explains how each service type payment system works.

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Medicare Rehabilitation Nursing Regulations 52

HIT Consultant

JUNE 16, 2022

healthcare system. As a result, the Centers for Medicare and Medicaid Services (CMS) has since issued new guidance regarding the IDR process for disputing parties. Both payers and providers will need to be prepared to adapt and pivot accordingly to uphold the regulations and protect those who matter most – the patients.

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Regulations Hospitals Medicaid Medicare 52

Vie Healthcare

APRIL 24, 2024

Episode Introduction Cole explains why transfer of knowledge is a key goal of the Journal, why healthcare strategy can be described as moving from checkers to chess and emphasizes the importance of thinking before you speak. He also explains the importance of competition in healthcare and identifies humility as an essential leadership trait.

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Healthcare Hospitals Process improvement Ambulatory Care 98

Cloud Blogs

FEBRUARY 28, 2022

Healthcare stakeholders are moving away from fee-for-service and towards value-based models to meet the demands of aging and millennial populations while also meeting an ambitious national healthcare agenda. The 21st Century Cures Act has accelerated healthcare innovation, technology advancement, and improved interoperability.

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Integration Healthcare Quality of Care Regulations 140

HIT Consultant

MARCH 9, 2023

Rajesh Sharma, Vice President and General Manager of Systems Integration, Data Analytics and Interoperability Product Offerings, Gainwell Technologies The Centers for Medicare and Medicaid Services (CMS) has laid the critical groundwork to create a connected healthcare system in which patients, providers, and payers can easily exchange information.

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Healthcare Prevention Medicaid Integration 94

HIT Consultant

JUNE 9, 2022

Shawna Koch Mishael, Head of Healthcare and Biomedical, RN, MBA, SenecaGlobal. While the healthcare industry has been extolling the virtues of data interoperability for years until recently it has remained one of the biggest obstacles to providing quality healthcare today. Yet, the tides are turning.

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Healthcare Regulations Prevention Medicaid 98

Sheppard Health Law

JANUARY 10, 2024

Sustainability of our healthcare system was an interesting topic at Day 2 of the 42 nd Annual J.P. Morgan Healthcare Conference. Paul Markovich, CEO of Blue Shield of California, expressed the concern that “[T]he status quo is an existential threat to our healthcare system.”

Healthcare 52

Healthcare Ambulatory Care Primary Care Medicare 52

Briggs Healthcare

JUNE 1, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare The OIG posted the results of this physician services audit – same title as this blog – on May 30, 2023. Practitioners report a two-digit place-of-service code on a Medicare claim line that generally reflects where the practitioner furnished the service.

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Medicare Regulations Nursing Hospitals 40

Briggs Healthcare

SEPTEMBER 28, 2022

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare. In response to the COVID-19 pandemic, the Department of Health and Human Services (HHS) temporarily waived certain Medicare restrictions on telehealth—the delivery of some services via audio-only or video technology.

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Medicare Regulations Healthcare 52

Health Populi

APRIL 16, 2024

The four stories we generate are: Retail Health For All, starring “The Consumer” DIY Healthcare, starring “The CEO” Fragmentation Meets Bureaucracy, starring “The Castaway,” and, “One World, One Health,” starring “The Health Citizen.” Presidential elections to that point, and that the last retiring Baby Boomer enrolls in Medicare that year.

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Healthcare Tertiary Care Primary Care Medicare 73

HIT Consultant

MAY 2, 2023

Andy Auerbach, Chief Revenue Officer of SafeRide Health As the healthcare industry continues to evolve, there is a growing need for innovative solutions that not only improve the quality of care but also make care more accessible. In a recent study , 21% of U.S.

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Medicaid Regulations Medicare Integration 96

HIT Consultant

MARCH 22, 2023

Unfortunately, America still struggles with high, painfully opaque pricing across healthcare that hurts employers, workers, patients, and taxpayers. The Centers for Medicare and Medicaid Services recently announced that in 2021, the nation spent $4.3 At the same time, 100 million Americans find themselves in healthcare debt.

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Healthcare Patient Experience Hospitals Medicaid 97

Briggs Healthcare

FEBRUARY 9, 2022

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare. The Medicare and Medicaid certification of providers and suppliers in a State whose oversight process is substantially deficient may be jeopardized if CMS cannot ensure that the regulatory minimum health and safety standards have been met.

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Medicaid Medicare Regulations Quality of Care 52

Healthcare It News

OCTOBER 14, 2021

A group of healthcare organizations announced this week the launch of the Advanced Care at Home Coalition, an advocacy effort aimed at creating a pathway toward safeguarding access to hospital-level services. The coalition's perspective, he said, is that regulators should "put guardrails on, but let us continue the good work."

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Hospitals Home Care Regulations Medicaid 262

p3care

JULY 2, 2023

Likewise, the healthcare sector is no exception to this trend. Healthcare practices find it difficult to handle significant PHI in their systems. Therefore, the EHRs must adhere to the regulations to receive voluntary certification. Through the Certification program, ONC has set forth the national standards for healthcare IT.

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Performance improvement Healthcare Providers Quality of Care Integration 237

p3care

AUGUST 7, 2023

Today’s healthcare landscape emphasizes care quality and patient outcomes more than anything else. Also, Medicare is the primary payer for healthcare facilities in the US. For implementing the value-based healthcare model, medical billing and coding services do the same. Thus, the practices must strictly focus on KPIs.

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Regulations Accountability Medicare Healthcare 246

HIT Consultant

OCTOBER 30, 2023

Under the Medicare Shared Savings Program, a healthcare provider that is an Accountable Care Organization (ACO), ACO participant, or ACO provider or supplier would be deemed ineligible to participate in the program for a period of at least one year. What You Should Know: – The U.S.

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Medicare Accountable Care Healthcare Providers Regulations 98

Briggs Healthcare

APRIL 5, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare On April 4, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare payment policies and rates for the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for fiscal year (FY) 2024.

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Medicare Regulations Patient Experience Medicaid 40

HIT Consultant

OCTOBER 18, 2023

Hilton Hudson, MD, FACS, and CEO of HPC International In May 2022, a California doctor was sentenced to nearly eight years in prison for his involvement in a $12 million Medicare fraud scheme. million in reimbursements from Medicare over a three-year period. He received $4.5

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Regulations Accountable Care Prevention Medicare 105

Health Populi

JUNE 18, 2021

Gallup and West Health noted that this intensity of support for price regulation was noteworthy in this study. The details in the study were that people with private insurance were less likely than folks with Medicare to have a personal physician and more likely to have unstable insurance coverage. One-half of U.S.

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Healthcare Medicaid Medicare Regulations 133

Healthcare It News

FEBRUARY 5, 2024

You contend telepsychiatry will continue to grow because it enables access to mental healthcare – which is a big challenge today. However, depending on the state and its regulations, patients may need to, at times, be seen in person. What does this mean for mental healthcare this year? Enterprise Taxonomy:

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Regulations Telemedicine Remote Care Prevention 245