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The Sunshine Act requires manufacturers of drugs, medical devices, biological and medical supplies covered by the three federal health care programs Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) to collect and track all financial relationships with physicians and teaching hospitals and to report these data to the Centers for Medicare and Medicaid Services (CMS).
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 85 million low-income and disabled people as of 2022; [3] in 2019, the program paid for half of all U.S. births. [4]
For every patient encounter, providers must record both ICD codes to identify the diagnosis and CPT codes to document the treatment. Given the vast number of codes—approximately 70,000 for ICD and over 10,000 for CPT—using advanced medical billing software is recommended to streamline the coding process, reduce errors, and ensure compliance ...
Mako Medical, a Raleigh-based lab-testing company, has agreed to pay the state $2.1 million after state investigators identified unnecessary Medicaid billing for urine drug tests over five years.
The structure of the insurance plan may also include a Health savings account or HSA, which enable workers to save money tax-free for health expenses. The Kaiser Family Foundation reported that employer-based health insurance premiums for a family of four averaged $18,765 in 2017, up 3% from the prior year, although there was considerable ...
There’s another $950 million from the provider taxes used across 16 lines of the Medicaid budget, drawing at least $1.8 billion in federal funds. The taxes have been renewed 16 times during ...
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