This past year, the WPS Government Health Administrators Medical Review department was allocated additional funding from the Centers for Medicare & Medicaid Services (CMS). The money was used to perform reviews of beneficiaries with dual eligibility with Medicare and Medicaid to protect the Medicare Trust Fund. With this additional funding, they were able to bring on 10 additional nurse analysts to form a team referred to as the Medi-Medi team.
This past year, the WPS Government Health Administrators Medical Review department was allocated additional funding from the Centers for Medicare & Medicaid Services (CMS). The money was used to perform reviews of beneficiaries with dual eligibility with Medicare and Medicaid to protect the Medicare Trust Fund. With this additional funding, they were able to bring on 10 additional nurse analysts to form a team referred to as the Medi-Medi team.
“Medi-Medi" is short for Medicare and Medicaid.
The Medi-Medi team members have worked hard over the past few months to become efficient and proficient with their assigned work. The focus of their analysis and review is primarily on outpatient therapy. They are looking for documentation to support that the skills of licensed physical or occupational therapies are reasonable and necessary. They also look for inappropriate payment or billing.
Examples of this might be billing Medicare for more than what was provided or billing Medicare for services that no longer meet the requirements to be considered skilled services. Their work allows WPS to better serve its customer, CMS, by protecting the Medicare Trust Fund.
The Medi-Medi team also provides education to providers. Either by reaching out via telephone or written letters, they educate on Medicare guidelines for coverage, Medicare documentation requirements, and ways to improve internal documentation to support the level of service provided.
"The addition of the Medi-Medi workload has allowed GHA Medical Review to have a greater positive impact on the Medicare Trust Fund. Protecting the Medicare Trust Fund isn't just about preventing inappropriate payments; it is also about educating providers in order for the beneficiaries to receive the appropriate care," said Linda Oliver, Medical Review Clinical Manager. "The addition of the nurses dedicated to the Medi-Medi workload has allowed us to do both and grow our Medical Review department."
