Centers For Medicare & Medicaid Services - Medicaid .
Audit ToolkitTarget Audience: Medical professionals and State Medicaid agencies.Purpose: The Audit materials compare and contrast the various Medicare and Medicaidreviews, audits, and investigations and provide information on how to minimize compliance riskand prepare for compliance reviews. The toolkit also describes how to design, execute, document,and monitor the results of a basic compliance self-audit of a health care business or medical practice.Toolkit Items: 1 PowerPoint Presentation, 1 Booklet, 1 Fact Sheet, and 1 Resource GuideBasic Data Mining ToolkitTarget Audience: Medical professionals, office billing managers, and StateMedicaid agenciesPurpose: The Basic Data Mining materials provide a crash course for providers and their officestaff who want to know how to understand the metrics of their practice. Providers will learn the basiccharacteristics of data, the various methods for analyzing data, how to ensure data is valid and relevant,how to describe and visualize data, and how to identify qualitative and quantitative anomalies.Toolkit Items: 1 PowerPoint Presentation1 Sample Claim Worksheet, 1 Job Aid,1 Resource Handout, andBehavioral Health Services ToolkitTarget Audience: Behavioral health providers, family physicians, communitymental health centers, and State Medicaid agenciesPurpose: The Behavioral Health Services materials provide important and current educationon billing for behavioral health care services in a variety of settings. The materials help providersunderstand how to bill for basic services such as Early and Periodic Screening, Diagnostic, andTreatment (EPSDT) services for those under 21 years old; Screening, Brief Intervention, and Referralto Treatment (SBIRT) for those with substance use disorders; and community and clinical mental healthservices for all ages.Toolkit Items: 1 Booklet, 1 Checklist, 1 Fact Sheet, and 1 Resource GuideBeneficiary Card Sharing ToolkitTarget Audience: Beneficiaries, beneficiary advocacy groups, community leaders,providers, and State Medicaid agenciesPurpose: The Beneficiary Card Sharing materials provide education on the issues associatedwith sharing Medicaid cards or numbers. The focus of the materials is deterring Medicaidbeneficiaries from fraudulent activity through education about the problems and possible outcomesassociated with sharing a Medicaid card or number.Toolkit Items: 1 PowerPoint Presentation, 1 Fact Sheet, and 1 PostcardMedicaid Education Toolkits are now available on the Medicaid Program Integrity Education tion/edmic-landing.html
Documentation Matters ToolkitTarget Audience: Medical professionals and State Medicaid agenciesPurpose: The Documentation Matters materials describe Medicaid documentation rulesrequired by a variety of medical professionals and preventive strategies they can use toimprove services and billing and decrease improper payments.Toolkit Items: 1 PowerPoint Presentation1 Resource Guide, and 1 Resource Handout, 1 Case Study Guide, 4 Fact Sheets,Drug Diversion ToolkitTarget Audience: Pharmacists, pharmacy technicians, pharmacy residents, pharmacystudents, and State Medicaid agenciesPurpose: The Drug Diversion materials review various aspects of drug diversion, includingthe types of drug diversion, the targeted medications for drug diversion, drug diversionbehaviors, preventive actions, and the consequences for providers and patients involved in drugdiversion activities.Toolkit Items: 3 PowerPoint Presentations, 1 Presentation available for CE*6 Booklets, 2 Fact Sheets, and 1 Resource Guide,*Registration is required on the Medicare Learning Network (MLN) for CE.Electronic Health Records ToolkitTarget Audience: Medical professionals and State Medicaid agenciesPurpose: The Electronic Health Records materials focus on potential program integrityissues while helping providers recognize that moving from paper medical records to electronichealth records can improve the quality, safety, and efficiency of the nation’s health care system.Toolkit Items: 3 Booklets, 2 Checklists, 1 Decision Table, 2 Fact Sheets, 2 Job Aids, and1 Resource HandoutFraud, Waste, and Abuse ToolkitTarget Audience: Medical professionals and State Medicaid agenciesPurpose: The Fraud, Waste, and Abuse materials give a general overview of Medicaidfraud and abuse so providers will be able to recognize, report, and prevent them. The toolkitalso informs providers of Medicaid fraud prosecutions and settlements and some of the programintegrity measures taken by government agencies.Toolkit Items: 1 PowerPoint Presentationand 1 Resource Handout, 1 Booklet, 1 Fact Sheet, 1 Resource Guide,Medicaid Education Toolkits are now available on the Medicaid Program Integrity Education tion/edmic-landing.html
