Medicaid's Quality Control System is Not Realizing Its Full Potential: Report to the Congress |
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Report to the Congress United States. General Accounting Office. B 1,509,057 BY THE COIVI ROLLER GENERAL Report To The Congress PUB UNITED STATES HD 7102 .U4 U5582 1981 Medicaid's Quality ... quality control program ( which includes analyses ...
Report to the Congress United States. General Accounting Office. B 1,509,057 BY THE COIVI ROLLER GENERAL Report To The Congress PUB UNITED STATES HD 7102 .U4 U5582 1981 Medicaid's Quality ... quality control program ( which includes analyses ...
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Report to the Congress United States. General Accounting Office. Request for copies of GAO reports should be sent to : U.S. General Accounting Office Document Handling and Information Services Facility P.O. Box 6015 Gaithersburg , Md ...
Report to the Congress United States. General Accounting Office. Request for copies of GAO reports should be sent to : U.S. General Accounting Office Document Handling and Information Services Facility P.O. Box 6015 Gaithersburg , Md ...
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... quality control program because it is a primary means of identifying actions needed to reduce erroneous Medicaid payments , which are esti- mated to exceed $ 1 billion a year . Copies are being sent to the Director , Office of Manage ...
... quality control program because it is a primary means of identifying actions needed to reduce erroneous Medicaid payments , which are esti- mated to exceed $ 1 billion a year . Copies are being sent to the Director , Office of Manage ...
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Report to the Congress United States. General Accounting Office. рив HD 7102 04 45582 1981 COMPTROLLER GENERAL'S REPORT TO THE CONGRESS Tear Sheet MEDICAID'S QUALITY.
Report to the Congress United States. General Accounting Office. рив HD 7102 04 45582 1981 COMPTROLLER GENERAL'S REPORT TO THE CONGRESS Tear Sheet MEDICAID'S QUALITY.
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Report to the Congress United States. General Accounting Office. COMPTROLLER GENERAL'S REPORT TO THE CONGRESS Tear Sheet MEDICAID'S QUALITY CONTROL SYSTEM IS NOT REALIZING ITS FULL POTENTIAL DIGEST Based on data from the Medicaid Quality ...
Report to the Congress United States. General Accounting Office. COMPTROLLER GENERAL'S REPORT TO THE CONGRESS Tear Sheet MEDICAID'S QUALITY CONTROL SYSTEM IS NOT REALIZING ITS FULL POTENTIAL DIGEST Based on data from the Medicaid Quality ...
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Common terms and phrases
accuracy administrative costs AFDC Alabama APPENDIX II APPENDIX base period believe claims paid claims processing errors claims processing reviews claims processing sample corrective action activities corrective action plans corrective action program disallowance dollar effective eligibility determinations eligibility review eligible for Medicaid erroneous Medicaid payments erroneous payments example Federal Medicaid regulations Federal regulations Federal sharing fiscal penalties fiscal sanctions funds GAO Recommendation HCFA MQC reviewers HCFA regional offices HCFA reviewers HCFA subsample HCFA's identified implementation improve incentives Louisiana Medicaid eligibility Medicaid program Medicaid Quality Control misspent MQC corrective action MQC data MQC file MQC program MQC system MQC unit MQC's Office of Quality Oklahoma paid claims percent problems processing and third-party program weaknesses quality control program re-review recipients recovery efforts review criteria review month Secretary of HHS State's Medicaid statistical sample stratum Supplemental Security Income target error rate third-party liability reviews verification Washington
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Page 2 - Association, the national professional association of registered nurses. The American Nurses' Association is the professional organization of over 200,000 registered nurses in 50 States, the District of Columbia, Guam, Puerto Rico, the Virgin Islands, and the Canal Zone. I have with me two members of the staff, Mr. Zembower and Mr. Craig who are members of the staff of the American Nurses' Association to answer any questions you might have.
Page 1 - Medicaid— authorized by title XIX of the Social Security Act, as amended (42 USC 1396...
Page 2 - AFDC family (adjusted for family size) and 13SVs percent of the payment to such AFDC family. All of these variations — in benefits offered, in groups covered, in income standards, and in levels of reimbursement for providers — mean that Medicaid programs differ greatly from state to state. All states require Medicaid patients in longterm care institutions to contribute their excess income (generally all income over the $25 they require for personal needs) to help pay for the cost of their care....
Page 1 - Medicare, this is the Health Care Financing Administration (HCFA), Department of Health and Human Services (HHS).
Page ii - ... of which would reduce erroneous payments. Because the error rates are tied to the penalties, HCFA has placed its emphasis on developing quality control processes and policies which will provide statistically defensible error rates which can withstand challenge if penalties are assessed.
Page 2 - MQC findings), approximately $461 million was paid for health services to ineligible beneficiaries, $74 million was lost in unrecovered third-party liability, and $100 million was wasted through claims processing errors.
Page 11 - Unfortunately, this emphasis on corrective action plans apparently was an effort not so much to improve Medicaid management as to avoid imposing the fiscal penalties.
Page 7 - Because corrective action is the ultimate purpose of MQC, the threat of penalties has partially negated its expected benefits...
Page ii - This could be accomplished by — reducing the magnitude of the penalties for poor performance and — providing rewards of similar magnitude for good performance...
Page 44 - MEDICAID'S QUALITY CONTROL SYSTEM IS NOT REALIZING ITS FULL POTENTIAL" Overview The report accurately indicates certain improvements which will increase the usefulness of the Medicaid Quality Control (MQC) system.