Partner Cheryl Wagonhurst spoke with James G. Sheehan, New York State Medicaid Inspector General and Paul Levy, M.D., Ralph W. Prince Professor of Medicine and Vice Chairman of the Department of Medicine at the University of Rochester Medical Center for a VHA audio conference titled “Interplay and Interaction of Federal and State Quality and Compliance Initiatives” on October 20, 2008.
CMS and State Medicaid agencies are moving from being a passive payer to an active purchaser of value based services and are establishing monitoring systems to ensure they pay for quality services that are medically necessary. The quality of care being provided and billed is under dramatically increased scrutiny.
The full implementation of the Medicaid Integrity Program (MIP) along with other federal initiatives such as Value Based Purchasing (VBP), Pay For Performance (P4P), Present on Admission Indicators (POA), and the Recovery Audit Contractor (RAC) Program highlight this focus of State and Federal agencies on compliant quality care. Enforcement is increasing and providers need to take stock of their internal processes.
This program provided insight and guidance to providers on:
- Recent trend of enforcement actions against healthcare providers
- Impact of data mining, reporting obligations, pay for performance and CMS quality initiatives
- OIG/AHLA guidance for Boards of Directors
- How to integrate quality into your compliance program