Administrative Compliance Support
Recovery Audit Solutions, Inc. (RASI) performs a payment integrity analysis of prepaid and postpaid claims data to determine if services were provided based on contractual, policy and procedural standards. RASI’s experienced staff utilize cutting-edge tools and technology to deliver accurate audit results and identify process improvement recommendations for our clients.
Eligibility Determination
Contract Compliance
Complex Payment Terms
Monthly Membership Report (MMR) Validation
Non-Covered Benefits
Duplicate Payments
Coordination of Benefits
Third Party Liability
Subrogation
Credit Balance
Case Study
Monthly Membership Report (MMR) Validation
– Case Description
Medicare Advantage (MA) plans are responsible for reconciling CMS Monthly Membership Reports (MMR). A small Medicare Advantage health plan sought a vendor to validate CMS MMR payments for their Medicare Advantage members.
Summary
Recovery Audit Solutions, Inc. (RASI), was the vendor of choice to perform a review and reconciliation on behalf of the plan. RASI’s experienced staff combined with RASI’s cutting edge technology identified weaknesses in the plan’s processes and uncovered significant findings allowing the plan to obtain reimbursement of missing dollars and significant cost savings for future dollars.
Benefit
$1 million dollars recovered within 4 months
Improved internal processes
Increased future revenue
Final Result
The plan was able to adapt RASI’s processes to improve internal measures, implement an internal monthly reconciliation process and ensure compliance in MMR report reconciliation.