Category: Healthcare News

healthcare compliance issue Logs

Healthcare Compliance Issue Logs & Risk Assessment

Troubleshooting and insurance: These are the dual purposes of maintaining a detailed Healthcare Compliance Issue Logs, according to a senior compliance executive. Speaking at AAPC’s HEALTHCON Regional, the senior compliance executive highlighted the Office of Inspector General’s (OIG) new voluntary compliance guidance, emphasizing its importance even for organizations already familiar with the seven elements of […]
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medical necessity documentation

Medical Necessity Documentation: A Guide to Reducing Claim Denials

Claim denials are a significant headache for healthcare providers, impacting revenue and administrative efficiency. While denials can stem from various issues, a large majority are rooted in documentation errors, particularly those related to demonstrating medical necessity. Defining Medical Necessity: The American Medical Association (AMA) defines medical necessity as healthcare services or products provided to a […]
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Clinical validation Queries

Enhancing Clinical Validation Queries to Address Rising Denials

The volume of clinical validation denials is increasing, yet clinical validation queries have not kept pace. One key reason for this discrepancy is the complexity involved in constructing clinical validation queries, which require precise and thorough documentation to ensure accurate coding and reimbursement The Unique Challenges of Clinical Validation Queries Unlike traditional queries that request […]
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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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