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Category Archives: Compliance & Regulation

Final Updates to Stark Law Will Ease Transition to Value-Based Care

Blog Posts, Compliance & Regulation, Cover StoryBy Nan SloanJanuary 12, 2021

New rules will ease administrative burden, speed up reimbursement and remove fears of accidental violations.

Post-Election Healthcare Policy Implications

Compliance & Regulation, Industry Spotlight, PodcastsBy MedecisionDecember 4, 2020

Liberation Lab turns its sights to the potential implications of the November 2020 election on US healthcare policy. Our expert guests include Colin Roskey, Principal and Partner at Lincoln Policy…

Making Measurable Improvements in Healthcare Quality

Blog Posts, Compliance & RegulationBy Nan SloanJuly 21, 2020

Moving forward, Fast Healthcare Interoperability Resources (FHIR) will be used for the digitalization of HEDIS quality measures.

Medecision’s Path Toward MARS-E Compliance

Blog Posts, Compliance & Regulation, Cover StoryBy Brenton McKinneyJune 23, 2020

In January 2019, Medecision launched a yearlong process to achieve MARS-E compliance. Here’s how we did it.

Proposed Stark Law Changes Reflect Move Toward Value-Based Care

Blog Posts, Compliance & RegulationBy Nan SloanJune 16, 2020

In October 2019, CMS proposed changes to the Stark Law, which was enacted in 1988 to prevent physicians from prioritizing financial concerns over patient care. Now, CMS says that changing…

CMS and ONC Interoperability Rules: What Do the Latest Updates and Enforcement Delays Mean for the Industry?

Blog Posts, BOLD Leadership, Compliance & Regulation, Cover StoryBy MedecisionMay 26, 2020

CMS and ONC delays to enforcement give the industry a few additional months to prepare for major overhauls to ensure the appropriate sharing of patient health information. Yet the need…

Leveraging Utilization Management to Reduce Medical Loss Ratio Rebates

Blog Posts, Compliance & RegulationBy Debbie Hill, MSN, RNMarch 18, 2020

Medical loss ratio (MLR) rebates hit a record $1.3 billion in 2019 because health plans spent too little on medical claims and too much on administrative costs. How can health…

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Mitigate Compliance Risks by Addressing These Key Documentation and Billing Challenges for Medicaid Managed Care Plans

Blog Posts, Compliance & Regulation, FeaturedBy MedecisionJanuary 16, 2020

More state Medicaid programs are now addressing SDOH through managed care plans and Section 1115 demonstration waivers. However, while these Medicaid programs offer states the ability to experiment and innovate…

Automating Compliance in the Cloud

Blog Posts, Compliance & Regulation, FeaturedBy MedecisionDecember 13, 2019

In his “Automating Compliance in the Cloud” session during the CTO Roundtable at Liberation 2019, Gerry Miller, the founder and CEO of Cloudticity, discussed the inherent benefits and challenges of…

New Rules From CMS Carry Heavy Weight for Payers

Blog Posts, Compliance & Regulation, FeaturedBy Chip TerhuneDecember 5, 2019

In February 2019, the Centers for Medicare and Medicaid Services (CMS) issued new requirements for Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans, mandating they…

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