Watch our webinar recording to learn how both a coding and a clinical perspective can add value in the medical review process and support successful investigative outcomes.
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Have you ever wondered whether you should have a coder or a nurse perform a medical review? You are not alone. In this article, a few of Integrity Advantages nurses and coders share the different, yet valuable perspectives that that each bring to the table when doing a medical review and how to leverage these insights for better investigative outcomes.
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Integrity Advantage had a fabulous time hosting our first booth at the National Association of Medicaid Program Integrity, or NAMPI, conference. One of our Rockstars, Cailin Kehoe, shares her impressions as a first-time attendee of this conference.
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Applied Behavior Analysis (ABA) cases have been a hot topic - even more so since the pandemic. Many plans are finding that these investigations and medical reviews are far more complex than typical FWA cases and require great collaboration among investigators and clinical staff. Download our article to learn the best ways to tackle the ABA cases in your pipeline.
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We see an exorbitant amount of claim lines and dollars paid for genetic tests that don't meet documentation standards. Check out this video to learn more about a particular case reviewed by Integrity Advantage Rockstar Monique Mayes LPN, CPC and gather takeaways to apply to your investigations.
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Most medical review teams do not have an active role in sampling. However, understanding that the review of an allegation may require an investigator to request records in a certain manner can make the difference between a strong case and one that is indefensible. But how do you destress the sampling process? Having a clear process in place is just one step. You really should include the medical review perspective before you sample. This article shares some key considerations to include in your sampling process to ensure an effective fraud, waste and abuse medical review.
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Medical reviews are a critical part of many FWA investigations. It isn’t enough to simply look at them as line-by-line results. Drive more value by kicking it up a notch. In this article, we share 5 ways to take your medical review process to the next level.
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Safeguarding the integrity of your medical record review is critical during a fraud, waste and abuse investigation, as it can be closely scrutinized when there is provider push-back. Conditions of Payment in FWA are often overlooked and can have a significant impact on the outcome of the medical review. This article provides information that FWA leaders should consider when determining what are acceptable reasons to deny payment and recommendations to help safeguard the integrity of the investigative process.
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What do the following have in common: Communication/Relationships, Access, Organization and Conditions of Payment?They’re the building blocks of an effective medical review. Listen to this discussion for a firsthand perspective from our clinicians and coders!
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Here’s part 2 of that video which shows how you can use an Advanced Filter to narrow down your data. Never used an advanced filter? Watch on! It allows you to quickly and easily filter down a dataset on 1 or more column(s) of criteria. I find it to be quicker and easier than using vlookups or index match functions (not to mention there’s no concatenation required).
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Most FWA programs rely on recoveries and savings as the measure of success. But there is another critical component that's a hidden risk and amounts to big dollars: Prevented Losses. We are bringing prevented losses to the forefront, not just in concept, but also in terms of the financial impact on healthcare payment integrity. This article discusses challenges that continue to exist and what we need to do as an industry in order to continue to evolve the value of our FWA programs.
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Many investigative teams fear being expendable. Some resist new technology capabilities because they feel threatened. This fear is rooted in process - steps they are expected follow when working investigations. This video prompts the question - are you building a team of thinkers or a team of robots?
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No matter what tools you may use, nearly everyone will use Excel files of claims data at some point in the process of doing an FWA investigation. This video shows you a way to isolate boiler plate billing using a cool Excel hack.
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One common question we all grapple with is how long we should leave a provider on prepay? Watch this video to learn some of our tips related to prepay monitoring of providers and what you should do if you aren't sure how to handle a provider that consistently bills inappropriately.
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In this short video, Jess provides a helpful trick for formatting dates in excel.
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Outsourcing is often thought to be a dirty word. But don’t be fooled - outsourcing can be a cost effective, high impact investment into the success of your team. Since many of you know this is precisely the business we are in - we decided to discuss some common misconceptions we’ve heard over the years and the many lessons learned as a result.
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Surviving in the world of FWA is somewhat like surviving in the wild. Without some essential elements, your shot at success decreases. Don’t go on the journey alone. Download Integrity Advantage’s SIU Survival Guide and read about ten critical elements that you can implement to set up your FWA program for success. In it, we share tips and lessons learned from many years of hands-on experience working with payers of various sizes and different lines of business. Take our guide with you on your journey and reimagine the value of your FWA Program!
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When holding your FWA team accountable for identifying enterprise risks, setting the goal is only the first step. Many leaders struggle with step 2 - which is "how" do we measure this? In this video, Jala talks about the key components to include when considering the goal of risk identification.
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When we say "invite the conversation" there are some things that you should keep in mind and prepare to share about the FWA Program and how it contributes to the organization. Do you know what those are? In this video, Jess let's you in on a few things that you should be ready for when you invite the conversations.
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Many FWA leaders wonder how to get their company to reimagine the value of their team. This video provides some quick tips on ways to make your organization aware of the value found on your FWA team. It could be as simple as inviting the conversation and questions!
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