Program Integrity & compliance The Case for Program Integrity in Medicaid Managed Care | Part Seven In our previous post on encounter data, we offered recommendations for meeting the challenges of problematic encounter data. In this installment, we present a Case Study from one of our own engagements, in which we helped our client transition from PI…
Program Integrity & Compliance The Case for Program Integrity in Medicaid Managed Care | Part Six Encounter Data Recommendations The Impact of Incorrect or Incomplete Data: In our previous post on encounter data, we discussed how faulty encounter data can affect rate setting and create ongoing program risk. In this post, we offer recommendations for managing potential…
Public Health & Community Impact Cancer Awareness Month: Empowering Through Knowledge and Support October marks Cancer Awareness Month, a pivotal time to raise awareness about the challenges and disparities surrounding cancer care while empowering individuals with essential knowledge and support. Key Takeaways As we honor those affected by all forms of cancer, it’s vital to…
Client Alert CMCS Informational Bulletin: State Directed Payment Quality Evaluations CMS recently issued guidance outlining new quality evaluation and reporting expectations for state directed payments (SDPs), including requirements for states to demonstrate how SDP arrangements support quality strategies, establish measurable performance targets, and evaluate results. Key Takeaways The Centers for Medicare & Medicaid Services (CMS)…
Program Integrity & Compliance The Case for Cost Reports | Part Five How Myers Can Help Learn about our comprehensive portfolio of services, risk-based auditing approach, and commitment to helping agencies achieve their goals for serving the nation’s most vulnerable populations. Key Takeaways In our series on cost reports, we looked at why they still…
Program Integrity & Compliance The Case for Program Integrity in Medicaid Managed Care | Part Five Encounter Data and Problematic Data The Impact of Incorrect or Incomplete Data: As we discussed in our previous post, the medical loss ratio (MLR) structure may incentivize MCOs against pursuing program integrity (PI) to fight fraud, waste, and abuse (FWA). Here, we detail how faulty…
Client Alert CMCS Informational Guidance on Section 71116 of the Big Beautiful Bill Act (H.R.1): State Directed Payments (SDP) CMS has released informational guidance to help states understand new requirements for Medicaid state directed payments (SDPs) under Section 71116 of the Big Beautiful Bill Act (H.R. 1), including payment limits, grandfathering provisions, and preprint requirements….
Conferences Myers and Stauffer Attends the National Adult Protective Services Association Conference Missy Parks, CFE, AHFI (principal) and Kevin Jenkins, CFE (senior manager) from our Forensic Accounting and Litigation Support (FALS) team recently attended the National Adult Protective Services Association (NAPSA) conference. Read on to see what Kevin had to say about why they attended, what their goals were…