This is an article the Healthcare system in the state of Missouri. The paper answers some of the questions regarding the Federal requirements on the acquisition of Medicare and Medicaid particularly on the light of the new regulations. The article focuses on the challenges of the current status of the provision of the health services amongst stakeholders. Focusing in St. Louis, this essay examines the cultural, social, and political challenges that affect both the providers of healthcare and the recipient patients.
In the conditions for participation, CMS has undertaken a carefully done review of their conditions with the aim of eliminating previously put laws that hindered hospitals burden on the acquisition of Medicare. The changes have occurred out of the new legislations, the modernization of the services courtesy of technology, as well as the evolution of healthcare delivery. While the new burdens have been eliminated, they have not reduced burdens on medical professionals. Professionals now have to act faster and more careful to increase efficiency as well as providing good patient care. CMS reviewed all Medicare/Medicaid requirements that are misaligned for dual eligible individuals to identify those it should revise based on conflicting or contradictory requirements (CMC. GOV. 2013).
I am surprised by the requirement that Medicare FFS review claims already reviewed by independent medical review contractors for the sake of determining if they were already properly billed in the areas of medical coverage, coding, and billing rules. It is even unusual that if the given criteria are not followed, then the claim is automatically regarded as total or improper medical payment. I was also surprised that the last payments are measured on the account of medical requirements are not flexible enough to accommodate for unusual occurrences. It was also important that in the state of Missouri, the CERT program has no jurisdiction to label a claim as fraudulent. To Improve the CERT program in Missouri, I would encourage offering webinars and forums about the program. My goal would be to ensure that the public are aware of how the program runs.
In the state of Missouri, the MO Health NET claims are usually processed and sponsored by state agent who must operate according to the policies set MO Health Net within the department of social services. The problem with the Medicare provision in Missouri is the inability of some hospitals to claim some services as Medicaid revenue. Instead, they claimed the same services as charitable donations. Because of this method of classification, over 15 hospitals were overpaid at the rate of $8,356,888. The period from 1997- 2001 reports that the state of Missouri failed to claim taxes that violated medical rules and regulations. Some Hospitals in Missouri claimed Medicaid as revenues instead of reduced expenses or donations. Together with other discrepancies, these misunderstandings claimed so many problems associated with the program’s efficiency (MaCellan, 2004).
The False Act is also known as the Lincoln Law. The law is a federal law that gives penalty of liability for frauds committed by agents or contractors of governments. The most used provision of the act on the Medicare/Medicaid area includes the first and the second aspects of the law. The first aspect prohibits the presentation of false claims to the United States government with forged documents with an intention of having a false claim paid. In some cases, the law involves aspects like overcharging on costs as well as minor details and following the right protocol for the reimbursements. The implementation of these programs has led to the reanalysis of the program at the Federal level (CMC.Gov, 2013).
In conclusion, this has been a paper on the effectiveness of the Medicaid and Medicare provisions that have been postulated by the new structures.
Work Cited
CMC. GOV. (2013). Comprehensive Error Rate Testing (CERT). Retrieved from CMC. GOV website: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/CERT/index.html?redirect=/CERT/
MaCellan, M. (May, 2004). Department of Health and Human Services OFFICE OF INSPECTOR GENERAL. REVIEW OF THE CLASSIFICATION OF MISSOURI PROVIDER TAX REFUNDS ON HOSPITALS’ MEDICARE COST REPORTS, 2(1), 1-12.
