Posted and filed under Community, FWA, Healthcare.

Program Integrity Perspectives

The LA Times recently featured a story on a New England labor union that kept medical bills in check. “Everyone says we can’t do anything about costs, or we just have to get patients to put more ‘skin in the game,’” said John Brouder, a longtime health benefits consultant who worked with [the union] Local 26 to develop…

Read the full article

Posted and filed under Coding, Medical Record Auditing.
claims data

Auditing Claims Data: What Can The Data Tell You?

There are many techniques to extracting data that can range from reviewing claim line billing data to actual medical record reviews. Relying exclusively on the claims data to analyze and identify atypical billing patterns or potential red flags is always challenging. As auditors we all know that the value of the audit process is only…

Read the full article