Category: Healthcare News

Reproductive Healthcare Data Privacy

Understanding the HIPAA Reproductive Healthcare Data Privacy Final Rule

The final rule issued by the Biden administration aimed to bolster the privacy of reproductive healthcare data under HIPAA, a significant move following the Supreme Court’s overturning. Health and Human Services (HHS) officials hoped this rule would alleviate the “chilling effect” on individuals seeking or providing legal reproductive healthcare, stemming from both legal challenges and […]
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FY 2026 IPPS Proposed Rule

IPPS Proposed Rule: Key Updates to HRRP, HAC, and VBP Programs

The Centers for Medicare & Medicaid Services (CMS) has unveiled its Fiscal Year (FY) 2026 IPPS Proposed Rule, which outlines significant updates to three key Medicare hospital quality initiatives: the Hospital-Acquired Condition (HAC) Reduction Program, the Hospital Readmissions Reduction Program (HRRP), and the Hospital Value-Based Purchasing (VBP) Program. These proposed changes, outlined in the IPPS […]
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Open-Source AI Medical Diagnostics

Open-Source AI Medical Diagnostics: Matches GPT-4 in Study

A groundbreaking study from Harvard Medical School has revealed that an Open-Source AI Medical Diagnostics model performed on par with GPT-4—one of the leading proprietary AI models—in diagnosing complex medical cases. Published in JAMA Health Forum, the findings suggest that physicians may soon have more options for integrating AI into clinical decision-making while maintaining greater […]
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FHIR-based ePA

Mastering CMS Rule 0057: Optimizing FHIR-Based ePA for Health Plans

The CMS Rule 0057 mandates that health plans develop and support FHIR-based APIs to facilitate FHIR-Based ePA. Whether this investment merely ensures compliance or unlocks broader benefits such as improved provider experience, enhanced efficiency, and streamlined operations depends on strategic planning and collaboration rather than cost alone To assist health plans in addressing these critical […]
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Gender-affirming care coding

Impact of Policy Changes on Gender-Affirming Care Coding

The landscape of healthcare policy in the United States has recently been shaken by an executive order issued by the U.S. President, introducing significant potential shifts, particularly concerning Gender-Affirming Care Coding. This has ignited widespread concerns about insurance coverage, general medical coding practices, and compliance obligations for hospitals and healthcare facilities nationwide. On January 28th, […]
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Medicare Physician Reimbursement Cuts

Medicare Physician Reimbursement Cuts: Doctors Warn of Healthcare Crisis

Physicians have expressed strong opposition to the newly proposed federal spending plan, which fails to address a crucial issue: the 2.83% reduction in Medicare Physician Fee Schedule reimbursement for 2025, representing significant Medicare Physician Reimbursement Cuts. While the House of Representatives Appropriations Committee introduced the bill on March 8, with an anticipated floor vote this […]
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MIPS performance disparities

MIPS Performance Disparities: How Individual Radiologists Are Impacted

A recent study published in the Journal of the American College of Radiology reveals stark MIPS performance disparities, with individual radiologists facing significant disadvantages compared to those participating in group reporting or Advanced Payment Models (APMs) within the Centers for Medicare & Medicaid Services (CMS) Merit-Based Incentive Payment System (MIPS). The research, analyzing data from […]
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Statistical extrapolation in healthcare audits

Statistical Extrapolation: Navigating Multimillion-Dollar Healthcare Audits

Imagine the chilling realization that a review of a mere 100 patient claims could trigger a demand for multimillion-dollar repayments from your healthcare organization. This is not a hypothetical scenario; it’s a stark reality faced by healthcare providers nationwide, driven by the potent auditing technique known as statistical extrapolation in healthcare audits. While the underlying […]
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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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