PCG staff members joined over 500 attendees at the 35th Annual NAMPI Conference in August. As always, the conference was an excellent way for program integrity (PI) leaders to network with one another while sharing best practices, lessons learned and innovative ideas within the Medicaid arena.
The NAMPI conference covered a range of topics, from larger presentations on the Medicaid Fraud Control Unit (MFCU) and Centers for Medicare and Medicaid Services (CMS) updates, to smaller breakout sessions on topics such as data solicitation, Managed Care Organization (MCO) and MFCU collaboration, Electronic Visit Verification (EVV), and using artificial intelligence (AI) to ensure program integrity—to name just a few. Below, we have compiled a few key themes and topics that emerged from this conference.
Data Analytics and Program Integrity Provider Oversight
Data analytics and AI platforms dominated the majority of system-related sessions at NAMPI. Key sessions focused on the use of data sources by providers in work with local law enforcement agencies to achieve a greater localized impact on the opioid crisis, as well as utilizing data to address beneficiary fraud schemes. Each provider oversight and analytics system had differing features and capabilities, giving attendees a chance to find the best match for their Program Integrity Units (PIU). The overarching theme from these presentations was the importance collaboration among PIUs using AI as their engine. If you would like to learn about how PCG can help to maximize the impact of data analytics for your PIU, as well as our other provider oversight services, click here.
Electronic Visit Verification (EVV)
A recurring theme at the past few NAMPI conferences, EVV continued to get significant attention at this year’s event. Similar to the focus of EVV presentations at the recent HCBS conference, which PCG reported on in last month’s edition, presenters at NAMPI 2019 provided valuable insights for states that have implemented—or are in the process of implementing—systems to comply with the 21st Century CURES Act. Presenters discussed key benefits of EVV, including increased program efficiencies, reduction of costs, improved patient care, and allowing for alternate payment methods. State leaders and vendors also shared lessons learned on the procurement, implementation, and use of EVV systems, such as the importance of ensuring proper resource allocations, strong stakeholder engagement, and sound methods of communication.
If your state still needs to implement EVV as required under the 21st Century CURES Act, PCG’s EVV Careify™ solution satisfies all requirements outlined in the legislation and serves as a third-party EVV data aggregator. You can find additional information on our Careify™ web page.
Long-Term Support Services Oversight
PCG had the opportunity to present to conference attendees about how to plan for long-term support services growth by oversight. Our presentation dove into approaches to the rapidly growing industry, as well as challenges through oversight of other healthcare areas—such as managing fraud, waste, and abuse in home and community-based settings.
Based on our experience working with states on these issues, PCG’s presenters highlighted the importance of using cross-team collaboration across states’ varying units to holistically approach the service continuum. In particular, states should consider how different units can better use PIU data points; what items a PIU has to better improve in their efforts; and how the PIU can facilitate greater coordination outside of the office.
CMS and MFCU Updates
Everyone in attendance of the conference gathered to listen to representatives from the Centers for Medicare and Medicaid Systems and Medicaid Fraud Control Unit (MFCU) speak about their current Medicaid program integrity initiatives. The U.S. Department of Health and Human Services Office of Inspector General’s Korby Horshaw provided an overview of current and emerging fraud trends across the country, with particular emphasis on common schemes with durable medical equipment involving telemarketing, kickbacks, and other predatory actions. Genetic testing was also flagged relative to provider kickbacks and authorizing testing for patients that have never been examined. All parties gave updates describing their current PI challenges, initiatives, and proven keys to success; important takeaways from their presentations include the importance of fostering a collaborative environment with your MFCU and PIU and establishing constant methods of cross training.
Also of Note
The conference included many other presentations of note, such as those related to the clustering of therapy services at nursing facilities, best practices for MCO and government collaboration, and data strategies to combat the opioid epidemic. All NAMPI presentations, with links to their materials, can be found online here.
If you have any questions about the conference, or how PCG can help you address these issues discussed above, please feel free to contact us at jpeck@pcgus.com
