The IntegrityM Blog

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 […]

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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 […]

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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 […]

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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 […]

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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, or The Generally Accepted Government Auditing Standards, that is used by audit organizations.  Evaluation work does not have a well-known equivalent and organizations are often […]

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