Manage compliance with medical necessity requirements on every patient case.
Medicare and Medicaid reimbursements represent a significant portion of most hospitals’ operating revenues. Over the last several years, there has been a dramatic increase in both the number of CMS auditing agencies and the scope of their audits with the primary focus of rooting out fraud, waste and abuse in our health care system. There also has been a significant increase in Office of Inspector General (OIG) and Department of Justice (DOJ) activity. Medical necessity continues to be a primary target in ongoing audit and investigation activity.