Data Mining for Multiple Diagnostic Radiology Overpayments
A recent audit of National Medicare Health plan, found over $400,000 in overpayments in a 12-month period for multiple diagnostic radiology claims.
Medical Risk Adjustment in Global Capitation Arrangements
Gain the framework needed for understanding medical risk adjustment and the business processes required to perform under a global capitation arrangement.
The Benefits of a Medical Claims Audit
There are numerous approaches and benefits of a medical claims audit. Understand the types of medical claims audits and how they help everyone involved.
What is Population Health?
What is Population Health? It really explores the underlying social & cultural issues that affect the health of large populations and their health outcomes.
Reinsurance and Stop Loss in Provider Incentive Plans
Get the facts about reinsurance and stop loss in provider incentive plans. Review the types of agreements and benefits of stop loss programs.
Understanding Medical Reinsurance
Medical reinsurance, also known as stop loss insurance is an added layer of protection that help cover situations that are outside even the best predictive models. Understand more about medical reinsurance now.
10 Facts about HEDIS Reporting & Measurements
HEDIS measures are revised every year and are strictly defined and are the reporting guidelines for gaps in care. Take a look at the 10 facts about HEDIS reporting our expert team has compiled.
Medicare Risk Adjustment (MRA) Key Dates and Best Practices
Get the facts about Medicare Risk Adjustment (MRA) and the best practices around implementation. Don't let MRA scare you off, get it right with our help.
CMS Provider Incentive Plans (PIP) Regulations and Stop Loss Reinsurance Requirements
An in depth review of the CMS Provider Incentive Plans (PIP) regulations and the Stop Loss Reinsurance requirements from the FRG expert editorial team.
What are Physician Incentive Plans (PIP) and Why Do They Matter?
Gain a high level view of what Physician Incentive Plans (PIP) are and how PIP works in today's healthcare industry, dominated by Medicare & Medicaid.