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Improvements Are Needed To Ensure Provider Enumeration And Medicare Enrollment Data Are Accurate Complete And Consistent
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Book Synopsis Improvements Are Needed to Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and Consistent. by : CreateSpace Independent Publishing Platform
Download or read book Improvements Are Needed to Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and Consistent. written by CreateSpace Independent Publishing Platform and published by Createspace Independent Publishing Platform. This book was released on 2018-07-03 with total page 46 pages. Available in PDF, EPUB and Kindle. Book excerpt: Improvements are needed to ensure provider enumeration and Medicare enrollment data are accurate, complete, and consistent.
Author :United States. Department of Health and Human Services. Office of Inspector General Publisher : ISBN 13 : Total Pages :41 pages Book Rating :4.:/5 (951 download)
Book Synopsis Improvements are Needed to Ensure Provider Enumeration and Medicare Enrollment Data are Accurate, Complete, and Consistent by : United States. Department of Health and Human Services. Office of Inspector General
Download or read book Improvements are Needed to Ensure Provider Enumeration and Medicare Enrollment Data are Accurate, Complete, and Consistent written by United States. Department of Health and Human Services. Office of Inspector General and published by . This book was released on 2013 with total page 41 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Managing Information Risks by : William Saffady
Download or read book Managing Information Risks written by William Saffady and published by Rowman & Littlefield. This book was released on 2020-10-28 with total page 257 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managing Information Risks: Threats, Vulnerabilities, and Responses identifies and categorizes risks related to creation, collection, storage, retention, retrieval, disclosure and ownership of information in organizations of all types and sizes. It is intended for risk managers, information governance specialists, compliance officers, attorneys, records managers, archivists, and other decision-makers, managers, and analysts who are responsible for risk management initiatives related to their organizations’ information assets. An opening chapter defines and discusses risk terminology and concepts that are essential for understanding, assessing, and controlling information risk. Subsequent chapters provide detailed explanations of specific threats to an organization’s information assets, an assessment of vulnerabilities that the threats can exploit, and a review of available options to address the threats and their associated vulnerabilities. Applicable laws, regulations, and standards are cited at appropriate points in the text. Each chapter includes extensive endnotes that support specific points and provide suggestions for further reading. While the book is grounded in scholarship, the treatment is practical rather than theoretical. Each chapter focuses on knowledge and recommendations that readers can use to: heighten risk awareness within their organizations, identify threats and their associated consequences, assess vulnerabilities, evaluate risk mitigation options, define risk-related responsibilities, and align information-related initiatives and activities with their organizations’ risk management strategies and policies. Compared to other works, this book deals with a broader range of information risks and draws on ideas from a greater variety of disciplines, including business process management, law, financial analysis, records management, information science, and archival administration. Most books on this topic associate information risk with digital data, information technology, and cyber security. This book covers risks to information of any type in any format, including paper and photographic records as well as digital content.
Book Synopsis Geographic Adjustment in Medicare Payment by : Institute of Medicine
Download or read book Geographic Adjustment in Medicare Payment written by Institute of Medicine and published by National Academies Press. This book was released on 2012-05-23 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare is the largest health insurer in the United States, providing coverage for 39 million people aged 65 and older and 8 million people with disabilities, and reaching more than an estimated $500 billion in payments in 2010. Although Medicare is a national program, it adjusts fee-for-service payments according to the geographic location of a practice. While there is widespread agreement about the importance of providing accurate payments to providers, there is disagreement about how best to adjust payment based on geographic location. At the request of Congress and the Department of Health and Human Services (HHS), the Institute of Medicine (IOM) examined ways to improve the accuracy of data sources and methods used for making the geographic adjustments to payments. The IOM recommends an integrated approach that includes moving to a single source of wage and benefits data; changing to one set of payment areas; and expanding the range of occupations included in the index calculations. The first of two reports, Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, assesses existing practices in regards to accuracy, criteria consistency, evidence for adjustment, sound rationale, transparency, and separate policy adjustments to reform the current payment system. Adopting the recommendations outlined in this report will mean a change in the way that the indexes are calculated, and will require a combination of legislative, rule-making, and administrative actions, as well as a period of public comment. Geographic Adjustment in Medicare Payment will inform the work of government agencies such as HHS, the Centers for Medicare and Medicaid Services, congressional members and staff, the health care industry, national professional organizations and state medical and nursing societies, and Medicare advocacy groups.
