American Medical Compliance

FEBRUARY 19, 2025

The CMS Interim Final Rule The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule with comment period (IFC) to implement section 6052 of the Deficit Reduction Act of 2005 (DRA). As a result, this rule guides how Medicaid will reimburse for case management services.

Medicaid 52

Medicaid Professional Development Medicare Communication 52

American Medical Compliance

AUGUST 7, 2024

CMS (Centers for Medicare & Medicaid Services) These regulations provide essential guidelines for healthcare providers participating in Medicare and Medicaid programs. For example, CMS requires accurate and timely documentation of patient care to ensure proper billing and reimbursement.

HIPAA 105

HIPAA Medicaid Medicare Legal Issues 105

Daily Nurse

APRIL 24, 2023

Centers for Medicare and Medicaid Services. Document your patient care assessments, observations, communications, and actions in an objective, timely, accurate, complete, and appropriate manner. Remind patients to seek emergency treatment if a condition worsens, and document this action.

Malpractice 145

Malpractice Nurse Practitioner Long Term Care Medicaid 145

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. Through accurate documentation, ethical billing practices, continuous education, and robust internal controls, providers can significantly lessen FWA risks.

Medicaid 105

Medicaid Continuing Education Medicare Communication 105

Relias

APRIL 28, 2022

Many participants have a role to play in the revenue cycle, and at each stage they must employ their specialized knowledge of how that patient interaction and service is documented in the patient’s health record. How Clinical Documentation Integrity Affects Revenue. CDI Affects More Than Financial Health.

Medicaid 52

Medicaid Medicare Patient Experience Education 52

Hospital Recruiting | Nursing

APRIL 1, 2020

The emergency decision by the Center for Medicare and Medicaid Services (CMS) on March 17, 2020 (and retroactively in effect beginning March 6, 2020) to pay for telehealth visits outside of rural areas has eased physician concern.

Telemedicine 73

Telemedicine Medicaid Medicare Licensing 73

Relias

JUNE 1, 2022

Coding and clinical documentation have never been more important in healthcare. “We You’ll need ongoing training for your staff to improve your clinical documentation and avoid the following coding disasters. The documentation and coding are appropriate on our end. Insufficient Clinical Documentation or Underreported codes.

Outpatient Clinic 52

Outpatient Clinic Retirement Legal Issues Medicaid 52

Relias

JUNE 1, 2022

Coding and clinical documentation have never been more important in healthcare. “We You’ll need ongoing training for your staff to improve your clinical documentation and avoid the following coding disasters. The documentation and coding are appropriate on our end. Insufficient Clinical Documentation or Underreported codes.

Outpatient Clinic 52

Outpatient Clinic Retirement Legal Issues Medicaid 52

American Nurse

JUNE 3, 2024

Create a care plan based on the patient’s ASD assessment, communicate it to all care team members, and document it in the patient health record. Admission history document. If the patient is ever re-admitted, the care team can retrieve and update the document as needed. 3W3aHFM Centers for Medicare & Medicaid Services.

Communication 111

Communication Medicare Self-Care Mental Health 111

Relias

APRIL 28, 2023

The Centers for Medicare and Medicaid Services (CMS) requires all health facilities in the Medicare program to track and report data reflecting pressure injury development on all clients. All such checks should be documented as well.

Medicare 98

Medicare Long Term Care Medicaid Promotion 98

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 52

Medicaid Medicare Long Term Care Communication 52

American Medical Compliance

FEBRUARY 15, 2023

The impact of these losses and risks magnifies as Medicare continues to serve a growing number of beneficiaries. Even organized crime groups infiltrate the Medicare Program and operate as Medicare providers and suppliers. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

Medicare 52

Medicare Medicaid Pharmaceutical Federal healthcare 52

American Medical Compliance

FEBRUARY 15, 2023

The impact of these losses and risks magnifies as Medicare continues to serve a growing number of beneficiaries. Even organized crime groups infiltrate the Medicare Program and operate as Medicare providers and suppliers. The Centers for Medicare and Medicaid Services (CMS) require FWA training.

