Current Engagements

Discovering value in Center's research-based approach

For Massachusetts, the Center for Health Care Financing provides services in a range of areas, from third-party liability to benefit coordination, from federal revenue maximization to program integrity. Other states also are benefitting from the Center's research-based approach to developing financial management programs.

Helping tens of thousands

Beginning in 2006, UMass Medical School invested in new staff and technology to better understand the interaction between the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS), the federal agency responsible for Medicaid agency administration.

To date, the Center for Health Care Financing's research has helped the SSA implement comprehensive changes to its information systems and eligibility determination processes. Those reconfigurations have resulted in enhanced federal benefits to tens of thousands of individuals, while positioning states across the country to benefit from hundreds of millions of dollars in retroactive adjustments. 

• In 2009, the Center's research played a role in national insurance adjustments for states that were valued at more than $250 million.
• The Center has been working to measure the financial harm to states in a case in which a national coalition is seeking a $4 billion net insurance adjustment.

Medicare Appeals yield $1 billion for New York

States lose millions of dollars each year due to inappropriate billing for home health services. For many, the challenge is a lack of resources required to successfully appeal Medicaid home health claims. To date, the Center has helped return more than $1 billion to the state of New York, with many millions more recovered for the states of Massachusetts and Pennsylvania, as a result of the Center’s efforts to identify and appeal paid Medicaid claims that may be covered by Medicare.

School-based Medicaid Claiming (students with special needs)

Hawaii, Massachusetts, Rhode Island, Vermont, Virginia, and Washington are among the states that rely on the Center to provide a full range of school-based Medicaid claiming activities on behalf of Medicaid-eligible students with special needs.

Online Random Moment Time Studies

The states of Connecticut, Ohio, Utah, and Washington are benefitting from the Center’s customized analytic tools for online random moment time studies.

Enhanced Medicare Identification

The Center is working on behalf of the states of California, Massachusetts, and Pennsylvania to enhance federal benefit eligibility for residents of those states (enhanced Medicare identification service).

Municipal Billing

The Center provides billing services to more than 100 municipalities as part of its school-based claiming efforts and has developed technology tools to facilitate their participation in the program. The Center recently created a billing system that allows municipalities to secure reimbursement from private health care plans for H1N1 and seasonal flu vaccine services provided to health plan members by municipalities.