"Result for Medicaid"

Modular systems for Medicaid Administration

May 3, 2017

Modular systems for Medicaid Administration The Medicaid program has accrued political significance due to its positive impact on the health of underprivileged citizens. As a result, there has been constant fine-tuning of its policies (Affordable Care Act being the last update) to improve its reach to the needy sections cutting across the society.

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A nightmare for both Healthcare Providers and Medicaid Enrollment Analysts

October 5, 2016

Providers are struggling – Providers face a tough challenge in filling paper applications costing weeks and even months due to the increasingly complex eligibility and documentation requirements. The inherent complexity often leads to large percentage of deficiencies and rejections due to errors and omissions. Portals where available remain simple and static and are often less preferred than paper due to severe limitations.

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While Medicaid focus on mere member eligibility, the MCOs reap the benefit

August 3, 2016

The attitude, the opportunity and the environment together bolsters certain individuals to abuse the healthcare system. When it comes to ineligible beneficiaries, fraud permeates in different dimensions from eligibility abuse and card sharing to Doctor shopping and drug diversion. However, not all the Medicaid abuse is directly attributable to ineligible beneficiaries, but, the payout of huge lot of such unnecessary premiums

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Fraud – not just confined to Providers

July 6, 2016

Medicaid, a federal–state health-financing program for low-income and medically needy individuals, is a significant expenditure for the federal government and the states, with total federal outlays of $331 billion in fiscal year 2015. The federal watchdog Government Accountability Office estimates that about $29 billion of the payments made under Medicaid are “improper payments” which encapsulate fraud,

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Doctor Shoppers ? Not all of them….or are they ?

May 4, 2016

Let’s begin with a story – A patient consults a physician for a particular chronic ailment; buys a controlled drug based on the physician’s prescription; not satisfied with the results, visits multiple physicians; gets multiple prescriptions on scheduled drugs, but still in vain. In this case, irrespective of whether the patient gets pain relief or not,

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