The first major update to HIPAA in more than a decade will eliminate the distinction between “required” and “addressable” safeguards, making key cybersecurity and physical security measures mandatory for all healthcare providers. This shift will expose gaps in hospitals’ fragmented security systems, though, according to Kumar Sokka, CEO of cybersecurity platform Acre Security.

The post Why Some Hospitals Won’t Be Able to Comply With Upcoming HIPAA Updates appeared first on MedCity News.

A consultant who has analyzed healthcare policy over many decades declares that MA is in the middle of a fundamental reset both in terms of market headwinds and federal scrutiny.

The post Policy Expert Believes CMS is Taking “Adversial Posture” to Medicare Advantage appeared first on MedCity News.

Some of the most powerful scenes aren’t the dramatic saves, but the quiet moments when clinicians connect with patients amid the chaos. Healthcare teams deserve access systems that allow for more of those moments.

The post What ‘The Pitt’ Gets Right About Emergency Medicine — and What It Reveals About Healthcare IT appeared first on MedCity News.

As legal and compliance professionals, we champion privacy and cybersecurity in our organizations — but success requires a team effort.

The post The Evolving Landscape of Privacy and Cybersecurity: Essential Strategies for Legal and Compliance Professionals appeared first on MedCity News.

Every life sciences organization needs to consider how best to apply machine learning (ML) to RWE to support better patient outcomes. Here’s how they can ensure RWE is “ML-ready.”

The post Real-World Evidence Meets Machine Learning: What It Takes to Future-Proof Evidence Generation appeared first on MedCity News.

Organizations that excel don’t treat migrations as IT exercises. They treat them as compliance projects that require technical execution. Their methodology begins with regulatory obligations, builds technical architecture around them, and conducts relentless validation before calling the migration complete.

The post Proven Methodologies For Ensuring Seamless CRM Migrations In Highly Regulated Environments appeared first on MedCity News.

By adopting a modern digital payment solution, payers can streamline operations, improve provider relationships and reduce fraud exposure. Most importantly, they gain a flexible, scalable foundation built to meet today’s demands and tomorrow’s challenges.

The post Healthcare’s Paper Check Problem appeared first on MedCity News.

When tax-advantaged dollars enter a care model, they do more than expand purchasing power. They reorganize incentives, accelerate intermediary involvement, and clarify who holds leverage.

The post When HSA Dollars Enter Direct Primary Care, Control Follows appeared first on MedCity News.

A handful of states have issued guidance documents that illustrate how regulators are viewing the IV hydration and IV therapy businesses, which infusion providers should consider as part of their overall compliance monitoring efforts.

The post Infusion Industry Boom Raises Red Flag from State Regulators appeared first on MedCity News.

Recent advances in generative AI have made it a lot easier and safer to bring HCC coding in-house, lowering costs, and strengthening audit readiness.

The post Why It’s Time to Bring HCC Coding In-House appeared first on MedCity News.

A universal medical coder, applied consistently across care settings, offers a practical solution to the enduring challenge of data integrity.

The post The Case for a Universal Medical Coder in Achieving True Interoperability appeared first on MedCity News.

How can healthcare providers contend with a regulatory environment that has never been more fragmented? Here are three lessons on why privacy is your competitive advantage.

The post Privacy Rules Are Tightening, Again. Here’s How Your Healthcare Marketing Can Embrace Compliance to Thrive appeared first on MedCity News.

CMS and AHIP are raising the floor, but forward-thinking plans are aiming higher. They’re designing utilization management systems that are clinically sound, operationally efficient, and aligned with enterprise goals.

The post Why Health Plans Are Reclaiming Utilization Management, and What It Takes to Do It Right appeared first on MedCity News.

Without systemic redesign, these efforts risk reinforcing the same pain points that made prior authorization a flashpoint for payers and providers.

The post CMS and AHIP Isn’t the Finish Line: It’s the Starting Gun for Prior Auth Innovation appeared first on MedCity News.

By prioritizing sustainability-minded and compliant waste management in the workplace, healthcare leaders can advance patient and employee well-being, as well as environmental and fiscally responsible programs.

The post Advancing Patient & Planet Health Through Proper Healthcare Waste Management appeared first on MedCity News.

