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Health Policy Support & Research
- Regulatory and Policy Analysis
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- Payer and Provider Solutions
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A global management consulting firm was engaged by the federal government to identify improper payments among Medicaid providers across six states. The firm's consultants were highly experienced in the area of improper payments, but needed support to analyze and assess state-specific and federal regulations and policies regarding Medicaid reimbursement.
The Rainmakers Solution:
As a part of this engagement, Rainmakers was responsible for conducting legislative and regulatory research. This research included examination of state laws and manual governing provider reimbursement for inpatient, outpatient and pharmacy services, beneficiary eligibility, provider enrollment and medical coverage/medical necessity guidelines. In addition, extensive review of Title XIX of the Social Security Act was performed.
The guidance developed by Rainmakers as a result of this health care policy research enabled the client to successfully recoup millions of dollars in Medicaid overpayments.