Background Considerations and Methodology Sample Clauses

Background Considerations and Methodology. Without this matching program, VHA and CMS would be unable to efficiently identify dual enrolled beneficiaries and duplicate claims paid by VHA and Medicare for the same healthcare services. This CBA used calendar year 2019 claims data to estimate the number and dollar value of claims for which VHA and Medicare made duplicate payment. For this one year alone, CMS made over $42.5 million dollars of duplicate payments for the same services for which VHA also made payment. CMS and the VHA are confident that overpayments were also made by both agencies for years prior to and after the 2019 calendar year, since no relevant factors existed that were unique to that year. Matching program costs for CMS will be primarily labor, upstart, and annual maintenance to perform data programming, matching, review/adjudication of results, and recovery of funds. The costs for VA will primarily consist of staff resources for extracting data and reviewing/adjudicating results, with the addition of some computer costs for transmitting data. Costs for both agencies are categorized below as personnel costs and computer costs. Although this is a new matching program, and therefore the quantified costs and benefits are only estimates, CMS and VHA strongly believe that the benefits will significantly outweigh the costs to CMS and VHA.‌