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A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
Medicaid coverage gap; Medicaid Drug Rebate Program; Medicaid Home and Community-Based Services Waivers; Medicaid waiver; Medical necessity; Medical savings account (United States) Medically indigent adult; Medically Unlikely Edit; Medicare Advantage; Medicare and Medicaid Extenders Act of 2010; Medicare for All Act; Medicare Fraud Strike Force
Dual-eligible beneficiaries (Medicare dual eligibles or "duals") refers to those qualifying for both Medicare and Medicaid benefits. In the United States, approximately 9.2 million people are eligible for "dual" status. [1] [2] Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid ...
Electronic visit verification (EVV) is a method used to verify home healthcare visits to ensure patients are not neglected and to cut down on fraudulently documented home visits. Beginning January 1, 2020, home care agencies that provide personal care services must have an EVV solution in place or risk having their Medicaid claims denied, under ...
If states provide a choice of at least two plans, they can mandate enrollment in managed care. Healthy children and families make up the majority of Medicaid managed care enrollees, but an increasing number of states are expanding managed care to previously excluded groups, such as people with disabilities, pregnant women, and children in ...
[12] [13] Softening the eligibility requirements for Medicaid was a central goal of the ACA, [14] forming a two-pronged policy along with subsidized private insurance via health insurance marketplaces to expand health insurance coverage in the U.S. [15] [7] [3] The Medicaid expansion provision of the ACA allowed states to lower the income ...