Book Synopsis Geographic Adjustment in Medicare Payment by : Institute of Medicine
Download or read book Geographic Adjustment in Medicare Payment written by Institute of Medicine and published by National Academies Press. This book was released on 2012-04-23 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare is the largest health insurer in the United States, providing coverage for 39 million people aged 65 and older and 8 million people with disabilities, and reaching more than an estimated $500 billion in payments in 2010. Although Medicare is a national program, it adjusts fee-for-service payments according to the geographic location of a practice. While there is widespread agreement about the importance of providing accurate payments to providers, there is disagreement about how best to adjust payment based on geographic location. At the request of Congress and the Department of Health and Human Services (HHS), the Institute of Medicine (IOM) examined ways to improve the accuracy of data sources and methods used for making the geographic adjustments to payments. The IOM recommends an integrated approach that includes moving to a single source of wage and benefits data; changing to one set of payment areas; and expanding the range of occupations included in the index calculations. The first of two reports, Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, assesses existing practices in regards to accuracy, criteria consistency, evidence for adjustment, sound rationale, transparency, and separate policy adjustments to reform the current payment system. Adopting the recommendations outlined in this report will mean a change in the way that the indexes are calculated, and will require a combination of legislative, rule-making, and administrative actions, as well as a period of public comment. Geographic Adjustment in Medicare Payment will inform the work of government agencies such as HHS, the Centers for Medicare and Medicaid Services, congressional members and staff, the health care industry, national professional organizations and state medical and nursing societies, and Medicare advocacy groups.
Book Synopsis Developing an Information Infrastructure for the Medicare+Choice Program by : Institute of Medicine
Download or read book Developing an Information Infrastructure for the Medicare+Choice Program written by Institute of Medicine and published by National Academies Press. This book was released on 1999-03-09 with total page 75 pages. Available in PDF, EPUB and Kindle. Book excerpt: On March 4 and 5, 1998, the Institute of Medicine (IOM) Committee on Choice and Managed Care held a 2-day workshop entitled Developing the Information Infrastructure for Medicare Beneficiaries. This workshop was a follow-up to the IOM report entitled Improving the Medicare Market: Adding Choice and Protections. The workshop focused on the Medicare provisions in the Balanced Budget Act of 1997, which mandate that the Health Care Financing Administration (HCFA) develop a "nationally coordinated education and publicity campaign" in 1998 and move Medicare beneficiaries to an open-season enrollment process by the year 2002.
Author :U. S. Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781542871174 Total Pages :30 pages Book Rating :4.8/5 (711 download)
Book Synopsis Medicare Advantage by : U. S. Government Accountability Office
Download or read book Medicare Advantage written by U. S. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-02 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt: Since GAO issued its July 2014 report, the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) has made limited progress to validate the completeness and accuracy of Medicare Advantage (MA) encounter data. CMS collects encounter data-detailed information about the care and health status of MA enrollees-to determine payments to MA organizations (MAO). These entities received approximately $170 billion to provide coverage to nearly one-third of all Medicare beneficiaries in 2015. The agency uses a risk adjustment process to account for differences in enrollees' expected health care costs relative to an average beneficiary. Without complete and accurate encounter data, CMS cannot appropriately risk adjust MAO payments. CMS has begun compiling basic statistics on the volume and consistency of data submissions and preparing automated summary reports for MAOs indicating diagnosis information used for risk adjustment. However, CMS has yet to undertake activities that fully address encounter data accuracy, such as reviewing medical records. (See figure.) Furthermore, some health insurance and provider trade associations GAO interviewed voiced concerns about CMS's ability to properly identify diagnoses used for risk adjustment. CMS officials noted that they are working with MAOs to refine how the methodology used to obtain diagnoses data is applied. To the extent that CMS is making payments based on data that have not been fully validated for completeness and accuracy, the soundness of billions of dollars in Medicare expenditures remains unsubstantiated. Given the agency's limited progress, GAO continues to believe that CMS should implement GAO's July 2014 recommendation that CMS fully assess data quality before use.
