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Author: John E. Dicken
Publisher: DIANE Publishing
Keywords: oversight, mcs, state, complaint, investigations, improve, guidance, homes, reliable, data, consistent, nursing
Number of Pages: 58
Published: 2011-08
ISBN-10: 1437985572
ISBN-13: 9781437985573

The Centers for Medicare & Medicaid Services (CMS) contracts with state survey agencies to investigate complaints about nursing homes from residents, family members, and others. CMS helps assure the adequacy of state complaint processes by issuing guidance, monitoring data that state survey agencies enter into CMS's database, and annually assessing performance against specific standards. Concerns have been raised about complaint investigations and CMS's oversight. This report examined: (1) complaints received and investigated by state survey agencies; (2) whether those agencies were meeting CM

Author: James Cosgrove
Publisher: DIANE Publishing
Keywords: limited, marketing, data, scope, issue, inappropriate, affected, advantage, cms, assists, beneficiaries, medicare
Number of Pages: 48
Published: 2010-05
ISBN-10: 1437928080
ISBN-13: 9781437928082

Questions have been raised about complaints that some Medicare Advantage (MA) org. and their agents inappropriately marketed their health plans to Medicare beneficiaries. Inappropriate marketing may include activities such as providing inaccurate info. about covered benefits and conducting prohibited marketing practices. The Centers for Medicare and Medicaid Services (CMS) is responsible for oversight of MA org. and their plans. This report examined: (1) the extent to which CMS has taken compliance and enforcement actions; (2) how CMS has helped beneficiaries affected by inappropriate marketin

Author: Linda M. Calbom
Publisher: DIANE Publishing
Keywords: federal, reimbursement, needed, claims, state, financial, management, oversight, medicaid
Number of Pages: 46
Published: 2003-07
ISBN-10: 0756725305
ISBN-13: 9780756725303

The Fed. gov't. & states share responsibility for the fiscal integrity & fin'l. mgmt. (FM) of the jointly funded Medicaid program. At the Fed. level, the Centers for Medicare & Medicaid Services (CMS) is responsible for overseeing state fin'l. activities & ensuring the propriety of expend. reported by states for Fed. reimburse. This report reviews the adequacy of CMS's fin'l. oversight process for Medicaid. It assesses whether: CMS has an adequate oversight process to help ensure the propriety of Medicaid expend.; CMS adequately evaluates & monitors the results of its oversight process; & the

Author: Kay L. Daly
Publisher: DIANE Publishing
Keywords: management, internal, control, pervasive, contract, deficiencies, medicare, medicaid, services, centers
Number of Pages: 65
Published: 2010-10
ISBN-10: 1437926258
ISBN-13: 9781437926255

As a result of internal control deficiencies discussed in a 2007 report on certain contracts at the Centers for Medicare and Medicaid Services (CMS), the auditor was asked to identify the extent to which CMS: (1) implemented effective control procedures over contract actions; and (2) established a strong control environment for contract management. The auditor used a statistical random sample of 2008 CMS contract actions to assess CMS internal control procedures. The results were projected to the population of 2008 CMS contract actions. The auditor reviewed contract file documentation and inte

Author: Linda T. Kohn
Publisher: DIANE Publishing
Keywords: encourage, healthy, information, technology, programs, incentive, prescribing, cms, address, inconsistencies, electronic
Number of Pages: 81
Published: 2011-06-01
ISBN-10: 1437981844
ISBN-13: 9781437981841

Congress established two Centers for Medicare & Medicaid Services (CMS)-administered programs - the Electronic Prescribing Program and the Electronic Health Records (EHR) Program - that provide incentive payments to eligible Medicare providers who adopt and use health information technology, and penalties for those who do not. This report examined how CMS determines which providers receive incentive payments and avoid penalties from that program and how many providers received incentive payments in 2009. Also, it reviewed relevant laws and regulations, interviewed CMS officials, and analyzed C

Author: Leslie G. Aronovitz
Publisher: DIANE Publishing
Keywords: medical, equipment, supplies, payments, improper, improvements, needed, address, medicare
Number of Pages: 34
Published: 2007-08
ISBN-10: 1422315630
ISBN-13: 9781422315637

The Centers for Medicare & Medicaid Services (CMS) -- the agency that administers Medicare -- estimated that the program made about $700 million in improper payments for durable medical equipment, prosthetics, orthotics, & supplies (DMEPOS) from April 1, 2005, through March 31, 2006. To protect Medicare from improper DMEPOS payments, CMS relies on 3 Program Safeguard Contractors (PSC), & 4 contractors that process Medicare claims, to conduct critical program integrity activities. This report examines CMS¿s & CMS¿ contractors¿ activities to prevent & minimize improper payments for DMEPOS, &

Author: Kathleen M. King
Publisher: DIANE Publishing
Keywords: implementation, contractors, performance, standards, progress, made, contracting, reform, agency, medicare
Number of Pages: 68
Published: 2010-08
ISBN-10: 1437932878
ISBN-13: 9781437932874

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 significantly reformed contracting for payment of Medicare's $310 billion per year in fee-for-service claims. The Centers for Medicare and Medicaid Services (CMS) is transitioning claims administration to 19 new entities known as Medicare Administrative Contractors (MAC) and plans to complete the process ahead of Oct. 1, 2011, the date required by law. This report examined: (1) how CMS has implemented Medicare contracting reform; (2) how CMS assessed the performance of the MACs and what the results of its assessments ha
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