The alert reminded providers under New York’s Medicaid program to “consider, as part of their compliance program’s risk assessment activity, how various Medicaid reimbursement models may impact their risk assessment factors, processes and outcomes.” The alert did not specify any risk assessment activities providers must pursue.
State officials said while New York State’s Medicaid program historically operated under a fee-for-service model, transitions to alternative payment models like capitation, risk-sharing arrangements and value-based payments require providers to review compliance requirements.
“Risk assessments may need to expand beyond the integrity of the billing and payment process to include an assessment of the processes involved in the delivery of Medicaid reimbursable services,” the alert reads.
To view the alert, click here.
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