Aberrant Claim

(redirected from Aberrant Claims)
A medical claim submitted by a physician or other health care provider for reimbursement from third-party payers, that may be financially abusive or fraudulent
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Highmark also reduced the time necessary to identify fraudulent claims by comparing aberrant claims data with that of peers, reducing the number of post-payment fraud investigations and the cost to dispute them.
The Partnership has developed a targeted program integrity reform proposal -- Skilled Home Health and Integrity Program Savings (SHHIPS) -- to prevent payment of aberrant claims by strengthening claims review processes, creating payment safeguards and tightening participation standards, including temporary entry limitations to prevent excess growth.
Our claims staff repeatedly acknowledged that Payment Optimizer helped to identify aberrant claims that would have otherwise gone undetected," said Greene.
The Partnership has put forth the Skilled Home Healthcare Integrity and Program Savings Act (SHHIPS) proposal, which would move Medicare away from the failed "pay and chase" model by preventing payment of aberrant claims, strengthening claims review processes, and implementing improved participation standards, including temporary entry limitations to prevent excess growth.
The Skilled Home Health Integrity and Program Savings Act (SHHIPS) would target Medicare fraud and abuse by preventing the payment of aberrant claims, strengthening the claims review process, improving participation standards, and establishing temporary entry limitations to prevent excess growth, which are critically needed to reduce spending and shore up the Medicare Trust Fund.
Skilled Home Health and Integrity Program Savings (SHHIPS) Proposal : Strengthens Medicare program integrity through solutions that will prevent the payment of aberrant claims before they occur and tighten the claims review process and conditions of participation standards for Medicare home health providers.
Other SHHIPS measures include hard-wired safeguards to prevent the payment of aberrant claims, stronger claims review processes, and the implementation of temporary entry limitations to prevent excess growth.
To aid in advancing program integrity reform, the Partnership has put forth the Skilled Home Health Integrity and Program Savings (SHHIPS) proposal, which would prevent payment of aberrant claims, strengthen the claims review processes, improve participation standards and establish temporary entry limitations to prevent excess growth.
The Partnership has developed a targeted program integrity reform proposal - Skilled Home Health and Integrity Program Savings (SHHIPS) - to prevent payment of aberrant claims by strengthening claims review processes, creating payment safeguards and tightening participation standards, including temporary entry limitations to prevent excess growth.
In support of this effort, the Partnership has put forth the Skilled Home Health and Integrity Program Savings (SHHIPS) proposal, which would move Medicare away from the failed "pay and chase" model by preventing payment of aberrant claims through firm payment safeguards, strengthened claims review processes, and tighter participation standards, including temporary entry limitations to prevent excess growth.
For this reason, the Partnership has put forth a targeted solution called the 'Skilled Home Health and Integrity Program Savings' (SHHIPS) proposal, which offers solutions to stop the payment of aberrant claims before they occur and tightens the claims review process and conditions of participation standards.
For example, the Partnership developed the Skilled Home Health and Integrity Program Savings (SHHIPS) plan, which includes strong measures to prevent the payment of aberrant claims through proven payment safeguards, improved claims review processes, elevated participation standards, and entry limitations to prevent excess growth.