Medicare 52

Medicare Medicaid Pharmaceutical Federal healthcare 52

American Nurse

DECEMBER 8, 2023

The Centers for Medicare & Medicaid Services won’t reimburse hospitals for the care of this condition and may apply a value-based penalty fee. Comprehensive documentation of any dysfunction in skin integrity aids early diagnosis and prompt treatment to improve overall outcomes.

Clinical Nurse Specialist 98

Clinical Nurse Specialist Medicaid Medicare Communication 98

Capitol Beat

JANUARY 4, 2024

Not surprisingly, the main focus of advocacy is the federal Department of Health and Human Services (HHS) and its subagency, the Centers for Medicare and Medicaid Services (CMS). CMS is strengthening the Medicare Diabetes Prevention Program (MDPP) , which ANA supports.

APRN 73

APRN Medicare Long Term Care Medicaid 73

Relias

MAY 16, 2025

Over a decade ago, the Center for Medicaid and Medicare Services (CMS) Hospital Readmissions Reduction Program (HRRP) focused on reducing 30-day readmissions for high-volume, high-cost conditions like heart failure, pneumonia, and total joint replacements.

Self-Care 75

Self-Care Medicaid Medicare Care coordination 75

American Medical Compliance

MARCH 15, 2024

Furthermore, it prohibits knowingly submitting false or false claims to Medicare, Medicaid, or other federally funded healthcare programs. While EHRs offer numerous benefits, including improved documentation and care coordination, they also introduce complexities and potential vulnerabilities.

HIPAA 105

HIPAA Self-Care Health Insurance Best Practices 105

Relias

NOVEMBER 16, 2022

In April, the Centers for Medicare and Medicaid Services proposed a $320 million decrease in Medicare payments to skilled nursing facilities for fiscal year 2023. A study published in Value in Health on the cost of chronic wound care for Medicare beneficiaries revealed that nearly 15% of the patients (8.2 billion to $96.8

Education 10

Education Medicare Medicaid Business 10

Healthcare Law Insights blog

OCTOBER 17, 2023

To best position the nursing home for the most successful outcome at the appeal hearing, the facility must follow specific rules and requirements as it discharges or transfers the resident and the facility must ensure it documents all necessary facts along the way. What documentation is required before sending the notice of discharge?

Long Term Care 59

Long Term Care Medicaid Medicare Communication 59

IntelyCare

JANUARY 10, 2023

The RAI process is also a federal requirement from the Centers of Medicare and Medicaid Services (CMS) as outlined in section §483. Reimbursement The facility’s state Medicaid reimbursement is calculated using the MDS assessments produced from the RAI process. F641 Accuracy of Assessments 483.20(g)

Medicaid 52

Medicaid Medicare Mental Health Licensing 52

Relias

APRIL 18, 2022

Providing consistent, evidence-based care and thorough documentation. Avoiding penalties and legal risks that go along with inaccurate assessments, incomplete documentation, and preventable pressure injuries. Chronic wounds affect about 15% of Medicare beneficiaries each year. Build Your Reputation as a Specialist.

Education 52

Education Medicare Promotion Medicaid 52

American Medical Compliance

DECEMBER 26, 2023

What you will learn: Situations where the No Surprises Act applies Specific requirements for compliance with the No Surprises Act Billing and payment processes under the No Surprises Act The importance of accurate documentation Details Course length: 45 minutes.

Health Insurance 52

Health Insurance Medicaid Medicare 52

Relias

DECEMBER 8, 2022

Every year, the Centers for Medicare and Medicaid Services (CMS) releases the Program for Evaluating Payment Patterns Electronic Report (PEPPER). Utilizing data from the most recent three calendar years, the PEPPER offers providers specific Medicare data statistics for discharges or services that may be vulnerable to improper payments.

Medicare 52

Medicare Medicaid Self-Care Education 52

American Nurse

MARCH 6, 2024

The CMs documented all referrals as a problem, goal, and intervention (PGI) in the EHR and offered to assist with scheduling appointments. CM adherence The documentation of referrals in the EHR allowed the project manager to track nurse CM adherence with the referral process and determine the need for process changes.

