Compliance Checking Overview

Compliance Checking helps you demonstrate your intent to fully comply with all CMS and OIG guidelines, and your commitment to achieving accurate and proper documentation for full and appropriate reimbursement.

All Medicare claims must reflect reasonable and necessary services ordered by a licensed medical professional, and false or fraudulent claims can result in penalties. Through medical necessity checking prior to providing services, Compliance Checking plays an integral role in your efforts to promote accurate Medicare billing information and regulatory compliance.

OptumInsight Compliance Checking:

• Helps you receive accurate, timely reimbursements
• Easily integrates into your scheduling, registration, medical records, or order entry systems
• Customized to help your organization deal with complex Medicare regulation while supporting existing workflow