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PHARMACY DRUG REBATE – SELF DISCLOSURES

April 27th, 2016

The Deficit Reduction Act of 2005 (DRA) requires states to collect rebates for certain drugs.  In order to collect accurate data for the rebate process, all incorrectly billed pharmacy claims must be corrected in the Medicaid billing system so accurate … Continued


LONG-TERM CARE FACILITY CREDIT BALANCE AUDITS

April 26th, 2016

As reported in a previous gov.delivery message by Missouri Medicaid Audit and Compliance (MMAC), HMS will soon begin conducting credit balance audits on behalf of the Missouri Department of Social Services, MO HealthNet Division, (MHD) and MMAC. Click here to … Continued


HOSPITAL CREDIT BALANCE AUDITS

April 14th, 2016

  As reported in a previous gov.delivery message by Missouri Medicaid Audit and Compliance (MMAC), HMS will soon begin conducting credit balance audits on behalf of the Missouri Department of Social Services, MO HealthNet Division, (MHD) and MMAC. Click here … Continued


HOME AND COMMUNITY BASED SETTING REQUIREMENTS

April 12th, 2016

What are Home and Community-Based Setting Requirements?   The Centers for Medicare & Medicaid Services (CMS) published a final rule to enhance the quality of Home and Community-Based Services (HCBS) and to provide protections for participants.  The rule, or “setting … Continued


HMS TO CONDUCT CREDIT BALANCE AUDITS (CBA) AND LONG TERM CARE AUDITS (LTC) ON PATIENT ACCOUNTS

April 5th, 2016

Credit balances on patient accounts occur for a variety of reasons.  For instance, providers sometimes receive duplicate payments, charges may be reversed, billing data may be incomplete, and third party liabilities may be incorrectly applied.  Providers routinely identify and refund these … Continued