Health Care Claims Data Analysis and Review- RIAS™
Strategic Management’s health care claims data review and analysis services enable health care organizations to trend, analyze, and report on claims and other data that they generate on a daily basis. The Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies have increased regulatory and enforcement efforts and surveillance with the use of data analysis techniques and statistical auditing including extrapolation methods. The next frontier in preventing and mitigating risks in the health care industry is to conduct internal claims data analysis reviews, design billing monitoring techniques and programs, and design and apply metrics that flag billing and documentation risk before submitting that data to regulators, and being prepared to respond to government audits that use data prospecting, overpayment extrapolation, RAT-STATS, SAS, pattern detection and other methods with the same heavy arsenal the government applies. Automated and complex reviews have become the norm. Being proactive is critical, leveraging one’s own data and medical documentation before the government auditors and contractors do is not only prudent and financially smart. Our Revenue Integrity and Audit Services (RIAS™) provide you with the techniques and support to enable health care providers and organizations to take proactive steps in mitigating any potential enforcement action that might otherwise ensue.
For more information about claims data analysis and the other services we provide, please contact us by calling (703) 683-9600 or filling out our online contact form.
Health Care Claims Data Analysis Related Resources
The following articles provide additional information regarding claims data analysis:
- Billing Monitoring: Weakest Link or Greatest Strength?
- OIG RAT-STATS: Response Strategies to Government Claims Audits
- OIG’s updated Provider Self-Disclosure Protocol: Sampling and Overpayment Extrapolation
View all Health Care Compliance Services.
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