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CMS launches next phase of new Quality Improvement Program

July
18

The Centers for Medicare & Medicaid Services (CMS) today awarded additional contracts as part of a restructuring the Quality Improvement Organization (QIO) Program to create a new approach to improve care for beneficiaries, families and caregivers. QIOs are private, mostly not-for-profit organizations staffed by doctors and other health care professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care.

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CMS Fraud Prevention System Identified or Prevented $210 Million in Improper Medicare Payments in 2nd Year of Operations

June
25

In its second year of operations, CMS’ state-of-the-art Fraud Prevention System, that employs advanced predictive analytics, identified or prevented more than $210 million in improper Medicare fee-for-service payments, double the previous year. It also resulted in CMS taking action against 938 providers and suppliers, according to a report sent to Congress today.

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CMS initiative helps people make the most of their new health coverage

June
16

Today, the Centers for Medicare & Medicaid Services (CMS) launched a national initiative “From Coverage to Care” (C2C), which is designed to help answer questions that people may have about their new health coverage, to help them make the most of their new benefits, including taking full advantage of primary care and preventive services.  It also seeks to give health care providers the tools they need to promote patient engagement.   

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CMS Announces Opportunity to Apply for Navigator Grants in Federally-facilitated and State Partnership Marketplaces

June
10

The Centers for Medicare & Medicaid Services (CMS) today announced the availability of funding, totaling $60 million, to support Navigators in Federally-facilitated and State Partnership Marketplaces in 2014-2015. Navigators provide unbiased information to consumers about health insurance, the Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

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Prior Authorization to Ensure Beneficiary Access and Help Reduce Improper Payments

May
22

The Centers for Medicare & Medicaid Services today announced plans to expand a successful demonstration for prior authorization for power mobility devices, test prior authorization in additional services in two new demonstration programs, and propose regulation for prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies. Prior authorization supports the administration’s ongoing efforts to safeguard beneficiaries’ access to medically necessary items and services, while reducing improper Medicare billing and payments.

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