Home and Community-Based Services ToolkitTarget Audience: Medicaid hospice providers, physicians, nursing facility administrators,beneficiaries and persons that help guide their care, and State Medicaid agenciesPurpose: The materials, broken into three toolkits, provide an overview of the Medicaid hospicebenefit; the certification and enrollment process; examples of fraud, waste, and abuse; new practicesfor improvement in communication, documentation, and quality of care; and what hospice providersand other stakeholders can do to help reduce improper payments.Toolkit Items: 2 PowerPoint Presentations13 Fact Sheets, and 1 Resource Guide, 2 Booklets, 5 Beneficiary and 6 Provider Newsletters,Hospice Care ToolkitTarget Audience: Medicaid hospice providers, physicians, nursing facility administrators,beneficiaries and persons that help guide their care, and State Medicaid agenciesPurpose: The Hospice materials provide an overview of the Medicaid hospice benefit; thecertification and enrollment process; examples of fraud, waste, and abuse; new practices forimprovement in communication, documentation, and quality of care; and what hospice providersand other stakeholders can do to help reduce improper payments.Toolkit Items: 2 Booklets, 1 Checklist, and 2 Fact SheetsManaged Care Plan Compliance ToolkitTarget Audience: Managed care plans (MCPs) and State Medicaid agenciesPurpose: The MCP Compliance materials encourage providers and stakeholders in theMedicaid community to become actively involved in preventing, detecting, and reportingMedicaid fraud, waste, and abuse. Materials provide clear and concise guidance to providers ondetecting fraud, waste, and abuse; appropriate follow-up actions; sharing information; and makingmeaningful referrals.Toolkit Items: 1 PowerPoint Presentation1 Resource Handout, 1 Fact Sheet, 1 Referral Guideline, andMedicaid Compliance for the Dental Professional ToolkitTarget Audience: Dentists and State Medicaid agenciesPurpose: The Medicaid Compliance for the Dental Professional materials define andexplain basic elements of a compliance program for dental professionals and how to facilitatecompliance at the practice level. The products explain how to properly document medicalnecessity in the dental context and ways in which a dental practice can implement a Medicaidcompliance program.Toolkit Items: 1 PowerPoint Presentation, 1 Booklet, 1 Fact Sheet, and 1 Resource GuideMedicaid Education Toolkits are now available on the Medicaid Program Integrity Education tion/edmic-landing.html
Non-Emergency Medical Transportation ToolkitTarget Audience: Medicaid beneficiaries, non-emergency medical transportationproviders, and State Medicaid agenciesPurpose: The Non-Emergency Medical Transportation materials explain Medicaid transportationbenefits and the importance for providers and beneficiaries to know the transportation rules in theirStates and to abide by them.Toolkit Items: 1 PowerPoint Presentation, 1 Booklet, and 1 Fact SheetNursing Home ToolkitTarget Audience: Medicaid-participating nursing home providers, Medicaid beneficiaries,beneficiary families and representatives, and State Medicaid agenciesPurpose: The Nursing Home materials contain an overview of nursing home Medicaid coveragerules and services, and discuss quality of care and reporting of abuse and neglect, as well as fraud,waste, and abuse in a nursing home environment.Toolkit Items: 2 Booklets and 2 Fact SheetsOff-Label Pharmaceutical Marketing ToolkitTarget Audience: Medical professionals, pharmaceutical manufacturers andrepresentatives, and State Medicaid agenciesPurpose: The Off-Label materials describe the prohibition on manufacturer promotion ofoff-label uses of prescription drugs, suggest ways of recognizing and reporting off-labelpromotion, and provide links to resources that discuss the prohibition against manufacturerpromotion of off-label uses and government efforts to curtail such promotion.Toolkit Items: 1 Fact Sheet and 1 Resource GuidePartners in Integrity ToolkitTarget Audience: Medical professionals and State Medicaid agenciesPurpose: The Partners in Integrity materials focus on providers’ and physicians’responsibilities to recognize drug diversion; safeguard provider identifiers; and preventfraud, waste, and abuse within the durable medical equipment and home health services fields.Toolkit Items: 3 Booklets, 2 Fact Sheets, and 1 PostcardMedicaid Education Toolkits are now available on the Medicaid Program Integrity Education tion/edmic-landing.html
Personal Care Services ToolkitTarget Audience: Personal care services contractors, personal care attendants,State program integrity personnel, and State Medicaid agenciesPurpose: The Personal Care Services materials define personal care services, list commonimproper billing practices found in personal care services, explain the potential consequencesof such improper billing, and list steps providers can take to avoid improper billing.Toolkit Items: 1 Booklet and 1 Fact SheetPharmacy Education ToolkitTarget Audience: Prescribing physicians, pharmacists, and State Medicaid agenciesPurpose: The Pharmacy Education materials provide the FDA-approved uses, risks, andpotential adverse effects and applicable boxed warnings for both adult and pediatric use of thefollowing drug classes: anticonvulsants, antidepressants, stimulants, atypical antipsychotics,proton pump inhibitors, and enoxaparin.Toolkit