Read about how we transitioned a large health plan client from a prior process of manually verifying thousands of false positives every month to our automated, exact-match exclusion monitoring. Our solution leveraged our enhanced primary source data to catch exclusions their previous process never found.
Tag: Health Plan
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It's finally here. Learn all about the new CMS Preclusion List, what it is, who is included, how to monitor it, and how to prepare your organization.
* Updated from original post on 12/17/2015 Healthcare compliance is complicated and full of regulations, guidelines, and oversight. Since federal tax dollars are used to reimburse health care providers for services, the Department of Health and Human Services (HHS) as well as the Department of Justice (DOJ) have oversight on how those dollars are spent. The purpose of this blog post is to give a basic understanding of exclusions, industry best practices, and a brief description of the federal exclusion databases.