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Understanding OIG Compliance

February 22, 2017

 

On October 15, 1976, President Ford signed into law legislation creating an Office of Inspector General (OIG) at the Department of Health, Education and Welfare (HEW).  HEW OIG would become HHS-OIG in 1980 when the Department was redesignated as the Department of Health and Human Services (HHS).

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Coalition Targets Root Causes of Health Disparities

February 15, 2017

 

The notion that healthcare needs are human needs is gaining ground within the healthcare sector.  So is the view of hospitals as important economic anchors that must address these human factors as well as the medical needs of the communities they serve, because the two sets of needs are inextricably linked.

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National Health Expenditures and Federal Funding of Medicaid

February 8, 2017

 

In December 2016, the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) issued a study of 2015 National Health Expenditures (NHE).  According to the study, overall health spending grew by 5.8 percent in 2015 to $3.2 trillion or about $10,000 per U.S. citizen, and accounted for 17.8 percent of the Gross Domestic Product (GDP).

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Consumers, Employers and Providers Take the Hit from Rising Healthcare Spending

February 1, 2017

 

Healthcare is changing so fast it will make your head spin.  Keeping up with all the changes is a huge task, even for industry insiders.  Recent news reports demonstrate this:

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OIG Report Reveals Two-Midnight Rule Vulnerabilities

January 25, 2017

 

A study by the Office of Inspector General (OIG) has revealed “vulnerabilities” under the Two-Midnight hospital policy that initially went into effect on October 1, 2013.  In response to the findings, OIG has recommended that the Centers for Medicare and Medicaid Services (CMS) improve oversight of hospital billing under the policy and take steps to increase protections for beneficiaries.  As a result, hospitals are likely to see closer scrutiny to determine whether they are appropriately characterizing inpatient and outpatient stays.

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Healthcare Industry Strategic Trends: Takeaways from the JP Morgan Healthcare Conference

January 18, 2017

 

Last week, MiraMed's senior executives attended the JP Morgan Healthcare Conference in San Francisco along with top executives from more than 450 private and public companies in biotech, pharmaceutical, medical device and technology, as well as healthcare providers, payers, private equity and venture capital firms.  Presentations provided a glimpse of the future in terms of strategic thinking and trends among some of the nation’s largest providers, vendors and investors.

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Healthcare’s Newest Security Threat: IoT

January 11, 2017

 

One of the greatest technological achievements in the 21st Century was is the creation of the Internet.  Its formation has effectively changed almost every aspect of business and personal communication.

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Study Shows How to Meet the Needs of Complex High-Need Patients

January 4, 2017

 

Hospitals and health systems can make a more meaningful dent in the costs of care and improve the value of the care they deliver by zeroing in on the social and behavioral health needs of their most complex high-need patients, according to a new report published by The Commonwealth Fund.

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Veterans Affairs Issues Final Rule Expanding Practice Authority

December 28, 2016

 

On December 14, the Department of Veterans Affairs (VA) published a final rule amending its medical regulations to expand the scope of practice for certain Advanced-Practice Registered Nurses (APRNs) at VA facilities.  The VA believes the rule, which becomes effective January 14, 2017, will make it easier for veterans to be seen by medical professionals by increasing the number of available primary-care providers.

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2016 Healthcare Year in Review

December 14, 2016

 

The spotlight on the healthcare industry grows brighter every day.  The industry is facing immense scrutiny on every aspect of the clinical and business drivers.  Healthcare delivery is morphing from a fragmented multi-organizational industry to a more consolidated business structure where major players are merging or acquiring smaller entities.  This consolidation transition is happening within a complex, highly regulated and systematized industry.  Healthcare delivery is at a crossroads with its consumers.  Patients have more control over who provides their care, how it is paid for and the way it is administered.  Consumerism is flourishing, and patients now have new tools that provide them with more transparency and control, allowing them to be better prepared to navigate the care continuum.

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Ensuring Access to Care in Urban and Rural Communities

December 7, 2016

 

A report from the American Hospital Association (AHA) outlines emerging strategies to help hospitals in rural and urban communities strengthen their viability in the current environment and preserve their ability to deliver services to vulnerable populations.