Items: 11 Dosing Tables, 1 Billing Guide, and 11 Fact SheetsPharmacy Auditing and Dispensing ToolkitTarget Audience: Private and institutional pharmacy managers andState Medicaid agenciesPurpose: The Pharmacy Auditing materials provide a comprehensive, step-by-step walkthrough of pharmacy practices and policies across four modules. The materials help pharmaciesaudit incoming prescriptions for validity and authenticity, manage controlled substances stock anddistribution, manage invoices to compare inventory to expected product on hand, and audit billingand distribution practices like partial fills that may be prone to errors.Toolkit Items: 4 PowerPoint Presentations1 Resource Handout, 4 Booklets, 1 Checklist, 4 Job Aids, andSafeguarding Your Medical Identity ToolkitTarget Audience: Medical professionals and State Medicaid agenciesPurpose: The Safeguarding Your Medical Identity materials discuss the scope and definitionof medical identity theft, common schemes using stolen identities, consequences for victims,mitigation strategies, and appropriate actions for potential victims of medical identity theft.Toolkit Items: 1 PowerPoint Presentation available for CE*1 Fact Sheet, and 1 Resource Handout, 1 Booklet,*Registration is required on the Medicare Learning Network (MLN) for CE.Medicaid Education Toolkits are now available on the Medicaid Program Integrity Education tion/edmic-landing.html
Email the Education MIC at MedicaidProviderEducation@cms.hhs.gov with any questions or to receivemore information.Follow us on Twitter#MedicaidIntegrityDisclaimerThis product was current at the time it was published or uploaded onto the web. Medicaid and Medicare policies change frequently so links to the source documents havebeen provided within the document for your reference.This product was prepared as a service to the public and is not intended to grant rights or impose obligations. This product may contain references or links to statutes,regulations, or other policy materials. The information provided is only intended to be a general summary. Use of this material is voluntary. Inclusion of a link does notconstitute CMS endorsement of the material. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accuratestatement of their contents.March 2016Medicaid Education Toolkits are now available on the Medicaid Program Integrity Education tion/edmic-landing.html
Toolkit Items: 2 Booklets, 1 Checklist, and 2 Fact Sheets. Managed Care Plan Compliance Toolkit. Target Audience: Managed care plans (MCPs) and State Medicaid agencies. Purpose: The MCP Compliance materials encourage providers and stakeholders in the Medicaid community to become actively involved in preventing, detecting, and reporting
Centers for Medicare & Medicaid Services National Train‐the‐Trainer Workshops Instructor Information Sheet Module 1: Understanding Medicare Module Description Original Medicare, Medicare Advantage and Other Medicare Health Plans, and Medicare Prescription Drug Coverage are choices in the Medicare program.
Medicare Advantage Plans, stand‑alone Medicare drug plans, employer/ union group health coverage, Medicaid, or TRICARE. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the . Medicare‑approved amounts for covered health care costs. Then, your Medigap policy pays its share. Medicare doesn't pay any of the
Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or Medicare prescription drug coverage (Part D). For more information . Remember, this guide is about Medigap policies. To learn more about Medicare, visit Medicare.gov, look at your “Medicare & You” handbook, or call 1‑800‑MEDICARE (1‑800‑633‑4227).
Bruksanvisning för bilstereo . Bruksanvisning for bilstereo . Instrukcja obsługi samochodowego odtwarzacza stereo . Operating Instructions for Car Stereo . 610-104 . SV . Bruksanvisning i original
Medicaid reimbursement methodology for practitioner claims for Medicare/Medicaid dually eligible individuals. Medicaid will no longer reimburse partial Medicare Part B coinsurance amounts when the Medicare payment exceeds the Medicaid fee or rate for that service. This article clarifies that this change applies to Part B services, including .
This software was developed by the Centers for Medicare & Medicaid Services (CMS) for use by Medicare providers/suppliers to view and print a Health Insurance Portability and Accountability Act (HIPAA) compliant Medicare 835. Medicare has no liability and takes no responsibility for any other use of this software.
Medicare Getting Started provides an introduction to Medicare, Medicaid, and the hildren's Health Insurance Program (HIP). The Centers for Medicare & Medicaid Services (CMS) developed and approved this training module. CMS is the federal agency that administers Medicare, Medicaid, CHIP, and the Health Insurance Marketplace.
Medicare 101: The Basics of Medicare. . Original Medicare, Medicare Advantage, and Medicare Cost plans Other COVID-19 related benefits are available if Medicare guidelines are met Those who are in a Medicare Advantage Plan should check . PowerPoint Presentation Author:
