The IntegrityM Blog


Demystifying Medicare Prepayment and Postpayment Claim Reviews

Medicare and other health plans have a variety of tools at their disposal to prevent and identify improper payments. The tools can differ depending on whether they are applied before claims are paid (prepayment review), or after claims are paid (postpayment review). Pre and postpayment reviews are both important program integrity strategies, and can make […]

Read More

Medicare Overpayment Recovery: Identifying and Calculating Overpayments

In fiscal year (FY) 2015, the error rate for the Medicare fee-for-service (FFS) program was 12.1 percent, or $43.3 billion. This result is an improvement over FY 2014, in which Medicare FFS had an improper payment rate of 12.7 percent, or $45.8 billion. Identifying Medicare overpayments is no easy task. The Medicare program is large […]

Read More

Improper Payments Elimination and Recovery Act: Identifying and Reducing Improper Payments

Each year, the Federal Government makes billions of dollars in improper payments. Improper payments can take the form of overpayments, payments to the wrong person, or payments for the wrong reason. Two examples of improper payments include the Federal Government paying $180 million to 20,000 dead individuals over a three-year period, as well as paying […]

Read More

GLȲD(Σ): Revolutionizing Healthcare Data and Statistical Analysis

What if there was a healthcare data analysis solution that could save you a significant amount of time in the sampling and extrapolation process, resulting in substantial cost savings, and therefore greatly increasing your return on every dollar invested into this process?  More results with less time and costs! Manually performing sampling and extrapolation can […]

Read More

Network Adequacy: Meeting Requirements and the Impact of the ACA

The Affordable Care Act directed the Secretary of Health and Human Services to establish criteria for certification of qualified health plans, to include (1) ensuring a sufficient choice of providers and (2) providing information to enrollees and prospective enrollees on the availability of in-network and out-of-network providers.  45 CFR 156.230, entitled network adequacy standards, requires qualified […]

Read More

12345...

Contact Us

Get Industry Blog Updates Directly to Your Inbox