Which regulatory agency is responsible for overseeing Medicare and Medicaid services?

Prepare for the Certified Specialist Payment Rep Exam with detailed flashcards and multiple-choice questions. Each question includes hints and explanations to help boost your readiness. Master your exam preparation journey now!

The Centers for Medicare and Medicaid Services (CMS) is the regulatory agency that oversees Medicare and Medicaid services. CMS is a part of the U.S. Department of Health and Human Services and is primarily responsible for administering the nation's major healthcare programs. This includes ensuring compliance with relevant regulations, setting healthcare policies, and overseeing the implementation of Medicare and Medicaid programs.

CMS plays a crucial role in regulating the coverage of healthcare services, as well as managing payment systems for providers and beneficiaries. Its authority includes establishing guidelines for the delivery of care, quality assurance, and ensuring that programs adhere to legislative mandates. This makes CMS the central agency for anything related to Medicare and Medicaid services in the United States.

The other agencies mentioned are involved in different regulatory domains that do not pertain to Medicare and Medicaid. The Federal Trade Commission (FTC) primarily deals with consumer protection and antitrust laws. The Office of the Inspector General (OIG) functions to ensure the integrity of health and human services programs, conducting investigations and audits related to healthcare fraud and abuse, but it does not oversee the programs themselves. The Securities and Exchange Commission (SEC) is focused on regulating the securities industry and protecting investors, which is unrelated to healthcare services.

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