Big Savings for Iowa Medicaid
According to Medicaid Director Jennifer Vermeer, the new Medicaid program integrity initiative in the state of Iowa has effectively saved the taxpayers more than twenty million dollars in recoveries or cost avoidances in just its first year of operation.
Vermeer said, “We’ve shown that aggressive oversight can result in substantial savings or paybacks of public dollars without jeopardizing essential healthcare for some 400,000 Iowans who rely on Medicaid.”
She also said that the money that is being saved comes for a number of different strategies, including ensuring all paid services are medically necessary, making sure that upcoding claims is not possible by providers and ensuring Medicaid receives reimbursement when health services are ultimately paid by another insurer.
The savings are from a program integrity contract, which was given to Optuminsight, formally known as Ingenix, which is located in Eden Prairie, Minnesota. The savings from the first year are not only higher than the $14 million cost of the contract, but also more than the $20 million target for the first year set by Medicaid in Iowa. Savings the year before were roughly $8.6 million.
Around two-thirds of the savings come from recoveries that result from the analysis of paid claims, which includes $6.5 million from a program responsible for reviewing situations where a healthcare provider, typically a hospital, is paid by both Medicaid as well as another insurance provider for the same procedure or office visit.
Thousands of transactions are processed by hospitals every day. Most of these hospitals do not have the staff required to sniff out overpayments that should be reverted to Medicaid.
Vemeer says, “This is a new area of oversight for us and it has proven to be very helpful, especially in these days of limited public funds.”
photo credit: alancleaver_2000