Improper Payments create a new level of danger for providers.

Gregg Phillips

Recent reports place the dollar amount of improper payments in Medicaid at $1 trillion over the past ten years.

This year alone we have already eclipsed $100 billion, The Facts about Medicaid Fraud http://bit.ly/2cmkvVg 

The knee-jerk reaction of government program integrity teams will be dialing up the reviews, audits, and clawbacks.

All of this could not have come at a worse time with rising levels of uncompensated care coupled with the elimination of DSH subsidies.




July Update for CaseVue HPE

Taylor Phillips

Over the past month, we have been working hard to improve your overall CaseVue experience. 

That means addressing site load times, giving you access to view your data, as well constantly adjusting our outputs to satisfy the request from states.

New:

  • Reporting- CaseVue now provides users with access to reports to view what is happening on the account. The higher your permission is set, the more information you can analyze.

  • Fine Tuned Tax Screen- You now have the ability to make those little tweaks to a patient's tax situation and improve your capacity to make an accurate decision.

Updated:

  • IMPORTANT!  The state of Mississippi DOM requires that the date that is printed on the HPE Application form be the date that the decision was made. That means that the date you choose to approve or deny the patient is the date that is printed on the form. We understand that this is a concern of many, but it is imperative that you make a determination ASAP in or to cover the patient.

  • To that end, we have opened the user roles to allow all CERTIFIED users to make a case decision. (NOTE: some states require training and/or a test to become certified. Contact your state Medicaid office or contact us at hpehelp@casevue.com and we will help get to the bottom of any question you may have. )

  • AutoComplete had been disabled to not display old cases in your dropdown as an effort to increase patient data protection even further.

  • Server Upgraded- we have made several substantial changes to the way we deliver CaseVue to your browser. That means increased site speed across the board, access to even more security features, and the ability to analyze site errors(including downtime) often before you have time to report it to us. 

BugFixes:

  • Fixed the occurrence of an unborn child not counting correctly.

  • Fixed a very particular instance in which MS parent/caretaker category was being too tough to qualify.

  • Income rounding in MS follows the DOM request for rounding to the hundredths not thousandths (for example, it was 4.333, now it is 4.33). All states now follow their states recommended rounding rate.

  • Text changes to the My Cases page, the scoring screen, and several emails.

As always if you ever need help or have a question, we are here for you! Send us an email to hpehelp@casevue.com




AVS Projects Robust Return on Investment Saves a State Millions

Solara Cochran

In August 2013, AutoGov began processing Asset Verification Service (AVS) requests for one of our very innovative and aggressive state government clients. After a successful implementation, the entire team was eager to hit the ground running. We were excited and astonished by the swift return on investment: within the first two hours of operation, the uncovered assets found by our solution paid for the entire program in cost savings.

To gain a greater insight into the meaning of this discovery, we must first understand the costs associated with leaving these assets unfound. Using the net present value of $76,000 as the annual cost of a normal long term care (LTC) Medicaid case, use of the AutoGov AVS solution found a great deal more than previous manual verification programs. In fact, the AVS requests produced over one million dollars in previously unknown depository assets, and the solution took, on average, less than 6 days to uncover well over one hundred submitted cases that exceeded the allowable state threshold for Medicaid.

Congress passed Section 1940 of the Social Security Act. This amendment requires states to implement an electronic Asset Verification System (AVS) for the aged, blind and disabled Medicaid population. AutoGov is on the forefront of innovation for integrated eligibility and program integrity, and our AVS project is one of only two fully implemented solutions in the country.

Until now, Medicaid applicants were only required to volunteer their banking information. As an individual, they could simply choose not to disclose a checking, savings, or certificate of deposit account. Medicaid case workers had no way to verify that applicants were fully disclosing all assets. It's a new day, and that is no longer true. With the help of AutoGov and our data partners, Medicaid caseworkers can be sure they are approving the right individuals.

AutoGov continues to uncover waste, fraud, and abuse for state and federal entitlement programs. For a quick and easy AVS implementation with very little upfront cost, contact Solara Cochran at (512) 439-2900 or email solara.cochran@autogov.com.




Where does Medicaid expansion stand today?

Solara Cochran

What are the states going to do?



 The Affordable Care Act will significantly expand both eligibility for and federal funding of Medicaid beginning on January 1, 2014. Under the law as written, all U.S. citizens and legal residents with income up to 133% of the poverty line would qualify for coverage. However, the United States Supreme Court ruled that states do not have to agree to this expansion in order to continue to receive existing levels of Medicaid funding.  Many states have chosen to continue with their current funding levels and Medicaid eligibility standards. 

 Some states such as New Mexico are taking a more progressive approach, asking their Medicaid recipients to pay co-pays for some treatments.  Co-pays will be required for services such as ER visits for routine medical care or using a brand-name drug over a generic.  One of the main goals of the revamped program is to better coordinate the care provided to recipients to improve their health or keep medical conditions from worsening and becoming more costly to treat.  Empowering people to take responsibility for some of their own healthcare costs will likely save millions of dollars for New Mexico.

 The State of Missouri has opted out of the Affordable Care Act Medicaid expansion.  Missouri still plans on reforming Medicaid.  There are now three legislative committees set up to study Medicaid reform.  Missouri law makers want to try and solve some of the problems the Medicaid program faces.  “In my old, country way of looking at things, I’d like to fix the bucket,” said Missouri Senator Jay Wasson. “I’d like to stop the leak before I put more water in it. I wouldn’t put more water in a bucket that already leaks.”  Missouri's leaders seem to want Medicaid recipients to have some skin in the game.  Ideas like incentives for preventative care and co-pays are being seriously considered. 

 Today, Medicaid provides more questions than answers.  Regardless of the outcome, change is on the horizon.  One silver lining in all of the upheaval is technology continues to play an even larger role in finding solutions.  Now organizations like AutoGov can help states, healthcare providers, and the public make decisions based on real-time information.  "Big Data" is alive and well in healthcare.  It is impacting all of us each and every day.




Changes in Healthcare Means Limiting Freedom

Gregg Phillips

Healthcare providers have limited freedom to run their businesses due to rate cuts, price fixing and needless regulations.

AutoGov is a typical small software company. Our customers are healthcare providers such as nursing homes, hospitals and home health companies. We are entangled in the never ending struggle balance scarce resources against the needs of our customers to ensure high service levels are maintained while offering a disruptive product.

We are free to charge whatever we choose is the optimum price for CaseVue. We spend weeks analyzing our costs against feedback we receive from our customers. If we are right, the market rewards our decisions. If we are wrong, we are punished. But, they are always our decision.

Troubling trends have emerged for our customers, however. They are increasingly hamstrung by government sponsored price fixing - eliminating a key freedom that business leaders require to be successful. For many of these providers (aka businesses) the inability to set prices as they see fit requires doors to close, further limiting capacity in this $3 trillion industry.

We watch as politicians, faceless bureaucrats and and the well meaning healthcare advocates make decisions that ultimately stifle their ability to survive. The basic laws of supply and demand are ignored.

Price fixing and monopolies are always bad in free market economies.

Businesses, including healthcare businesses will fail. Hospitals and nursing homes will close. Home health providers will struggle to recruit quality care givers. Drug companies will discontinue key research.

Our customers are watching helplessly as decisions are made and rates are set, or rather fixed, that ensure their rights and freedoms to run their businesses are reduced or eliminated.

Fair warning to all involved, this will not end well.

We all deserve the opportunity to succeed.





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