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Medicare, Medicaid, Health Reform

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Monthly Archives: May 2011

Medicaid Fraud and Abuse: Investigations, Prosecutions, Spending, and Staffing by State Medicaid Fraud Control Units in 2010

Nearly every State has a Medicaid Fraud Control Unit (MFCU) to investigate and prosecute cases of Medicaid fraud and patient abuse and neglect.  MFCUs are a key part of an array of federal and state agencies combating healthcare fraud and abuse, including State Medicaid agencies, the HHS Office of Inspector General (OIG), and Center for Program Integrity at the Centers for Medicare...

Primary Care Physicians and Hospital Emergency Departments: Improving Communications

Hospital and emergency room utilization is expected to increase substantially when 35-40 million Americans become newly insured through Medicaid and State Health Exchanges starting in 2014.  Today, communication between primary care physicians and hospital emergency departments is poor.  An excellent new study by the National Institute for Health Care Reform (NIHCR) examines how primary care physicians (PCPs) communicate with hospital emergency departments (EDs)...

Electronic Health Records: Medicare and Medicaid EHR Incentive Payments for Hospitals and Physicians

Medicare and Medicaid payment incentives are available for hospitals, physicians, and certain other healthcare professionals that implement and use Electronic Health Record (EHR) systems.  To receive the payment incentives, eligible providers must engage in meaningful use of federally certified EHR systems. The federal health information technology initiative, created under the Health Information Technology for Economic and Clinical Health Act in...

Medicare and Medicaid Fraud: Voluntary Self-Disclosure of Potential Fraud by Hospitals, Physicians, and Other Providers

Medicare and Medicaid program integrity efforts – coupled with complex coding and claiming procedures, ever-increasing program requirements, new payment methods, and the growing market share of taxpayer-funded programs – present significant compliance challenges for health plans, hospitals, physicians, pharmaceutical and biotechnology firms, medical device makers, and other providers and suppliers. The HHS Office of Inspector General (OIG) encourages health care providers...

Preventive Services: Understanding Preventive Health Services Covered under the Affordable Care Act

Under the Affordable Care Act (ACA), most health plans are now required to provide preventive services to their enrollees without any co-payments or other cost sharing.  Over time, this is expected to significantly improve prevention and wellness, reducing costs and reducing incidence of preventable condtions.  However, the preventive services manadate is complex. Here is a quick primer. Three federal committees have...

Health Reform: CMS Waivers of Annual Dollar Limits on Health Insurance Benefits

While most of the major health reforms start in 2014, the Affordable Care Act (ACA) imposes several new requirements in 2011 on health plans and self-insured employers. To prevent either a large increase in premiums or a significant decrease in access to health coverage, the Centers for Medicare and Medicaid Services (CMS) has granted nearly 1,400 waivers of the ACA...

Centers for Medicare and Medicaid Services Plans to Modernize Business Processes, Technology, and Data Used to Manage Medicare, Medicaid, and Health Reform

The Centers for Medicare and Medicaid Services (CMS) plans to contract with an organization to help CMS modernize the business processes, information technology, data, and planning and analytical capabilities used to manage Medicare, Medicaid, and health reform at the federal level. Today, CMS faces extraordinary policy and management challenges and must face them with inadequate, disconnected, largely antiquated tools....

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