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2 Jun 2023, 2:50 am
Penalties for “Misclassification” The Medicaid Services Investment and Accountability Act of 2019 added new penalties to the Medicaid rebate statute for knowingly misclassifying a covered outpatient drug. [read post]
1 Jun 2023, 5:00 pm
Known colloquially as the “gag clause prohibition,” Section 201 of the CAA, codified as Section 724 of the Employee Retirement Income Security Act of 1974 (“ERISA”), prohibits a group health plan from entering into an agreement with a TPA, health care provider, or other vendor offering access to a network of health care providers that would directly or indirectly prevent the plan from accessing certain cost and quality information and providing that information to its… [read post]
1 Jun 2023, 8:39 am
Of particular interest to Ohio hospitals, changes to the adult cardiac catheterization services requirements include: Applicable to All Adult Cardiac Catheterization Services – Level I, II, and III Shortening the period for quality assessment review of major complications and emergency transfers from at least once every ninety days to at least once every sixty days Changing the minimum for adult cardiac catheterization services from 22 to 18… [read post]
31 May 2023, 12:49 pm
” Point 3- A complicating aspect of the seemingly simple rule is that whether a service is a “covered service” is determined solely by CMS, not by you. [read post]
29 May 2023, 10:00 am
Most Medicare Advantage plans require that a copy of the original claims, the remittance notification showing that the post-service claim has been denied, a complete copy of the patient’s relevant medical records, and any further documentation which supports the coverage and payment of the claim at issue. [read post]
24 May 2023, 5:16 pm
Like many service providers to medical practices, health plans or other HIPAA covered entities, MedEvolve was subject to HIPAA’s Privacy, Security, Breach Notification and business associate agreement requirements due to its access, possession, use, protection, and disclosure of PHI in the course of servicing its covered entity customers. [read post]
17 May 2023, 11:05 am
EEOC Sues Total Systems Services for Disability Discrimination and Retaliation (March 29, 2023); EEOC Sues United Labor Agency for Disability Discrimination (February 15, 2023). [read post]
15 May 2023, 2:23 pm
The news coincides with the end of the federal public health emergency on May 11, along with the anticipated end of the federal COVID-19 vaccination mandate for health care facilities certified by the Centers for Medicare and Medicaid Services (“CMS”). [read post]
11 May 2023, 9:01 am
On the federal level, the Centers for Medicare and Medicaid Services (CMS) oversees nursing homes participating in the Medicare and Medicaid programs. [read post]
10 May 2023, 8:49 pm
Second, the prescription must be issued pursuant to a communication between a practitioner and a patient using an interactive telecommunications system referred to in CMS requirements for telemedicine services set forth at 42 C.F.R. [read post]
8 May 2023, 12:28 am
Medicare Exclusion Risks: Employing Excluded Individuals Can Result in Significant Administrative, Civil and / or Criminal Liabilities (May 8, 2023): One of the most severe administrative sanctions available under the Social Security Act stems from the authority of the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS)[1] to “exclude” individuals and entities from participating in Federal health care programs.[2]… [read post]
5 May 2023, 5:49 pm
Citizenship and Immigration Services (USCIS) will continue to require the COVID-19 vaccination for adjustment of status applicants as part of the I-693 immigration medical examination, it appears that the end of the COVID-19 public health emergency may soon make such measures no longer necessary. [read post]
5 May 2023, 12:24 am
In response to these investigations, the Centers for Medicare & Medicaid Services (CMS) launched the National Partnership to Improve Dementia Care in Nursing Homes. [read post]
28 Apr 2023, 6:12 pm
Changes to Medical Care Advisory System The second rule, Ensuring Access to Medicaid Services (CMS-2442-P), also has a May, 3, 2023 scheduled publication date and a July 3, 2023 comment date. [read post]
20 Apr 2023, 7:59 am
For example, § 422.311(c)(3) states that MA organizations “may not appeal the [Secretary of Health and Human Services’] medical record review determination methodology or RADV payment error calculation methodology. [read post]
18 Apr 2023, 12:20 pm
The Centers for Medicare and Medicaid Services (CMS) now published turnover numbers for nursing staff and Administrators on Care Compare. [read post]
17 Apr 2023, 5:00 am
Each year, CMS selects several MA plans for RADV audits to ensure that medical record documentation supports diagnoses submitted for risk adjustment. [read post]
13 Apr 2023, 10:29 am
Shockingly, neither the Centers for Medicare and Medicaid Services (CMS) nor the New Jersey Department of Health tracks cumulative numbers of nursing home abuse complaints specific to resident-to-resident assaults. [read post]
13 Apr 2023, 8:41 am
In doing so, the agency stated that it will evaluate whether the diagnosis codes for a sample of plan enrollees are supported by the enrollees’ underlying medical records. [read post]
11 Apr 2023, 11:05 am
CMS has announced that the FY 2022 fee-for-service improper payment rate was 7.46%.[1] While this is a slight increase in the error rate from the past two years (6.27% and 6.26% respectively), it is still a significant improvement over a decade high of 12.09% in 2014. [read post]
