Skip to main content

"Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid.”

 

Congressional Testimony: The Honorable Christi A. Grimm, Inspector General for the U.S. Department of Health and Human Services, testifies before the United States House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations: "Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid.”  

Watch the Testimony Video 

https://www.youtube.com/watch?v=UpquPVaQrH8

Read the Testimony 

https://oig.hhs.gov/documents/testimony/9865/ig-grimm-testimony-04162024.pdf

Interesting time stamps:

36:07 opening statement Krisiti Grimm on Improper payments

46:45 Opening statement Dr. Chernew, chair of Medicare Payment Advisory Commission (MedPAC)

55:02 Mr. Griffith statements and question to Ms. Grimm

55:30 Krisiti Grimm response

57:41 question on how medicare advantage payments are calculated, enrollee risk score calculations and calculation of coverage payments

1:00:43 question of Ms. Grimm – reporting requirements

1:01:11 reply (chart reviews and risk assessments) home visits

 1:03:10 Mrs. Rodgers deceased beneficiaries concurrent enrollments Medicaid multiple states,

1:04:12 Ms. Grimm reply

1:13:20 questions greatest financial vulnerability presented by the current payment process for medicare advantage or medicaid is there a way to address them better

1:13:40 Ms. Grimm reply

1:21:00 define fraud waste abuse

1:31:35 Ms. Schakowsky - Denial of care and upcoding

1:35:00 Ms. Grimm’s reply

1:40:40 Mr. Peter’s question, How would improved data sharing help CMS reduce these managed care overpayments.

1:41:44 Ms. Grimm’s reply

these rest of this discover is up to you, the reader. Enjoy!

Labels:
Location: San Diego, CA, USA

Comments

Post a Comment

Popular posts from this blog

Guidelines for HIV coding

Chapter 1: Certain Infectious and Parasitic diseases (A00-B99) Human Immunodeficiency virus (HIV) Infections B20 Human immunodeficiency virus (HIV) disease (symptomatic) R75 Inconclusive laboratory evidence of human immunodeficiency virus (HIV) Z20.6 Contact with and exposure to human immunodeficiency virus (HIV) Z11.4 Encounter for screening for human immunodeficiency virus (HIV) Z71.7 human immunodeficiency virus [HIV] counseling Z21 Asymptomatic human immunodeficiency virus (HIV) infection status “Confirmation” does NOT require documentation for positive serology or culture for HIV; the provider’s diagnostic statement that the patient is HIV positive, or has an HIV-related illness is sufficient.   Once a patient is diagnosed with B20, they should never be assigned R75 or Z21. Sequencing of HIV Codes B20 should be sequenced as the first-listed diagnosis when patient is treated for an HIV related condition. Any non-related conditions get sequenced followi...
14 comments
Read more

Preliminary ICD-10-CM CMS HCC Mappings

The link below take you to the Preliminary ICD-10-CM Codes, CMS-HCC and RxHCC Models, Includes FY2014 preliminary list of  ICD-10 codes HCC Mappings from CMS. Last modified 9/30/2014.   Preliminary ICD-10-CM Mappings Diagnosis Code Description CMS-HCC PACE/ESRD Model Category V21 CMS-HCC Model Category V22 (clinically revised model implemented in 2014) RxHCC Model Category V04 CMS-HCC PACE/ESRD Model for 2015 Payment Year CMS-HCC Model for 2015 Payment Year RxHCC Model for 2015 Payment Year   #HCC  #ICD10  #CMS  #ICD9  #RiskAdjustment  #MedicalCoding #Mappings     Disclaimer : This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to s...
11 comments
Read more

Major Depressive Disorder

Major depressive disorder According to the American Psychiatric Association, major depressive disorder can be seen in patients who have suffered a depressive episode lasting at least two weeks, as manifested by at least five of the following symptoms: depressed mood, loss of interest or pleasure in most or all activities, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicidal ideation. Major depression is highly recurrent, with recurrent episodes occurring in 50% or more of patients. Remission and recovery from major depression Whether or not a patient is being treated for depression (e.g., counseling and/or medication), remission can be defined as a level of depressive symptoms basically indistinguishable from that in someone who has never been depressed. When reporting history of major depressive disorder, instead of coding V1...
9 comments
Read more