Book Synopsis Applying Quality Improvement Standards in Medicare by :
Download or read book Applying Quality Improvement Standards in Medicare written by and published by . This book was released on 2002 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicare Program Integrity by : U.s. Government Accountability Office
Download or read book Medicare Program Integrity written by U.s. Government Accountability Office and published by . This book was released on 2017-08-04 with total page 38 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Why GAO Did This StudyAccording to the Centers for Medicare & Medicaid Services (CMS)-the agency within the Department of Health and Human Services (HHS) that administers the Medicare program-more than 1.5 million health providers and suppliers of medical equipment were enrolled in the Medicare program in 2011, and 30,000 more enroll each month. CMS has established Medicare enrollment standards and procedures intended to ensure that only qualified providers and suppliers can enroll. While most providers and suppliers pose a limited risk to the Medicare program, our previous work found persistent weaknesses in CMS's Medicare enrollment standards and procedures that increased the risk of enrolling entities intent on defrauding the program. In 2010, the Patient Protection and Affordable Care Act (PPACA) authorized CMS to implement procedures to strengthen the Medicare enrollment process.GAO was asked to review CMS's Medicare provider enrollment procedures. In this report, GAO describes (1) how CMS and its contractors use provider and supplier enrollment information to prevent improper payments and factors that may affect the usefulness of this information, and (2) the extent to which CMS has implemented new provider and supplier enrollment screening procedures since the enactment of PPACA. To do so, GAO reviewed relevant regulations and documents, and interviewed officials from CMS"
Author :Agency for Healthcare Research and Quality/AHRQ Publisher :Government Printing Office ISBN 13 :1587634333 Total Pages :385 pages Book Rating :4.5/5 (876 download)
Book Synopsis Registries for Evaluating Patient Outcomes by : Agency for Healthcare Research and Quality/AHRQ
Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.
Book Synopsis Medicare by : United States. General Accounting Office
Download or read book Medicare written by United States. General Accounting Office and published by . This book was released on 1989 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicare accuracy of responses from the 1800MEDICARE help line should be improved : report to congressional committees. by :
Download or read book Medicare accuracy of responses from the 1800MEDICARE help line should be improved : report to congressional committees. written by and published by DIANE Publishing. This book was released on with total page 61 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Annual Medicare Program Statistics by :
Download or read book Annual Medicare Program Statistics written by and published by . This book was released on 1986 with total page 152 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis SAS Programming with Medicare Administrative Data by : Matthew Gillingham
Download or read book SAS Programming with Medicare Administrative Data written by Matthew Gillingham and published by SAS Institute. This book was released on 2014-05-01 with total page 168 pages. Available in PDF, EPUB and Kindle. Book excerpt: SAS Programming with Medicare Administrative Data is the most comprehensive resource available for using Medicare data with SAS. This book teaches you how to access Medicare data and, more importantly, how to apply this data to your research. Knowing how to use Medicare data to answer common research and business questions is a critical skill for many SAS users. Due to its complexity, Medicare data requires specific programming knowledge in order to be applied accurately. Programmers need to understand the Medicare program in order to interpret and utilize its data. With this book, you'll learn the entire process of programming with Medicare data—from obtaining access to data; to measuring cost, utilization, and quality; to overcoming common challenges. Each chapter includes exercises that challenge you to apply concepts to real-world programming tasks. SAS Programming with Medicare Administrative Data offers beginners a programming project template to follow from beginning to end. It also includes more complex questions and discussions that are appropriate for advanced users. Matthew Gillingham has created a book that is both a foundation for programmers new to Medicare data and a comprehensive reference for experienced programmers. This book is part of the SAS Press program.
Book Synopsis Medicare Program Integrity by : Kathleen M. King
Download or read book Medicare Program Integrity written by Kathleen M. King and published by . This book was released on 2012-11-05 with total page 37 pages. Available in PDF, EPUB and Kindle. Book excerpt: According to the Centers for Medicare & Medicaid Services (CMS) -- the agency within the Dept. of Health and Human Services (HHS) that administers the Medicare program -- more than 1.5 million health providers and suppliers of medical equipment were enrolled in the Medicare program in 2011, and 30,000 more enroll each month. CMS has established Medicare enrollment standards and procedures intended to ensure that only qualified providers and suppliers can enroll. While most providers and suppliers pose a limited risk to the Medicare program, GAO found persistent weaknesses in CMS's Medicare enrollment standards and procedures that increased the risk of enrolling entities intent on defrauding the program. In 2010, the Patient Protection and Affordable Care Act (PPACA) authorized CMS to implement procedures to strengthen the Medicare enrollment process. This report describes (1) how CMS and its contractors use provider and supplier enrollment information to prevent improper payments and factors that may affect the usefulness of this information; and (2) the extent to which CMS has implemented new provider and supplier enrollment screening procedures since the enactment of PPACA.Tables and figures. This is a print on demand report.
