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Diane Publishing Books
Medicaid Information Technology: CMS Supports Use of Program Integrity Systems but Should Require States to Determine Effectiveness
Valerie C. Melvin (au); Carolyn L. Yocom (au)
Medicaid is a joint federal-state program that provides health care coverage to certain low-income individuals. The program is overseen by the Centers for Medicare & Medicaid Services (CMS), while the states that administer Medicaid are tasked with taking actions to ensure its integrity. Such actions include implementing info. tech. (IT) systems that provide program integrity analysts with capabilities to assess claims, provider, beneficiary, and other data relevant to Medicaid; and preventing and detecting improper payments to providers. This report determined (1) the types and implementation status of the IT systems used by states to support program integrity initiative; (2) the extent to which CMS is making available data, tech. resources, and funds to support Medicaid programsäó» efforts to implement systems; and (3) key challenges that Medicaid programs have faced in using IT to enhance program integrity initiatives, and CMSäó»s actions to support efforts to overcome them. Figures. This is a print on demand report.
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