The Massachusetts Medicare Buy-In Quality Review Initiative

Monday, September 9, 2019
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Jenifer Hartman, BA
Commonwealth Medicine

Our Health Care Finance Solutions team manages Medicare Buy-In operations and customer service on behalf of MassHealth, the Massachusetts Medicaid program. There are approximately 248,000 Medicare buy-in members currently, which contributes to a cost of over $48 million in Medicare premiums paid by MassHealth every month. Making sure all of those costs are necessary can be a difficult task to reconcile given the operational complexity and size of the Medicare system. 

Our Medicare Buy-In Quality Review Initiative, which our TPL expert Jenifer Hartman presented on during the 2019 Medicaid Enterprise Systems Conference, digs deep to find gaps in quality control and has returned $25 million in Part A premium overpayments since 2009 for MassHealth. As of July 2019, the program has also helped recover another $2 million in Part B payments and received over $4 million in equitable relief. Discover more outcomes of the Massachusetts Medicare Buy-In Quality Review initiative in this presentation. 

Medicaid Enterprise Systems Conference 2019