The IntegrityM Blog
Four Traits of Every Successful Medical Billing and Coding Specialist
Medical coders often serve as the gatekeepers of compliance and quality for healthcare organizations. Errors and mistakes can result in denials, delayed payments, or even put an organization at risk for receiving improper payments. Coding can often involve a complex process and finding a coder with the right combination of skills can be difficult, especially […]
So You’ve Detected an Outlier… Now What?
Fighting fraud, waste, and abuse in health care programs is labor intensive often requiring multiple experts including but not limited to data analysts and statisticians, certified coders, clinicians, auditors and fraud investigators. According to The National Health Expenditure Accounts (NHEA), U.S. health care expenditures rose by 2.8 percent in 2015 accounting for approximately 17.8 percent […]
Five Traits of an Effective Healthcare Data Analyst
The key to successfully harnessing the power of data in healthcare is to analyze, interpret, and share the results in a way that is meaningful and effective for decision makers. Those located at the front lines — healthcare data analysts — play a central role in this process. As the healthcare industry rapidly changes, data […]
Efficiently Evaluating “Big Data” for Medicare Fraud Detection
With over 2 billion Medicare claims available for analysis since 2006, the term “Big Data” has no better application than in the health care industry. The opportunity for meaningful analyses resulting from big data is limitless. However, finding the best method for combing through Medicare claims data in an efficient manner can be tricky since […]
Statistical Bias in Health Care Fraud Detection and Prevention Systems
Organizations across the health care program integrity industry are using analytic solutions for fraud detection and prevention that intake and analyze data to signal the threat of fraud. These solutions can process huge amounts of data from multiple sources and remove much of the human element of potential fraud detection. When we think about these […]