The Massachusetts Medicare Buy-In Quality Review Initiative

Commonwealth Medicine is now ForHealth Consulting at UMass Chan Medical School. More information available here. This content has not been updated with the new name.

Our 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.

The Massachusetts Medicare Buy In Quality Review Initiative