Program Integrity

Ascellon’s Program Integrity practice area covers a range of services that include review of payment systems and medical records; analysis of reimbursement patterns, and risk modeling. At Ascellon, we strive to improve the overall effectiveness of the services our customers provide to their beneficiaries. We perform rigorous medical records and facility audits that aim to identify fraud, waste, and abuse behaviors that exist in government funded healthcare programs. Our teams of technical experts (data analyst, statisticians, economists, investigators, etc.) and medical professionals (medical record coders, physicians, registered nurses, etc.) effectively report inaccurate documentation, discrepant claims, and non-compliance issues.  What sets us apart is our quality assurance procedures and the viability of the customized tools we develop to ensure efficient checks and balances are in place and cultivate the best outcome.
Ascellon has in-depth expertise in Medicare and Medicaid programs, supporting Federal agencies with their program integrity efforts.

Services we provide in this area include:
      3D Bullet (RED)    Independent review of payment systems and processes
      3D Bullet (RED)    Independent medical record reviews to validate diagnosis codes (ICD-9, ICD-10, CPT, etc.) against
             claimed reimbursements
      3D Bullet (RED)    Simulating the impact of diagnosis changes on payment and reimbursement models
      3D Bullet (RED)    Identifying medical coding discrepancies and their impact on reimbursements
      3D Bullet (RED)    Healthcare Performance Improvement and Quality Assurance