Polaris Group -- A National INDEPENDENT REVIEW ORGANIZATION
Entrust the experience, skills and expertise of Polaris Group to function as your Independent Review Organization (IRO) with meeting the requirements of your Corporate Integrity Agreement (CIA).
Paralleling the specifics of your Corporate Integrity Agreement, Polaris Group provides the expertise required for billing, coding, healthcare reimbursement, statistical methodologies, and other requirements necessary to function as a professional, independent review organization. An array of services to meet your compliance needs can be provided be it auditing, reviewing, training, monitoring or consulting.
Claims Review: Perform paid claims reviews in compliance with CIA requirements. Polaris provides expert auditing to all applicable Medicare and Medicaid rules and reimbursement guidelines. Sample size is based on acceptable statistical practices required for the CIA. We perform discovery claims review with identification of overpayment error rates; with a full sample review as indicated. Report includes trends, analysis, claims involved and errors identified. Our reviewers include individuals who have a current, nationally recognized coding certification.
For each claim, a “walk through” of the system(s) and processes(s) that generated the claim is performed to identify problems or weaknesses that contributed to overpayment. Polaris Group provides a Summary Report with findings and recommendations for improvement to systems following the review.
Unallowable Cost Review:
Polaris Group will review compliance for unallowable cost provisions for state or federal payor. The analysis includes all payments sought in any cost report, cost statement, information report, or payment request that has already been submitted to evaluate cost adjustments for the inclusion of unallowable costs according to the CIA.
Training and Education:
Training, as indicated by CIA or findings by the IRO, is provided for both Medicare Part A and B and Medicaid billing claims. In addition, Polaris Group will provide training and consulting for therapy and nursing services, PPS, RUGs, and MDS.
Reviewers have a current nationally recognized coding certification.