Author :U. S. Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781548805760 Total Pages :30 pages Book Rating :4.8/5 (57 download)
Book Synopsis Medicare Advantage, Limited Progress Made to Validate Encounter Data Used to Ensure Proper Payments by : U. S. Government Accountability Office
Download or read book Medicare Advantage, Limited Progress Made to Validate Encounter Data Used to Ensure Proper Payments written by U. S. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-11 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt: " CMS collects MA encounter data to help ensure the proper use of federal funds by improving risk adjustment in the MA program-the private health plan alternative to traditional Medicare-and for other potential purposes. CMS's ability to make proper payments depends on the completeness and accuracy of MA encounter data. In July 2014, GAO reported that CMS had taken some, but not all, appropriate actions to validate the completeness and accuracy of encounter data and had not fully developed plans for using them. GAO was asked to provide an update on its July 2014 findings. In this report, GAO identifies (1) steps CMS has taken to validate MA encounter data, and (2) CMS's plans and time frames for using MA encounter data-as well as stakeholder perspectives on these steps and plans. To do this work, GAO compared CMS activities with the agency's protocol for validating Medicaid encounter data-comparable data collected and submitted by entities similar to MAOs-and federal internal control standards. In addition, GAO reviewed relevant agency documents and interviewed CMS officials on MA encounter data collection and reporting. GAO also reviewed comments in response to CMS's 2014 proposed rule and reports from stakeholder organizations.
Book Synopsis Medicare by : U.s. Government Accountability Office
Download or read book Medicare written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-26 with total page 24 pages. Available in PDF, EPUB and Kindle. Book excerpt: " Due to its size, complexity, and susceptibility to mismanagement and improper payments, GAO has designated Medicare as a high-risk program. In 2013, Medicare financed health care services for approximately 51 million individuals at a cost of about $604 billion, and reported an estimated $50 billion in improper payments-payments that either were made in an incorrect amount or should not have been made at all. Most of these improper payments were made through the Medicare FFS program, which pays providers based on claims and uses contractors to pay the claims and ensure program integrity. This statement focuses on the progress made and steps still to be taken by CMS to improve improper payment prevention and recoupment efforts in the Medicare FFS program. This statement is based on relevant GAO products and recommendations issued from 2007 through 2014 using a variety of methodologies. GAO also updated information by examining public documents and, in April 2014, GAO received updated information from CMS on its actions related to laws and regulations discussed in this statement. What GAO Found The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that oversees Medicare, has made progress improving improper payment prevention and recoupment efforts in the Medicare fee-for-service (FFS) program, but further actions are needed. Provider enrollment. CMS has implemented certain provider enrollment screening procedures authorized by the Patient Protection and Affordable Care Act (PPACA) that address past weaknesses identified by GAO and others. The agency has also put in place other measures intended to strengthen existing procedures, but could do more to improve provider enrollment screening and ultimately reduce improper payments. For example, CMS has hired contractors to determine whether providers and suppliers have valid licenses, meet certain Medicare standards, and are at legitimate locations. CMS also recently contracted for fingerprint-based criminal history checks of providers and suppliers it has identified as high-risk. However, CMS has not implemented other screening actions authorized by PPACA that could further strengthen provider enrollment. Prepayment controls. In response to GAO's prior recommendations, CMS has taken steps to improve the development of certain prepayment edits-prepayment controls used to deny Medicare claims that should not be paid; however, important actions that could further prevent improper payments have not yet been implemented. For example, CMS has implemented an automated edit to identify services billed in medically unlikely amounts, but has not implemented a GAO recommendation to examine certain edits to determine whether they should be revised to reflect more restrictive payment limits. GAO has found that wider use of prepayment edits could help prevent improper payments and generate savings for Medicare. Postpayment claims reviews. Postpayment claims reviews help CMS identify and recoup improper payments. Medicare uses a variety of contractors to conduct such reviews, which generally involve reviewing a provider's documentation to ensure that the service was billed properly and was covered, reasonable, and necessary. GAO has found that differing requirements for the various contractors may reduce the efficiency and effectiveness of such reviews. To improve these reviews, GAO has previously recommended CMS examine ways to make the contractor requirements more consistent.
