Category: Healthcare News

Prior Authorization reforms

CMS Prior Authorization Reforms: A Step Forward, But More Needed

The updated CMS regulations on prior authorization have been lauded as a significant step toward reducing administrative burdens for physicians. However, critics argue that the changes fall short of addressing the broader issues. Accelerating Prior Authorization and Enhancing Transparency Issued in January, these regulations mandate federally regulated health plans to enhance electronic health information exchange […]
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HIPAA cybersecurity regulations

HHS Proposes Enhanced HIPAA Cybersecurity Regulations

The Department of Health and Human Services (HHS) has introduced proposed regulations aimed at strengthening cybersecurity in the healthcare sector. Issued by the Office for Civil Rights (OCR), the proposed rule seeks to amend HIPAA to enhance the safeguarding of individuals’ protected health information (PHI) in compliance with HIPAA cybersecurity regulations. Content Highlights: Overview of […]
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HIPAA Security Rule updates

Healthcare Cybersecurity: Proposed Updates to the HIPAA Security Rule

The U.S. Department of Health and Human Services (HHS) has issued a Notice of Proposed Rulemaking (NPRM) aimed at strengthening the HIPAA Security Rule. If finalized, these HIPAA Security Rule updates will significantly impact the healthcare sector. HHS has highlighted that healthcare breaches pose far greater risks than breaches in other industries. In announcing the […]
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HIPAA-compliant e-signatures

The Ultimate Guide to HIPAA-Compliant E-Signatures in Healthcare

This blog delves into the critical aspects of HIPAA-compliant e-signatures in healthcare, exploring how to leverage their efficiency while ensuring strict adherence to HIPAA regulations. HIPAA’s Stance on E-Signatures Early Considerations: HIPAA initially envisioned standards for electronic signatures, focusing on financial transactions. However, early digital signature technology proved inadequate for the stringent security requirements. Shift […]
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Hospital Price Transparency Rule Compliance

Hospital Price Transparency Rule Compliance: A Deep Dive

Despite the federal Hospital Price Transparency Rule being in effect for nearly four years, many hospitals are still not fully compliant. While organizations like Hospital Price Transparency Company advocate for greater transparency, differing methodologies and criteria used by evaluators have led to varying assessments of hospital compliance. A Mixed Bag of Compliance While some hospitals […]
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Medicare Advantage organization determinations

CMS Clarifies Organization Determinations: Key Updates for Medicare Advantage

The Centers for Medicare & Medicaid Services (CMS) has introduced significant updates to clarify the definition and processes related to Medicare Advantage organization determinations, particularly in inpatient settings. The proposed rule reaffirms that decisions made during concurrent reviews, such as reclassifying an inpatient admission to outpatient or denying inpatient coverage, qualify as organization determinations under […]
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Medicare Advantage contract

Avoiding Medicare Advantage Contract Pitfalls: A Guide for Physician Practices

It’s a story many physician practice owners know all too well. A hardworking doctor secures a promising Medicare Advantage contracts with a major payer, expecting substantial revenue—100% of Medicare fee-for-service rates. The new contract seems like a win: more resources for staff, improved facilities, and better patient care. Table of Contents Common Contractual Pitfalls Best […]
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Hospital Price Transparency Compliance

Hospital Price Transparency Compliance Drops Significantly

Compliance with federal price transparency rules among hospitals dropped significantly, from 34.5% in February to 21.1% in November 2024, per a report by Patient Rights Advocate (PRA). This decline highlights the challenges in achieving full Hospital Price Transparency Compliance. The drop is attributed to weak federal enforcement, which has allowed hospitals to obscure pricing information […]
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Healthcare payment integrity

How AI and Automation are Revolutionizing Payment Integrity in Healthcare

Healthcare payment integrity is a crucial aspect of efficient claims processing, and its improvement can significantly reduce costs and improve patient care. Healthcare costs continue to climb, burdening patients, providers, and insurers alike. A significant driver of this issue is the inefficiency of healthcare administration, particularly in claims processing. Despite standardized claim formats, outdated systems […]
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medicare telehealth policy changes

Medicare Telehealth Policy Changes: What Patients and Providers Need to Know

Medicare Telehealth Policy Changes are set to reshape the landscape of telehealth services. As the COVID-19 public health emergency ends, Medicare will revert to pre-pandemic policies, imposing stricter rules for telehealth services starting January 1, 2025, unless Congress intervenes. Key changes include: Geographic Restrictions: Patients must generally live in a health professional shortage area, a […]
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