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Settlement Offer Announced for Appealed Medicare Claims

November 30, 2016

 

Medicare Administrative Contractors process an estimated 1.2 billion fee-for-service claims each year on behalf of the Centers for Medicare & Medicaid Services (CMS) for more than 33.9 million Medicare beneficiaries.  Of the 1.2 billion claims filed in 2015, 123 million or about 10 percent were denied, and 3.7 million of those (about three percent of total claims) were appealed.

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Separating Fact from Fiction in Healthcare Medical Chart Auditing

November 23, 2016

 

Chart auditing programs have become more important in light of increased federal payer audits.  As a result, many providers want assurances that their medical chart documentation is accurate and is descriptive of the provided medical services.  Validating processes and functions in a healthcare setting follows the same principles as fact checking a news story.  Medical chart auditing is analogous to fact checking political promises or even validating a tabloid claim.

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A Timely, Transparent Response to Unexpected Harmful Events

November 16, 2016

 

“We realize mistakes happen, and we can forgive that,” says patient advocate Carol Hemmelgarn, whose nine-year-old daughter died of medical error and a hospital-acquired infection (HAI) in a teaching hospital.  “But you harm us again by not being honest and transparent with us . . . we should be healing and learning together how to prevent this from happening to someone else.”

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Data Released on Medicare Bonuses

November 9, 2016

 

According to federal data released November 1, more than 1,600 hospitals will see bonuses from Medicare in 2017 under the Hospital Value-Based Purchasing (VBP) Program; about 200 fewer than last year.

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WikiLeaks, Hackers and Cybercriminals Keep Healthcare IT Stakeholders on Guard

November 2, 2016

 

You would have to be living completely off the grid to be unfamiliar with WikiLeaks, the multi-national media organization founded by Julian Assange.  WikiLeaks has elevated itself as the most well-known name in hacking, exposing classified, censored or otherwise restricted official materials involving war, spying and corruption.  The organization is despised for uncovering secrets that were not meant for public consumption and applauded by millions who believe that the world’s most persecuted documents should be available to everyone.  Who would have thought that hacking could land someone on the cover of TIME Magazine as the coveted Person of the Year?  Assange held that distinction in 2010.

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The Essentials of Emergency Preparedness

October 26, 2016

 

In slightly less than a year (by November 15, 2017), healthcare entities that participate in Medicare and Medicaid will be required to meet the provisions of the Centers for Medicare & Medicaid Services’ emergency preparedness final rule.

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Final MACRA Rule Released by CMS

October 19, 2016

 

In an e-Alert released last month, we noted that the Centers for Medicare and Medicaid Services (CMS) would soon be issuing a final rule relating to the Medicare Access and CHIP Reauthorization Act (MACRA).  That final rule was issued this past Friday, and includes changes and clarifications responsive to over 4,000 public comments.

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Deconstructing Healthcare Consumerism

October 12, 2016

 

Merriam-Webster defines consumerism as the promotion of the consumer's interests and it states that an increasing consumption of goods is economically desirable. The United States has become a society of increasing consumerism, where individuals are making increasing levels of purchases for a variety of consumer goods.

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A Framework for Tackling Health Disparities

October 5, 2016

 

In the introduction to its new white paper, Achieving Health Equity: A Guide for Health Care Organizations, the Institute for Healthcare Improvement (IHI) tells the story of Tommy Cannon, a black American with type 2 diabetes and no access to preventive healthcare, who died in 1973 at the age of 62. Cannon waited hours in a segregated physician’s office. When the physician finally saw him, he told him to go to a hospital 50 miles away because he was so ill. He died the next day from sepsis due to a ruptured appendix without ever being treated by a physician.

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Emergency Preparedness Requirements Finalized for Healthcare Facilities

September 28, 2016

 

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to establish consistent emergency preparedness requirements for healthcare providers participating in Medicare and Medicaid, increase patient safety during emergencies and establish a more coordinated response to natural and man-made disasters. Healthcare providers and suppliers affected by this rule must comply with and implement all regulations one year after the effective date of November 15, 2016.

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