Successful implementation makes all the difference between a seamless changeover and a poorly executed one that interferes with the delivery of patient care.

The post Best Practices in Managing Medical Equipment Rollouts appeared first on MedCity News.

If the guidelines for data sharing are not adhered to by providers, then all the work that has gone into revising this regulation will have been for nothing. But the road to compliance doesn’t have to be overwhelming. Here are three essential steps for healthcare leaders in navigating the soon-to-be Part 2 landscape.

The post Putting Part 2’s Data Privacy Protections into Play: 3 Key Considerations appeared first on MedCity News.

Running a behavioral health practice requires balancing patient volume and case diversity, while maintaining operations. Transparent practice policies are necessary for success and ensuring high-quality, consistent patient care.

The post 4 Practice Policies that Help Maintain Behavioral Health Practice Success appeared first on MedCity News.

Updated schema requirements are easy to mix up — here are a few simple solutions

The post Common MRF Mistakes Hospitals Are Making in 2024 appeared first on MedCity News.

Adding generative AI and other AI tools to coding and chart review practices streamlines a complex process and better positions plans for risk adjustment audits.

The post Medicare Advantage Audit Ready with AI appeared first on MedCity News.

Healthcare is a highly regulated industry, and any use of AI within it is dealing with the most sensitive data. In order to ensure you’re not putting you, your company or patients at risk, consider an evaluation framework for any AI tool that considers these three things.

The post From FOMO to FOMU: A Framework for Getting AI Right appeared first on MedCity News.

A culture of compliance means truly valuing an adherence to industry standards, rather than looking at SOPs as a series of boxes that need to be checked in order to claim that requirements have been met. 

The post Corporate Compliance in the Era of TEFCA appeared first on MedCity News.

The NCQA proposed standards updates are just one part of a healthcare landscape undergoing rapid transformation, but the imperative for optimizing operational processes has never been clearer.

The post From Risk to Trust: Tackling Inefficient Provider Verifications in 2024 and Beyond appeared first on MedCity News.

A good outsourced partner can work alongside in-house accountants and stay on top of the moving target of healthcare accounting regulations, addressing tax risks and identifying cost-saving opportunities.

The post Tax Challenges for Healthcare Accounting Teams Bring Opportunity for Innovation appeared first on MedCity News.

Where we’ve been, where we’re going, and how healthcare organizations can protect themselves from privacy risks caused by the Meta pixel and other third-party trackers

The post The Rising Stakes of Healthcare Data Privacy in 2024: The Need for Practical Guidance appeared first on MedCity News.

Organizations must take a proactive approach by implementing a comprehensive education program, internal audits, and automation technology.

The post Demystifying Coding Compliance: 3 Key Strategies for Navigating the Regulatory Waters of RCM appeared first on MedCity News.

Hospitals markedly improved their compliance with price transparency regulations in 2023, according to a new report. It found that more than 90% of hospitals have posted a machine-readable file containing gross charges, negotiated charges and cash prices for the services and items they provide.

The post Hospitals Finally Reached Widespread Price Transparency Compliance in 2023 appeared first on MedCity News.

WebMD Ignite — the company’s division that offers tech solutions to providers and health plans — teamed up with healthcare privacy platform Freshpaint. Through the partnership, WebMD Ignite is seeking to help its customers — which include organizations such as Providence, Trinity Health, Advocate Aurora, VillageMD and Centene — use web tracking technology to grow their businesses while staying clear of data privacy risks.

The post How WedMD Is Helping Providers Stay Compliant When Using Web Tracking Tools appeared first on MedCity News.

CMS has fined two hospitals in September for alleged violations of its price transparency rule. This marks the third month in a row that the agency has issued fines against hospitals for price transparency noncompliance, following a yearslong period of light enforcement.

The post CMS Is Getting More Serious About Penalizing Hospitals For Price Transparency Noncompliance appeared first on MedCity News.

The federal government has warned hospitals that using third-party analytics tools on their websites could violate HIPAA, and more than 20 hospitals are facing class-action lawsuits over the use of these tools. But a recent analysis found that hospitals are doing a poor job of fixing their websites and preventing patient data collection.

The post Most Hospitals Are Still Violating HIPAA By Using Web Tracking Tools, Despite Federal Warnings appeared first on MedCity News.