IntegrityM Blog

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 Expendi...

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....

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 th...

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 o...

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...

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 se...

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 Medica...

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 rel...

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 orde...

Healthcare fraud very seldom happens in a vacuum. Therefore, data matching — the ability to identify, match, and merge records that correspond to the same entities — is essential to healthcare data analysis. Using The NPPES Database For Data Matching The Centers for Medicare ...