HHS Office of Inspector General’s Post

End of
Translation

A CIA is an expensive, daunting and all consuming process mandating the augmentation and enhancement of your company’s Compliance Program (or implementation if one does not exist at all). Having an effective, robust Compliance Program in place to voluntarily identify and prevent FWA *ahead of time* is the more efficient method to promote a culture of corporate integrity.

Discover the latest strategies to combat fraud, waste, and abuse in the healthcare industry from SIU directors in our "Best Practices in Healthcare Payer FWA" webinar. Gain insights on investigative work plans, combining provider and claim level reviews, and overcoming resource challenges. Equip yourself with the knowledge and tools to protect your organization and members. Subscribe to our YouTube channel for more videos like this. https://bit.ly/3MfTfap #FWA #HealthPlans #SIU

Discover the latest strategies to combat fraud, waste, and abuse in the healthcare industry from SIU directors in our "Best Practices in Healthcare Payer FWA" webinar. Gain insights on investigative work plans, combining provider and claim level reviews, and overcoming resource challenges. Equip yourself with the knowledge and tools to protect your organization and members. Subscribe to our YouTube channel for more videos like this. https://bit.ly/3MfTfap #FWA #HealthPlans #SIU

United States: Information Blocking Final Rule And Proposed Disincentives For Healthcare Providers The Department of Health and Human Services ("HHS") Office of Inspector General ("OIG") recently released a final rule (88 FR 42820) for information blocking penalties and subsequently proposed a rule (88 FR 74947) to establish disincentives for healthcare providers found by OIG to have committed information blocking. Click the link below to read the complete article.

Navigating the No Surprises Act for Better Reimbursement The No Surprises Act was designed to protect patients, but it's also reshaping how providers handle out-of-network revenue cycle management. A recent report by Health Affairs highlights the need for providers to stay informed and adaptable. Stay ahead in the changing landscape of out-of-network revenue cycle management with HaloMD’s expert Independent Dispute Resolution solutions. Learn more at https://hubs.la/Q02hYj6x0. #NoSurprisesAct #HealthcareRevenueCycleManagement #OutOfNetworkRevenueCycleManagement #IndependentDisputeResolution #Arbitration #BalanceBilling

This article discusses how electronic prior authorization my decrease the burdens on healthcare systems, but would come with consequences of "a streamlined prior-authorization system for patient care and societal resources" It seems to me that such a streamline would be positive? #authorization #ushealthcare #healthinsurance #socialimpact #bioethics "Improving prior authorization is an important policy priority. Electronic prior authorization could offer needed relief from administrative burdens, but its implications for systemwide efficiencies remain uncertain. Operational design, behavioral responses by providers, and market reactions to increased transparency will determine the consequences of a streamlined prior-authorization system for patient care and societal resources. Ultimately, the U.S. health care system delegates coverage determinations to private plans (notably those administering publicly financed insurance programs) in part because of a general struggle with decisions involving trade-offs. In other countries, value-laden decisions about access to various health care services are often under the purview of the government. Prior authorization is one of the most enduring, infuriating, and effective tools in the United States for managing health care spending. Easing prior authorization would put even more pressure on payment policy to control spending. This reality shouldn’t deter policymakers from reforms aimed at reducing burdens for clinicians and improving access for patients. But it will also be necessary to grapple with the likely unintended consequences."

The REAL Health Providers Act is one of the rare examples of legislation with bipartisan support. Why? Because transparency and accuracy in data matters for everyone! Read more about the bill and how Orderly is (and has been) working on bringing transparency to healthcare since our inception! #healthcare #bipartisan #transparency

For anyone in Medicare Advantage trying to stay ahead of changes from DC, this post from the Orderly Health team is a must-read. ➡ Jones Point's DC Perspective: The Real Health Providers Act has a good chance of moving this year - either as part of the March spending bill or a broader healthcare package, so taking the time to get ahead now will pay dividends. #medicareadvantage #providerdatamangement #healthcareregulations #Realprovidersact Want to learn more? Check out our #NavigatorSeries Podcast with Orderly Health CEO Kevin Krauth https://lnkd.in/e4iEg9Ag