In March 2020, under former Governor Cuomo's administration, the New York Medicaid Redesign Team proposed that the state carve-out pharmacy benefits from the Medicaid program because of concerns involving pharmacy spend and provider transparency. The reform essentially changes prescription drug reimbursement from a managed care...
Syrtis Solutions distributes a monthly Medicaid news summary to help you stay up-to-date. The monthly recap highlights developments, research, and legislation that pertains to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a list of...
Since its passage in 1965, the Medicaid program has expanded to become the single largest payer for health care in the United States, costing $671.2 billion in 2020. Because of spikes in enrollment from the pandemic and the present administration's priorities, spending is only projected...
Over the last fifty years, Medicaid has helped deliver health services to the most vulnerable populations in the United States. As member enrollment surges, Medicaid TPL and fiscal responsibility have been problematic. To address these challenges, numerous legislative efforts have occurred to curb fraud, waste,...
The majority of Medicaid improper payments occur because of antiquated data systems that result in eligibility errors. As the Medicaid program has grown, determining primary commercial coverage, also referred to as Third Party Liability (TPL), has become significantly more complicated and challenging. By law, Medicaid...
Dependence on the Medicaid program has increased exponentially over time. Currently, it is the single largest insurer in the United States, and in 2019, it accounted for more than half of all federal funds distributed to states. Regrettably, as the safety net program has grown,...
Medicaid currently fails at providing a system that efficiently and accurately saves and utilizes member data. As Medicaid is a joint state and federally managed program, there are many issues with coordinating data platforms. Different states have their own unique data processing and storing, and...
Syrtis Solutions publishes an annual Medicaid review to help you stay informed. The yearly recap concentrates on highlights, research, and legislation that relates to Medicaid integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Below is a summary of...
Syrtis Solutions publishes a monthly Medicaid news summary to help you stay informed. The monthly recap concentrates on developments, analysis, and legislation that relates to Medicaid program integrity, cost avoidance, coordination of benefits, third party liability, improper payments, fraud, waste, and abuse. Here is a...
Over the last three years, the Coronavirus public health emergency was extended a number of times. The PHE and the Families First Coronavirus Response Act adjusted Medicaid eligibility, and consequently, Medicaid enrollment surged throughout the pandemic. Between February 2020 and July 2022, 82 million people...