Screening medicare claims for medical necessity: hearing before the Subcommittee on Human Resources and Intergovernmental Relations of the Committee on Government Reform and Oversight, House of Representatives, One Hundred Fourth Congress, second session, February 8, 1996
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AdminaStar analyze appropriate AUTO-AUDIT autoadjudicated screens basically billing bottom line Boyer carrier medical directors Chairman CHAKA FATTAH chart CHRISTOPHER SHAYS ClaimCheck claims data claims processing contractors code combinations colonoscopy correct cost criteria Davis denied diagnosis echocardiogram echocardiography efficient Equifax evaluate Everett Dirksen fact focused medical review fraud and abuse GMIS going HCFA HCFA's identify implement inappropriate claims incentive issue Jaggar JOE SCARBOROUGH Kavanagh Kelly kind look manual review Medi Medicaid medical community medical necessity medical protocol medical review policies Medicare contractors Medicare program Medicare Transaction System ment model medical policies non-Medicare overused services overutilization paid patient pay claims payment for unnecessary payment policies percent Phelps physician potential prepayment screens prior to payment private sector problems program safeguard question Reis Ruiz savings Shays six groups STEVEN SCHIFF strategy submitted there's things tractors unnecessary services utilization