Extrapolation is a statistical method used to estimate values for an entire population based on a smaller, randomly selected sample. In healthcare audits, this technique allows auditors to review a…
Expertise
What you need to know about the 2021 Open Payments Program Expansion
IntegrityM strongly encourages new ‘covered recipients’ to familiarize themselves with the Open Payments system, so that they can have a successful experience in CY2022. Open Payments Program Background: Under the…
Five Best Practices for Repairing Your Customer Relationship (Pt 2)
There are times, despite your best efforts, things may go wrong, impacting customer satisfaction. When conflict or uncomfortable situations arise, act swiftly to reduce tension and begin repairing your customer…
Five Customer Service Best Practices to Maximize Retention (Pt 1)
Most businesses have two basic goals: to maintain profitability and to grow revenue. As simple as these goals are, some companies are so focused on growing new business pursuits, they tend…
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…
Using the CIGIE Quality Standards for Inspection and Evaluation
It is important for every industry to have a framework of quality standards by which to measure performance and to establish credibility. Most people have heard of the Yellow Book,…
How Effective are Criminal Background Checks Really?
A U.S. Department of Health and Human Services Office of Inspector General (OIG) report from October, 2012 offers some interesting insights into the usefulness of criminal background checks for nurse…
No Wrong Door LTSS Program Evaluations and Planning
The No Wrong Door (NWD) system is intended to streamline access to long-term services and support (LTSS) options for older adults and individuals living with disabilities. NWD grants are collectively…
Healthcare Data Mining for Fraud Detection: Identify and Reduce False Positives to Build Stronger Models
One of the key goals of healthcare data mining is to reduce false positives. In health care fraud data mining, a false positive occurs when your model identifies a provider…
Peeling the Onion: Achieving More Significant Results by Digging Deeper into CMS Payment Data
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued an audit report to the Centers for Medicare & Medicaid Services (CMS) in February 2015…
