At 1ˢᵗ Credentialing we know that when our clients place their trust in us, we take that responsibility seriously by communicating with our clients to create a transparent and collaborative partnership.
Healthcare organizations of every size realize that hiring 1ˢᵗ Credentialing is the most economical and efficient way to solve their credentialing needs. We have the training, expertise and commitment it takes to keep a complex process moving forward at all times.
1ˢᵗ Credentialing supports healthcare practices of all sizes - from health systems, to community hospitals, to large group practices, to smaller organizations. We help get your providers up and practicing as fast as possible.
Learning more about the credentialing process benefits us and our clients. 1ˢᵗ Credentialing offers regular videos and newsletter updates to bring our clients and those interested in innovations in credentialing up to speed.
CMS Announces Initiatives to Strengthen Medicaid Integrity
The Centers for Medicare and Medicaid Services (CMS) recently announced several new initiatives to strengthen Medicaid integrity.
The initiatives are primarily focused on state Medicaid agencies. However, Medicaid providers and managed care organizations should expect an eventual effect that may impact their finances and operations.
Here is a brief description of the new CMS initiatives:
Targeted audits of managed care organization financial reporting in some states, focusing on previously identified high-risk vulnerabilities and other behavior found detrimental to Medicaid.
Audits of state beneficiary eligibility determinations in some states.
State data quality and completeness review.
Data analytics pilots to help states analyze Medicaid claim data and potential investigation target areas.
Pilot process to screen Medicaid providers on behalf of states on an opt-in basis.
Enhanced data sharing and collaboration with states – for example, the Social Security Administration’s Death Master File will be made available for states to assist with provider enrollment activities.
Public reporting of Medicaid scorecard performance by state along with integrity performance measures.
Medicaid provider education to reduce improper payments.
Impact on Managed Care Organizations and Providers
An analysis in Lexology.com summarized the impact of these initiatives as CMS adds pressure to states.
The states will apply pressure for accuracy and for compliance with Medicaid requirements on managed care organizations and providers. Providers should review their compliance plans to be ready for contact from state Medicaid.
In addition to improving Medicaid accuracy and compliance, another intended consequence of the initiatives may be to slow the dramatic increase in federal Medicaid expenditures that was experienced between 2013 and 2016 – a huge 38% increase.
Let Us Manage All Your Payer Enrollment Services
If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.
Our credentialing experts are here to help you assess exactly which solutions you need to put you on the right track. 1ˢᵗ Credentialing includes payor enrollment for all insurance networks. Don’t wait another minute, contact our team today!