/ en Sat, 26 Apr 2025 20:41:51 -0500 Mon, 04 Nov 19 15:02:00 -0600 /lettercomment/2019-11-04-aha-urges-cms-reconsider-medicare-program-integrity-rule <p><span>AHA's comments on the Centers for Medicare & Medicaid Services’ final rule with comment period on program integrity enhancements to the provider enrollment process. The agency indicates that this final rule is part of its ongoing effort to protect the Medicare program from improper behavior.</span></p> Mon, 04 Nov 2019 15:02:00 -0600 Program Integrity <p>On April 9, the Centers for Medicare & Medicaid Services issued a <a href="https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-07355.pdf">final rule</a> and related guidance that will implement the standards governing health insurance issuers and the Health Insurance Marketplaces for 2019. In the rule, CMS provides details on the benefit and payment parameters for qualified health plan issuers selling in the marketplaces. In addition, the rule finalizes policies intended to increase state flexibility and reduce regulatory burden.</p> <p>The AHA Special Bulletin below reviews highlights of the final rule and guidance, including the top six things hospital and health system leaders need to know.</p> Thu, 12 Apr 2018 15:27:37 -0500 Program Integrity /infographics/2017-10-24-infographic-federal-agencies-regulatory-or-oversight-authority-impacting <p> </p> <p data-entity-type="" data-entity-uuid=""><span><a data-entity-type="" data-entity-uuid="" href="/system/files/2018-01/info-regulatory-burden-federal-agencies.pdf"><img alt="" data-entity-type="" data-entity-uuid="" height="47" src="/images/printinfographic.gif" width="327" /></a><span title="Click and drag to resize">​</span></span></p> <p><span><span title="Click and drag to resize">​</span></span><br />  </p> <p><a data-entity-type="" data-entity-uuid="" href=/system/files/2018-01/info-regulatory-burden-federal-agencies.pdf"><img alt="regulatory burden federal agencies image" data-entity-type="" data-entity-uuid="" src="/sites/default/files/inline-images/regulatory-burden-federal-agencies-with-regulatory-or-oversight.jpg" /></a><img alt="" data-entity-type="" data-entity-uuid="" height="695" src="/sites/default/files/inline-images/info-regulatory-burden-federal-agencies.jpg" width="900" /></p> <p> </p> <p> </p> <hr /> <p> </p> <p><strong>Add this infographic to your web site by copying the code below. Share this with your friends!<br /> <br /> <p><a href="/system/files/2018-01/info-regulatory-burden-federal-agencies.pdf"><img src="/sites/default/files/inline-images/info-regulatory-burden-federal-agencies.jpg" alt="CHIP" title="Federal Agencies with Regulatory or Oversight Authority Impacting Hospitals"/></a></p><p>Check out other ºÚÁÏÕýÄÜÁ¿ Association <a href="/taxonomy/term/129">infographics</a></p></strong></p> Tue, 24 Oct 2017 00:00:00 -0500 Program Integrity /node/126 <p>In recent years, the Centers for Medicare & Medicaid Services has drastically increased the number of program integrity auditors that review hospital claims to identify improper payments. These audit contractors include recovery audit contractors (RACs) and Medicare administrative contractors (MACs). RACs are charged with identifying improper Medicare and Medicaid fee-for-service payments – both overpayments and underpayments. They are paid on a contingency fee basis, receiving a percentage of the improper payments they identify and collect. MACs conduct pre-payment and post-payment audits and also serve as providers’ primary point-of-contact for enrollment and training on Medicare coverage, billing and claims processing.</p> <p>No one questions the need for auditors to identify billing mistakes; however, responding to the increasing number of audits and challenging inappropriate denials drains hospitals’ time, funding and attention that could more effectively be focused on patient care.</p> <p> </p> Tue, 17 Oct 2017 09:36:13 -0500 Program Integrity /letter/2017-09-20-aha-hrsa-re-340b-civil-monetary-penalty-rule-delay Wed, 20 Sep 2017 00:00:00 -0500 Program Integrity <p>The HHS Jan. 13 issued a final rule that makes changes to the procedures for Administrative Law Judge appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare appeals.</p> Tue, 17 Jan 2017 00:00:00 -0600 Program Integrity /news/headline/2017-01-12-oig-issues-final-rule-implementing-aca-exclusion-authorities <p>The Department of Health and Human Services’ Office of Inspector General today issued a <a href="https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-31390.pdf" target="_blank">final rule</a> expanding its ability to exclude individuals or entities from federal health care programs, as authorized by the Affordable Care Act and other laws. The rule allows OIG to exclude individuals or entities for conviction of an offense in connection with obstructing an audit; failure to supply payment information; or false statements, omissions or misrepresentations of material fact in provider or supplier applications, among other provisions. Unlike the proposed rule, which included no time limit, the final rule limits the time period for initiating an exclusion action for fraud and other prohibited activities to 10 years.</p> Thu, 12 Jan 2017 16:26:00 -0600 Program Integrity <p>Beginning Dec. 1, the CMS will reopen settlement for certain inpatient status claims.</p> Mon, 14 Nov 2016 00:00:00 -0600 Program Integrity <p>The Department of Health and Human Services late June 28, issued a proposed rule that would make changes to the procedures for Administrative Law Judge (ALJ) appeals of payment and coverage determinations for items and services provided to Medicare beneficiaries, in addition to other Medicare appeals.</p> Wed, 29 Jun 2016 00:00:00 -0500 Program Integrity <p>Supreme Court issues decision in False Claims Act case.</p> Thu, 16 Jun 2016 00:00:00 -0500 Program Integrity