The IntegrityM Blog
Best Practices for Conducting Healthcare Fraud Investigation Interviews
Healthcare Fraud Investigators provide a valuable resource in the fraud analysis process. They perform in-depth evaluation and analysis of potential fraud cases and requests for information using claims and other sources of data. One method for gathering information during an investigation is performing interviews. Along with analysis of records and other data, conducting fraud investigation […]
Understanding the Telehealth Claims Landscape
Telehealth is expanding rapidly and transforming healthcare. According to the Medicare Payment Advisory Commission, the number of telehealth visits grew by over 500 percent from 2008 to 2014. Additionally, many commercial insurers cover — and many health systems offer — a variety of telehealth services. The industry has seen impressive advancements in telehealth technology, and […]
Five Things to Know About Federally Qualified Health Centers (FQHCs)
Federally Qualified Health Centers (FQHCs) provide primary care services to millions of people each year with limited access to care. Medicare Part B has covered FQHC services at certified FQHCs since 1991. They are an important and very unique part of the Medicare and Medicaid benefits with specific billing and payment rules that can get […]
The Benefits of Statistically Valid Random Sampling and Extrapolation for Health Care Audits and Investigations
When performed correctly, statistically valid sampling and extrapolation can be a powerful tool, allowing for the effective use of audit and investigative resources. Statistically valid sampling allows organizations to collect information about a particular universe for a relatively low cost. Rather than incurring the time and expense of reviewing the entire universe, the conclusions drawn […]
A Guide to Building a Robust Medical Review Team
Constructing a solid medical review team requires the successful networking, staffing, management, and ongoing support of the clinicians and the support team. The Significance of a Solid Team Medical review is the clinical review of medical records and supporting data in order to provide claims determinations and ensure that payment is made only for services […]