American Medical Compliance

MARCH 15, 2024

Let’s explore its significance, key regulations, challenges, and best practices. The Significance of FWA Compliance FWA includes activities that defraud healthcare programs, waste resources, or abuse the system. In this comprehensive guide, we delve into FWA compliance in healthcare.

HIPAA

American Medical Compliance

JUNE 21, 2024

The Department of Health and Human Services (HHS) estimated that improper payments in the Medicare and Medicaid programs exceeded $100 billion from 2016 to 2023. Fraud, waste, and abuse (FWA) in healthcare present significant challenges, causing substantial financial losses, eroding public trust, and compromising the quality of patient care.

Medicaid

Relias

APRIL 10, 2025

The Centers for Medicare and Medicaid Services (CMS) issued the Emergency Preparedness Rule to provide a national framework for healthcare organizations to improve their readiness for emergencies. This regulation established consistent emergency preparedness requirements for Medicare and Medicaid providers and suppliers of all types.

Medicaid

Relias

FEBRUARY 28, 2025

Key sources of IHS funding The IHS is primarily funded by federal appropriations, along with grants, Medicaid and Medicare reimbursements, and third-party billing. Medicaid and Medicare reimbursements Tribal health programs can enroll as Medicaid and Medicare providers to receive reimbursements for eligible services.

Medicaid

Health Leaders | Nursing

MARCH 5, 2023

A shared leadership/professional governance mindset is key to a successful practice redesign, CNE says. Gilbert spoke with HealthLeaders about how he and his organization are approaching practice redesign and best practices to implement a redesign. HealthLeaders: What is your definition of practice redesign?

Retirement

IntelyCare

MARCH 2, 2023

It shouldn’t be a huge surprise that many senior living communities have told McKnight’s that they will have to increase agency use this year , especially in light of the Centers for Medicare and Medicaid Services (CMS) potentially moving forward with a new minimum staffing standard in 2023.

HIPAA

American Nurse

JUNE 3, 2024

Using best practice recommendations from CARD and the literature, the team developed a questionnaire that allows the patient and caregiver to communicate their unique needs to the healthcare team. 3W3aHFM Centers for Medicare & Medicaid Services. Autism/developmental questionnaire. J Autism Dev Disord. 2017;47(5):1510-29.

Communication

Relias

OCTOBER 20, 2021

Telehealth has enabled providers to offer care to clients no matter where they live, without the need to break social distancing best practices. Several factors drove these concerns, such as licensing, Medicare/Medicaid?reimbursement, Medicaid beneficiaries use telehealth services. SoonerCare Medicaid program.

Medicaid

Relias

MARCH 12, 2025

For example, the Centers for Medicare and Medicaid Services (CMS) mandate facility assessments in long-term care facilities to ensure that staff competencies align with the needs of the patient population. Additionally, accrediting bodies emphasize the importance of competency verification as part of their quality standards.

Long Term Care

Relias

MARCH 15, 2022

Vendor partners help provide automated claim status, claims follow-up, out-of-state Medicaid credentialing, insurance credit balance resolution, payment variance on zero-dollar accounts, statement mailing, early-out/customer service, bad debt collections, and escheatment processing. “In

Business

American Nurse

DECEMBER 8, 2023

By eliminating travel time and expense, participants, especially NPs in rural practices, can easily connect with colleagues and acquire specialty knowledge.

Long Term Care

Relias

JUNE 28, 2023

To provide the best services possible, healthcare organizations of all kinds must understand how to implement integrated care management. Integrated care is a best practice model that combines evidence-based medical and behavioral healthcare services at one point of entry. What does integrated care management mean?

Mental Health

Capitol Beat

MARCH 15, 2022

As part of this appropriation, Congress would establish and/or fund the following agencies, among others: Centers for Medicare & Medicaid Services : $4 billion in total spending, an increase of $50 million. Agencies Health and Human Services : $108.3 billion in total spending, an increase of $11.3

Medicare

Relias

AUGUST 9, 2023

Tis the season for evaluating training programs and checking everything twice to make sure you’re on the Center for Medicare and Medicaid Services’ and The Joint Commission’s nice lists. There isn’t a test you can put in front of them to know whether they’re employing best practices.

Best Practices

Consult QD

MAY 8, 2023

3 Who to enroll in a lung cancer screening program : Guidance from the United States Preventive Services Task Force (USPSTF) has contributed to policy from Centers for Medicare & Medicaid Services and other payors for who should be screened.

Best Practices

Scrubs

JUNE 6, 2023

We’ve got to move forward and use our evidence-based health care and best practices to address the maternal mortality crisis.” “It’s a feeling state that physicians should be in control,” said Ami Goldstein, president of the North Carolina affiliate of the American College of Nurse-Midwives.

Private Practice

Capitol Beat

DECEMBER 22, 2022

This law will identify and disseminate best practices to reduce and prevent mental and behavioral health conditions, suicide, and burnout, as well as increase access to evidence-based treatment for nurses and other health care professionals. Read more about the #ICAN Act here.

Medicaid

Consult QD

MAY 11, 2023

Additionally, hospitals are not reimbursed by the Centers for Medicare & Medicaid Services for costs associated with sternal wound infections, so these infections can have a negative financial impact. DSWIs: Uncommon but impactful A DSWI is a devastating complication of cardiac surgery for the patient. healthcare system an estimated $3.5

Medicaid

Relias

MARCH 29, 2024

The California Toolkit to Transform Maternal Care, a series of evidence-based guidelines and resources to help hospitals implement best practices for the management of common and serious maternal complications, such as hemorrhage, preeclampsia, and sepsis.

Medicaid

American Nurse

DECEMBER 8, 2023

The Centers for Medicare & Medicaid Services doesn’t reimburse costs associated with healthcare-associated CAUTI, so prevention has financial implications. Significant contribution UTI remains an epidemiologically significant infection across all healthcare settings, especially related to growing concerns about antibiotic resistance.

Best Practices

American Nurse

JANUARY 3, 2024

The Centers for Medicare and Medicaid Services (CMS) worked with purchasers, physicians, healthcare organizations, and consumers to identify evidence-based process measures (core measures) to reduce morbidity, mortality, variability, and cost while improving quality outcomes. Several recent developments aim to address these issues.

Chief Nursing Officer

American Nurse

FEBRUARY 29, 2024

2530 would help examine best practices for nurse staffing and provide whistleblower protections for nurses who choose to advocate for the safety of their patients. Rather, having an individual NPI positions an APRN to open their own practice, as Medicare, Medicaid, and most private payers require an NPI for reimbursement.

APRN

Health Leaders | Nursing

FEBRUARY 27, 2024

The Acute Hospital Care at Home program, supported by the Centers for Medicare & Medicaid Services (CMS), took off during the pandemic and is now in place in more than 300 health systems across the country. More and more care will be in the home.

Telemedicine

Relias

MARCH 13, 2023

In the healthcare industry, regulations and best practices are always changing. The best way to protect your organization is to monitor your compliance risks proactively. Regular compliance audits help organizations provide the most efficient, effective patient care. But they can also be a source of stress and frustration.

Medicare

Relias

JULY 20, 2023

­The Centers for Medicare and Medicaid Services (CMS) issued a final rule in August 2022 to improve maternal health outcomes and advance health equity — two of the Biden-Harris Administration’s key priorities. It is important to focus on clinical protocols and reduction in practice variation. Sadly, U.S. rates are continuing to rise.

Medicaid