Medical Coverage in America and Medicaid Fraud - Essay Example

"Medical Coverage in America and Medicaid Fraud" is a controversial example of a paper on the health system. 
Medicaid is by far a necessity to many Americans. Without Medicaid, many Americans would not have any type of medical coverage what so ever. Medicaid provides specific services such as health, dental, optical, and vision. Each one of these services is highly necessary and can save an individual’s life or prevent an illness. With the costs of healthcare on the rise and the need for Medicaid services on the rise, it is important to find a solution to problems resulting from Medicaid nonpayments. Many of these problems can be avoided and every problem contains some sort of a solution.

            A company known as HMS provides a Medicaid RAC solution that is claimed to be proven to ensure proper payments and services. The company claims to have been in the field for 25 years and is well aware of how Medicaid varies in each state. What is offered by the company is a solution to slow paid claims, record keeping, and necessary audits. The company offers many different services that include data analysis, audit services, full-spectrum, sensitive recoveries, low appeal rate, right resources, and customized technology. Each one of the services provided is said to provide a solution to the current Medicaid issue.

            Data analysis provided by HMS includes housing over 7 billion claims. These claims include just about every aspect that Medicaid provides. Inpatient and outpatient care are monitored. Overpayment and dual processing are prevented and improper payments are also addressed. This service is quite important since Medicaid fraud is taking away from others who actually need government-provided services.

            Audit and full-spectrum services are also provided by HMS and said to provide a solution. Audit services ensure accuracy and include Medicaid and Medicare services. The audit services provide assistance for those new to receiving and accepting Medicaid so they can fully understand what to expect. Full Spectrum includes a thorough investigation of all types of claims made to ensure accuracy and proper payment. Making sure claims are covered and necessary is a great way to minimize fraud.

            Sensitive recoveries and a low appeal rate aid in finding a solution for Medicaid problems and low provider rates. Sensitive recoveries include the ability to recover overpayments while still maintain a good provider and client relationship. This type of sensitive recovery rate has lead to a low appeal rate. HMS provides great education and communication to providers to ensure Medicaid use accuracy and proper payment.

            HMS is said to utilize the proper resources and have the most up to date technology that ensures accuracy and efficiency. Utilizing the proper resources can bridge to gap between providers receiving Medicaid payment. Technology that is put into effect can keep client profiles organized and readily available.

            This solution may be what is needed to help assist hospitals, pharmacies, offices, and Medicaid beneficiaries with the services needed to keep Medicaid programs running smoothly. This type of service is a huge necessity as Medicaid is currently on the rise and funding is decreasing. When a need is larger then what is actually available to help it is important to make sure programs are being utilized in the best way possible. Making sure payments are accurate and contain zero fraud can help control spending and assist service providers with the proper knowledge needed to accept Medicaid patients.