Medicaid

Medicaid Eligibility Redeterminations PHE FFCRA Syrtis Solutions

27 Jun PHE MEDICAID ELIGIBILITY REDETERMINATIONS

In January 2020, DHHS declared the Coronavirus a public health emergency. Since then, the Public Health Emergency (PHE) has been renewed nine times, but it is set to expire this August unless it is extended again. Its expiration will have a significant impact on Medicaid,...

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MEDICAID IMPROPER PAYMENTS 2023 SYRTIS SOLUTIONS

28 Feb ELIGIBILITY ERRORS ARE COSTING MEDICAID BILLIONS

Since its passage in 1965, the Medicaid program has expanded to become the single largest payer for health care in the United States, costing $671.2 billion in 2020. Due to surges in enrollment from the pandemic and the current administration's priorities, spending is only expected to...

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House Energy and Commerce Committee Investigate MEDICAID IMPROPER PAYMENTS Syrtis Solutions

28 Oct MEDICAID IMPROPER PAYMENTS CAUSE CONCERN

Under the Payment Integrity Information Act of 2019, the Centers for Medicare & Medicaid Services (CMS) was required to review federal programs at risk of improper payments. The bill tasked CMS to assess what programs are at risk, estimate the number of improper payments, and report...

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MEDICAID TPL AND IMPROPER PAYMENTS LEGISLATION SYRTIS SOLUTIONS

30 Aug MEDICAID TPL AND IMPROPER PAYMENTS LEGISLATION

Over the last 56 years, Medicaid has helped provide health services to the most vulnerable populations in the United States. As member enrollment surges, Medicaid TPL and fiscal responsibility have been problematic. To resolve these issues, several legislative efforts have occurred to curb fraud, waste,...

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MEDICAID PHARMACY CARVE-OUT SYRTIS SOLUTIONS PROTPL

29 Jul MEDICAID PHARMACY CARVE-OUTS

    Wisconsin Pharmacy Carve-Out Last year, the Wisconsin Department of Health Services carved out prescription drugs from the Family Care Partnership Program and transitioned to a Fee-for-Service (FFS) delivery model. The carve-out ensured compliance with the 2020 Medicaid and CHIP Managed Care Final Rule and eliminated the...

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30 Jun MEDICAID CAN SAVE MILLIONS WITH E-PRESCRIBING

Medicaid payers of last resort face the challenging task of recovering claims payments made in error when program beneficiaries fail to report primary coverage information at the time services are provided. Plan members do not share other coverage information for a multitude of reasons, but...

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Cost Avoidance Coverage Eligibility Enrollment Medicaid 2021 Medicaid Financing ProTPL Section 1115 Waivers Syrtis Solutions

29 Jan MEDICAID IN 2021

The Coronavirus pandemic and the consequential economic recession accentuated the importance of the Medicaid program last year. By February, the Medicaid enrollment rate increased to 7.4 percent, and 76.5 million people were enrolled in the jointly funded program. In 2021, the new administration, economy, and...

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MEDICAID IMPROPER PAYMENTS SYRTIS SOLUTIONS CMS FY 2020

18 Dec $86.49 BILLION IN MEDICAID IMPROPER PAYMENTS

Medicaid is the single largest payer of health care in the United States. As the program has grown in size and scope, it has struggled with fraud, waste, abuse, and improper payments. Over the years, there have been a number of federal initiatives to rein...

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