Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicaid Reimbursement

Texas Wrongly Claimed $3.8M in Medicaid Reimbursements

April 10, 2017 - Texas’s Department of Health and Human Services failed to adhere to federal guidelines and inappropriately claimed $3.8 million in Medicaid managed care reimbursement.    The Office of Inspector General (OIG) recently published findings from their audit of the state agency in which it discovered that the state improperly claimed millions of dollars in managed care payments...


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Texas Wrongly Claimed $3.8M in Medicaid Reimbursements

by Thomas Beaton

Texas’s Department of Health and Human Services failed to adhere to federal guidelines and inappropriately claimed $3.8 million in Medicaid managed care reimbursement.    The Office of Inspector General (OIG) recently published...

MA Medicaid Wrongly Paid $193M in Fee-for-Service Claims

by Thomas Beaton

An audit of MassHealth, the Massachusetts state Medicaid program, found the agency improperly paid approximately $193 million in fee-for-service claims for behavioral healthcare between 2010 and 2015.   Questionable payments to the Massachusetts...

WI Improperly Claimed $3M in Medicaid Drug Reimbursement

by Thomas Beaton

Wisconsin’s Department of Health Services failed to correctly invoice providers for over $3 million in Medicaid drug reimbursement, says the Office of the Inspector General (OIG) in a new report, leading to improper reimbursement from federal...

Price, Verma Push for Better State Control of Medicaid Programs

by Jacqueline Belliveau

As one of her first actions as CMS Administrator, Seema Verma collaborated with the Department of Health and Human Services (HHS) Secretary Tom Price to detail how the federal government plans to improve its state partnerships to enhance state...

Org Offers 25-Point Plan for NJ Medicaid Program Improvement

by Jacqueline Belliveau

The New Jersey Health Care Quality Institute (NJHCQUI) recently partnered with the Nicholson Foundation to release a 25-point plan for modernizing and improving New Jersey’s Medicaid program. “The current program has too often failed...

Key Best Practices for Success on the Health Insurance Exchanges

by Vera Gruessner

Which healthcare insurers are succeeding in the health insurance exchanges? What best practices can be taken from these payers? The weekly newsletter Washington Health Policy Week in Review published an editorial answering these questions by...

Six Medicaid ACOs Vary in Consumer Engagement Success

by Vera Gruessner

Consumer engagement in a number of Medicaid accountable care organizations (ACOs) tend to vary significantly, according to a September 2016 report from the Center for Consumer Engagement in Health Innovation. With providers being incentivized...

CMS Seeks Input to Implement Modular Medicaid IT Solutions

by Vera Gruessner

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a request for information called Modular Solutions for Medicaid IT Enterprise and Pre-certification of Solutions. Essentially, CMS is seeking more information regarding...

CMS Awards $32M for Children’s Health Insurance Program

by Vera Gruessner

While the Affordable Care Act and other healthcare reforms have reduced the numbers of uninsured children around the nation, more work needs to be done and the Centers for Medicare & Medicaid Services (CMS) has invested more funds in ensuring...

NY’s Medicaid Payment Reforms Aim to Reduce Hospital Use

by Vera Gruessner

The state of New York is undergoing significant payment reforms within its Medicaid program. In 2014, Governor Andrew Cuomo finalized negotiations with federal agencies to create a waiver that would allow New York to renew $8 million in federal...

Long-Term Care has a Shorter Time Frame Due to ACA, CMS

by Vera Gruessner

The Affordable Care Act has impacted a variety of aspects of the health insurance landscape as well as the healthcare delivery system. The Patient Protection and Affordable Care Act also led to the Center for Medicare & Medicaid Innovation...

How CMCS Improved Managed Care in State Medicaid Programs

by Vera Gruessner

Earlier this week, the Centers for Medicaid and CHIP Services (CMCS) finalized its ruling on the managed care Medicaid reimbursement regulations. Soon afterward, the National Association of Medicaid Directors (NAMD) released a statement regarding...

$120 Million Settlement Ends Medical Claims Processing Failure

by Vera Gruessner

One medical claims processing technological project has been put to rest in the state of California. This project began in 2007 and has still failed to be completed, according to the California Healthline publication. The medical claims processing...

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