Medicaid managed care | The Health Law Firm Blog

CMS in the Hot Seat for Lax Oversight of Medicaid Managed Care Organizations

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm

For years, each state has kept an eye on its own Medicaid managed care plans, while the Centers for Medicare and Medicaid Services (CMS) is required to monitor how well each individual state is doing. However, a recent Government Accountability Office (GAO) report claims CMS is sleeping on the job. The report, released on June 20, 2014, stresses the need for more federal oversight of these plans.

With the implementation of the Affordable Care Act (ACA), the Medicaid program is expected to expand significantly. Most of the new beneficiaries enrolled in managed care are covered almost entirely by federal […]

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|Department of Health and Human Services, GAO, Government Accountability Office, Health Care Industry, HHS, In the Know, In the News, MCO, Medicaid, Medicaid managed care, Medicare, The Health Law Firm Blog|

Internal Medicine Specialists Should Be Aware of Impending Medicare Audits

Coming to a medical practice near you. . . It’s scary, it’s horrible, and it could cost you a lot of money!

It’s the dreaded Comprehensive Error Rate Testing (CERT) audit.

The Horror! The Horror!

First Coast Service Options, the Medicare contractor for Florida, announced a new prepayment audit program that will impact Internal Medicine Specialists. The prepayment program is focused on Initial and Subsequent Hospital Evaluation and Management Services, CPT Codes 99223 and 99233. The program is being launched due to the high CERT error rate associated with these codes.

The audits will start on October 21, 2014.

What is the CERT Program?

CMS created the CERT program to measure the paid claims error rate […]

By The Health Law Firm|2024-03-14T10:00:58-04:00June 1, 2018|CERT, Comprehensive Error Rate Testing, Internal Medicine, Medicaid, Medicaid audit, Medicaid Fraud Control Unit, Medicaid managed care, Medicare, Medicare Audit, Medicare Fraud, The Health Law Firm Blog|