Statistical Sampling is an effective tool in Healthcare FWA Investigations, and here are the regulations, resources and court cases to prove it.
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If you work in an SIU, chances are you’ve encountered cases dealing with Evaluation and Management services (E/M). In some E/M reviews, you may find yourself mystified by claims billed with Modifier 25. Though this modifier is intended to help create a clear delineation of distinct services, it isn’t always cut and dry. In our latest article, our rockstar team shares some important information to help you navigate the complexities of this modifier.
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Integrity Advantage was tasked to complete a review of medical records for a state Medicaid agency. If you are reviewing cases involving codes S5125 (Attendant care services), S5150 (Unskilled Respite Care) or T1019 (Personal Care Services), check out our case study. It’s full of eye opening findings and issues related to Home Health Services billing practices.
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Struggling to show value in a case with no recovery? We’ve got you covered! Every case has value, including a case with no recovery. Check out our latest article for four perspectives that can yield unexpected value to your organization.
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One of the most common questions we get from health plans is: "which FWA vendor would you choose?" But, the answer is not always simple or easy. Check out Integrity Advantage's President, Jala Attia, break down the things that your health plan should keep in mind when considering FWA solutions in the RFP process.
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When was the last time you took a step back to evaluate the effectiveness of your fraud, waste and abuse (FWA) program?
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If you don’t already love pivot tables, you may be shocked to find out just how easy they are to use. When navigating a large data set as part of a medical review, pivot tables take the painstaking process of sorting, summarizing, and processing data and make it easy to consume information with speed and ease. Check out our latest article for our 6 go-to pivot tables!
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This Valentine’s Day, we have decided to share some vendor neutral love with our technology vendor friends. Check out our Love Letter to Technology Vendors to learn 5 lessons that we think can help you build a better presence in the FWA industry.
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For many small to mid-sized health plans, the Special Investigations Unit (SIU) or FWA Program reports to a Compliance executive. In those situations, it can sometimes be a challenge to prioritize meeting the many SIU objectives and responsibilities, in addition to health plans compliance needs.
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In the third video of our series, Relating to the Reviewer, Terri Riis-Christensen tackles another important topic: not going into a review with preconceived notions or assumptions.
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As a medical records reviewer, do you ever feel the pressure to deny everything? Integrity Advantage's Terri Riis-Christensen shares her insight on this topic critical to the med review process.
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It's so easy to get caught going down a rabbit hole when performing medical record reviews. In this video, we take a moment to check in with one of our medical review experts, Terri Riis-Christensen, CPC who shares an important strategy that she uses when completing medical record reviews to avoid wasting time.
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ACA Enrollment is on the rise, and sadly, so is the fraud. So, what is happening and how do we mitigate the issues?
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Integrity Advantage helped a state review home health claims for FWA. This article highlights the main findings that you can look at when reviewing home health claims.
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In a victory for the FCA, the Supreme Court recently rejected an attempt to shift the knowledge standard in FCA cases that would have gutted the FCA.
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In the final video in this series, Jala walks us through Pitfall #3 of the Top 3 Program Pitfalls and how to Overcome Them. This pitfall focuses on the lack of organizational buy-in and how that can be impacted with communication with other business units.
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Continuing with the Top FWA Program Pitfalls series - Pitfall #2 is assuming that compliance ensures FWA program success. In this video, Jala discusses why this is not always the case and how you can overcome this pitfall.
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In this video, Jala Attia elaborates on Pitfall #1 in Top 3 FWA Program Pitfalls and How to Overcome Them. Pitfall #1 focuses on missing the signs of a struggling program and how to identify these challenges.
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With the expiry of the Covid-19 Public Health Emergency (PHE) as of May 11, 2023 at 11:59pm, healthcare is slowly getting back to “normal”. With rules and regulations ever shifting, it can be hard to determine what’s the new normal, and detecting Fraud Waste and Abuse (FWA) can be a moving target.
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With the sheer volume of complaints and referrals that make their way to the SIU, it’s no wonder many teams are overwhelmed with case backlogs. Check out our most recent article where we share how you can improve SIU effectiveness in 3 easy steps.
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