{"id":4591,"date":"2019-06-10T00:14:22","date_gmt":"2019-06-10T00:14:22","guid":{"rendered":"https:\/\/medisysdata.com\/?p=4591"},"modified":"2023-10-15T09:54:44","modified_gmt":"2023-10-15T04:24:44","slug":"how-cms-will-protect-medicaid-provider-payments","status":"publish","type":"post","link":"https:\/\/www.medisysdata.com\/blog\/how-cms-will-protect-medicaid-provider-payments\/","title":{"rendered":"How CMS Will Protect Medicaid Provider Payments?"},"content":{"rendered":"\r\n

CMS\u2019s Existing Initiatives Protect Medicaid<\/h2>\r\n\r\n\r\n\r\n

In 2014, CMS revised the Medicaid Provider Reassignment Regulation to provide for a new exception to the direct payment requirement for certain providers, which primarily include independent in-home personal care workers. This new regulatory exception authorized a state to make Medicaid payments to third parties on behalf of certain providers. After further review, CMS has determined that the new exception created by the 2014 rule is not authorized by the statute and may have resulted in provider payments being diverted in ways that do not comport with the law. Therefore, CMS is finalizing the rule to remove this impermissible exception.<\/p>\r\n\r\n\r\n\r\n

CMS\u2019s Unified Program Integrity Contractors (UPICs) – CMS\u2019s UPICs are contracted entities that perform activities that identify and reduce fraud, waste, and abuse by individuals and entities furnishing items and services under Medicare and Medicaid. The UPICs work closely with states to perform numerous functions to detect, prevent, and deter specific risks and broader vulnerabilities to the integrity of the Medicaid program, including conducting provider investigations and audits.<\/p>\r\n\r\n\r\n\r\n

Enhanced Medicaid Program Integrity Strategy<\/h3>\r\n\r\n\r\n\r\n

The responsibility for proper payments in Medicaid primarily lies with the states, oversight of the Medicaid program requires a partnership, and CMS plays a significant role in supporting state efforts and increasing state oversight, accountability, and transparency. Because of this responsibility, CMS<\/a> has announced new and enhanced initiatives that will create greater transparency in and accountability for Medicaid program integrity performance, enable increased data sharing and robust analytic tools, and seek to reduce Medicaid improper payments across states.<\/p>\r\n\r\n\r\n\r\n

The initiatives include stronger audit functions, increased beneficiary eligibility oversight, and enhanced enforcement of state compliance with federal rules like below:<\/p>\r\n\r\n\r\n\r\n