False Claim Risk Assessment (FCRA)
Polaris Group possesses the experience, skills and expertise to perform claims review to identify potential risk for inaccurate claims and overpayment to Medicare and/or Medicaid.
We have the expertise in billing, coding, healthcare reimbursement, reporting and other requirements necessary to function as a professional, independent review organization. We can provide an array of services to evaluate your compliance needs and risk.
Objective: To prevent or minimize false claims.
- Provides an evaluation of current billing practices for identification of possible errors on submitted claims.
- Decreases risk of overpayment errors in the future and/or OIG intervention.
- Implementation of systems that are in compliance with Medicare and/or Medicaid rules and regulations for reimbursement.
Services and Deliverables:
Claims Review: Polaris provides expert auditing to all applicable Medicare and Medicaid rules and reimbursement guidelines. Sample size is based on acceptable practices for this focused audit. We perform claims review with identification of overpayment error rates. Report includes trends, analysis, claims involved and errors identified.
- Our reviewers include individuals who have a current, nationally recognized coding certification.
For each claim, we can perform a “walk through” of the system(s) and processes(s) that generated the claim to identify any problems or weaknesses that contributed to overpayment. Polaris provides findings and recommendations for improvement to systems. Polaris can help you implement changes and monitor that the changes achieve accurate claims.
Unallowable Cost Review:
Training and Education:
A review for compliance with unallowable cost provisions for state or federal payors. The analysis includes any payments sought in any cost report, cost statement, information report, or payment request already submitted to evaluate cost adjustments for the inclusion of unallowable costs.
Polaris provides training for billing claims for both Medicare Part A and B and Medicaid. In addition, Polaris can provide training and consulting for therapy and nursing services, PPS, RUGs, and MDS or Medicaid specific systems.