Telemedicine 98

Telemedicine Health Insurance Health Literacy Promotion 98

American Nurse

JULY 5, 2023

The Centers for Medicare and Medicaid Services (CMS) provides federal oversight of care quality in all U.S. hospitals that receive Medi­care and Medicaid funding. Hospitals that accept patients with Medicare or Medicaid insurance (approximately 61.4 million have Medicare, Parts A and B, and 75.8 March 2023.

Medicaid 52

Medicaid Medicare Promotion Leadership 52

Relias

DECEMBER 21, 2021

For Medicare claims, you already track care quality and report it to the Centers for Medicare and Medicaid Services (CMS). Those quality ratings appear on Medicare’s Care Compare website and inform prospective clients how well you’re achieving positive outcomes. Improve Your Quality Ratings.

Medicare 52

Medicare Medicaid Staff Training Home Healthcare 52

Relias

NOVEMBER 4, 2021

Keeping an eye on your case mix is important with Medicare reimbursement shifting to value-based purchasing. The Centers for Medicare and Medicaid Services is planning to implement the Home Health Value-Based Purchasing (HHVBP) model nationwide in 2023. Increasing agency profitability.

Medicare 52

Medicare Business Professional Development Medicaid 52

Nurse.com

OCTOBER 12, 2023

Be sure to take pertinent documents with you to the consultation, including copies of the old policies and procedures. In addition, Medicare and Medicaid certification may be threatened if the policies are not managed correctly.

Medicaid 52

Medicaid Medicare 52

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 52

HIPAA Senior Living Best Practices Medicaid 52

American Nurse

SEPTEMBER 18, 2024

Outdated language in Medicare and Medicaid regulations were written in 1965 before APRNs were providers in the U.S. Improving Care and Access to Nurses (ICAN) (H.R. 2418): This bill does NOT change any APRN scope of practice but allows APRNs to be reimbursed for many services they already provide. Nurse Faculty Reduction Act (H.R.

APRN 52

APRN Long Term Care Medicaid Medicare 52

American Nurse

FEBRUARY 16, 2024

To address patients’ needs, Bayhealth Hospital has started sending a box of food home on discharge with patients who have food insecurities per their SDOH documentation and a referral to the Delaware Food Bank. In 2012, the Centers for Medicare and Medicaid Services implemented the Hospital Readmissions Reduction Program (HRRP).

Medicaid 52

Medicaid Medicare Long Term Care Self-Care 52

Capitol Beat

DECEMBER 6, 2022

Recently, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) entitled Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs. These recommendations also support ANA’s legislative advocacy as we encourage lawmakers to support H.R.

APRN 52

APRN Medicaid Medicare Licensing 52

Celayix

FEBRUARY 7, 2023

There is also the patient family, and the patient insurance provider, or the government in the case of Medicare or Medicaid. It can help to document everything so that you can review this with your patient later. There is of course, the patient. Then there is the healthcare provider. This, in turn, leads to patient complaints.

Home Healthcare 52

Home Healthcare Medicaid Business Medicare 52

Relias

OCTOBER 28, 2022

The Centers for Medicare and Medicaid Services (CMS) is ramping up survey scrutiny for hospice this year, training surveyors to focus on interdisciplinary group care planning and coordination of care as part of an emphasis on meeting four core Conditions of Participation. Documentation in the medical record.

Care coordination 52

Care coordination Communication Medicaid Medicare 52

Healthcare Law Insights blog

JULY 7, 2023

Importantly, although the court assumed the relator engaged in some protected activity, the court found that in many of her communications she, at most, characterized discrepancies in therapy documentation as mistakes or possible computer glitches, not fraud. Another noteworthy FCA decision is out of the Sixth Circuit.

Pharmaceutical 52

Pharmaceutical Medicare Medicaid Communication 52

Relias

JANUARY 30, 2024

Healthcare organizations receive scores from the HCAHPS survey , which according to the Centers for Medicare and Medicaid Services, is “the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.” The data is then tabulated to create the HCAHPS score.

Patient Satisfaction 52

Patient Satisfaction Patient Experience Medicare Self-Care 52

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. Regulatory readiness and compliance Regulatory audits and surveys require documented evidence of staff competency.

Long Term Care 40

Long Term Care Medicaid Medicare Patient Satisfaction 40