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The Centers for Medicare and Medicaid Services (CMS) has supported the states by initiating many projects, developing numerous products, and conducting workshops and seminars – all designed to provide technical assistance and tools to the states in order to perform their jobs more efficiently and effectively. Along with a description of each product, they have been categorized to provide guidance and reports of reviews, workshops and seminars. Guidance - State Medicaid Information Systems Resource Guide of State Fraud and Abuse Systems - The Information Systems Workgroup has compiled the responses to a May 2000 survey distributed to all State Medicaid Agencies. Information gathered from the states covers the types of systems they have, popular and effective fraud detection features, desired enhancements, and best practices in program integrity and surveillance and utilization review operations. This easy reference tool provides both ideas and contacts that will prove useful to states interested in enhancing their information systems. (See the Downloads section displayed below). Medicaid Managed Care Guidelines for Addressing Fraud and Abuse in Medicaid Managed Care - Provides information on Medicaid fraud and abuse detection and prevention in a managed care environment. Guidelines for Constructing a Compliance Program for Medicaid Managed Care Organizations and Prepaid Health Plans - Provides guidance for states and managed care organizations seeking to implement compliance programs. It is being offered as technical assistance, and in no way is to be construed as a requirement that states use this particular compliance program model. This document was developed for use on a voluntary basis. (See Managed Care Downloads link listed below.) Surveillance and Utilization Review (SURS) Guidance and Best Practices Relating to the States' Surveillance and Utilization Review Functions - Provides assistance to states in performing their SUR functions in accordance with federal regulations. (See the Downloads section listed below). Dual Eligibles Letter (June 2001) to Program Integrity (PI) Directors - Provides assistance to PI Directors in administering benefits for dually eligible beneficiaries. Also provides links to various websites to retrieve the Medicare law, regulations, manuals, local medical review policy, three separate sources to identify Medicare providers, as well as information on the Fraud Investigation Database (FID). (See the Downloads section listed below). Introduction to Medicare Operations - Medicaid State Agency Guide to Medicare Operations. "Introduction to Medicare Operations" was developed to better strengthen the working relationship between Medicare and Medicaid. This document is a compendium of materials that provides basic information about various aspects and activities of the Medicare program, and includes numerous reference aids and key contacts to obtain additional information. We hope it will become an invaluable information resource and an essential tool in preventing fraud and abuse. (See the Downloads section listed below).
Page Last Modified: 12/14/2005 9:44:00 AM
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