Cotiviti’s Post

❗️PSA for Home Care Agencies in North Carolina: As of July 1st, Tailored Plans are now in effect. What does this change mean for you? It opens up new opportunities but might also leave many providers feeling uncertain. Join me in my upcoming webinar where I’ll discuss these changes and other NC Medicaid topics in detail. If you're a home care owner or biller in #NorthCarolina, don't miss out. Registration Link: https://lnkd.in/gd2vGmZs

It's your weekly video! This week: expanded access to healthcare = substantial drops in crime. You want to be safer walking down the street? Get your neighbors access to doctors & medicines. The data goes both ways. First, the ACA's expansion of Medicaid dropped crime: https://lnkd.in/evZtvxEa Looking back at 2005 when Tennessee told everyone to fuck off and closed up TennCare (which 1/4 TN adults relied on for healthcare) in 2005 we see...the opposite. Crime rises when healthcare falls. Especially violent crime. https://t.co/cK6NugILk9 All of which is to say, if we really cared about public safety, we'd probably change our healthcare system to make sure that anyone who needed medicine could get it, and spend money on that instead of police who play Candy Crush in the subway.

This is a great month to talk to your senators and congressional representatives about Senate Bill S. 2973 + S. 3430, and House Bill H.R. 5378. S. 2973 - Bans spread pricing in Medicaid managed care by requiring a fair and transparent reimbursement to pharmacies and saves over $1 billion S. 3430 - Unanimously passed the Senate Finance Committee. Includes the No PBMs Act which requires CMS to define reasonable and relevant H.R. 5378 - Bans spread pricing in Medicaid managed care by requiring a fair and transparent reimbursement to pharmacies and saves over $1 billion FIGHT FOR CHANGE! #PBMreformNOW #GetLOUD

The case, which was initiated by a whistleblower, alleges that ChristianaCare provided free or below-market value support services to non-employee doctors, who then referred patients to the health system. These referrals in turn led to ChristianaCare billing Medicaid. State and federal authorities said providing free or below-market value support services induced referrals in violation of Delaware’s Patient Brokering and Anti-Kickback laws. Because the inducements were unlawful, any resulting billing to Medicaid was a false or fraudulent claim and illegal under the federal and state rules. Read full article: https://lnkd.in/e_tVHJsq #delawarenews #delaware #delawaremedia #delawareinvestments #christianacare

Wondering if Medicaid can take a portion of a nursing home settlement? Under Federal and Georgia law, Medicaid may have rights to some of the settlement money, especially if it's related to injury payments. This podcast episode delves into the specifics of when and how Medicaid can claim these funds. It's crucial information for anyone involved in a nursing home settlement case. Listen/Watch the full episode - https://lnkd.in/djDFB2Ju #MedicaidClaims #nursinghomesettlement #legaladvice #GeorgiaLaw #FederalLaw #injurycompensation #nursinghomeabusepodcast #settlementcase

Agents - do you have clients turning 65? Join Jon Randall today at 10 Central for a live discussion on bridging Medicare gaps with coverage that every 65-year-old could need! Click here to join us >> https://lnkd.in/egq3UncG #shorttermcare #extendedcare #insuranceagents #insurancesales

California really pushed the 1115 envelope on bringing up Enhanced Care Management for Long Term Care Populations. The attached DHCS Spotlight Focus on ECM is a great resource for state Executive/Legislative policy makers, Medicaid, BH/SUD/IDD/LTC state agencies, providers, advocates, and managed care plans/ACOs to learn about ECM and what aspects of the model can assist your vision, policy, and operational improvement plans. #bestpracticelearning

Billing the government for reimbursement of medical services is a complex task, and there are many different ways that coding errors or other mistakes can wind up being charged as fraud, with the potential for medical providers to lose their license, their practice, or even wind up in jail. Learn about navigating the complexities of Medicare and Medicaid (Medi-Cal) fraud in California. https://lnkd.in/dSaiEe_U

Procedural terminations are on the rise in Virginia. We noted an 11% increase in procedural terminations MoM. Effective Coverage Management solutions are essential for re-enrolling patients who have lapsed for procedural reasons. Learn how PointCare's full-service Medicaid Coverage Management solutions can help: https://bit.ly/4cchaTp

If you or a loved one is facing a diagnosis that often leads to long-term care, or you have a significant family history of your family needing long-term care, you might want to consider planning for Medicaid in advance. This is different from crisis Medicaid planning (although it may still present a financial crisis). In these situations, we have time to think and craft a plan, which may have more options than an emergency situation. Contact our office to book your FREE 30-MINUTE CONSULTATION! www.palumboandsweet.com ⠀ #palumboandsweet #attorney #elderlaw #medicaidplanning #estateplanning #assetprotection #freeconsultation