The Office of the Inspector General (OIG) under the terms of a Corporate Integrity Agreement (CIA) often requires the engagement of an Independent Review Organization (IRO). Although claim reviews are the most common requirements, a CIA may also involve eligibility, verification or quality monitoring. Beyond satisfying the requirements of the CIA, a qualified and independent entity can provide organizations with an objective assessment of internal processes and actionable recommendations for improvement.
VantagePoint has experience assisting clients in meeting the rigorous review and reporting requirements associated with a CIA. Utilizing certified auditors, revenue cycle consultants, clinicians, and certified coders with knowledge and expertise in CPT/HCPCS/ICD-10 coding, as well as familiarity with the billing requirements of Federal health care programs, claims reviews are conducted independently to determine accuracy and validity. We ensure, during such review, that claims have met federal and state statutory, regulatory and medical necessity guidelines. Additionally, our sampling strategy is in accordance with the Office of the Inspector General’s approved methodology utilizing RAT-STATS software.
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