Compliance Fraud Waste Abuse Services
Compliance, Fraud, Waste & Abuse
Compliance, Fraud, Waste & Abuse
SFUR is committed to improving the healthcare ecosystem. Both healthcare delivery participants and those entities that pay for healthcare, leverage the knowledge of the SFUR’s physician panelists. Monitoring compliance, fraud, waste and abuse starts with the SFUR physician panelists that can be impartial, objective and current in the knowledge and practice of their respective specialty.
Compliance, Fraud, Waste & Abuse Services
SFUR has the qualifications and experience to provide Independent Review Organization (IRO) Services to health care providers Corporate Integrity Agreements (CIAs) with the Office of Inspector General of the United States Department of Health and Human Services (OIG) and the related Settlement Agreements entered into with the United States.
Hierarchical condition category (HCC) ) relies on ICD-10 coding to assign risk scores to patients. HCC is becoming increasingly prevalent as the healthcare reimbursement environment shifts to value-based payment models. Along with demographic factors (such as age and gender), health plans use HCC coding to assign patients a risk adjustment factor (RAF) score. A patient’s RAF score predict costs.