“If you can’t measure it, you can’t change it.”
— Peter Drucker
Why Is a Strong Audit Program Important?
Identify underpayments
Build trust with stakeholders, such as governing bodies, through accountability metrics
Decrease cost per claim
Increase average reimbursement per patient encounter
Determine risk
Create operational efficiencies
nCite™ looks at 23 critical elements from the pre-bill and post-bill process
PRE-BILL = 6 Elements
CODING = 11 Elements
POST-BILL = 6 Elements
Clients can use the feedback for operational improvements to assess risk, quality, and efficiencies.
Pass or fail grade on each element.
Drill down to individual employees.
Utilize feedback on each element that failed.
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Seniors on Medicare and Medicaid recipients both deserve access to quality care in a system free from the fraud, waste, and abuse that enriches the unscrupulous and jeopardizes the programs themselves. We will take action to continue to love and cherish the Medicare and Medicaid programs to ensure they are preserved for those who need them most.
The Secretary of Health and Human Services shall therefore take appropriate action to eliminate waste, fraud, and abuse in Medicaid, including by ensuring Medicaid payment rates are not higher than Medicare, to the extent permitted by applicable law.
The White House. (2025, June 6). Eliminating waste, fraud, and abuse in Medicaid. Presidential Action. Retrieved from https://www.whitehouse.gov/presidential-actions/2025/06/eliminating-waste-fraud-and-abuse-in-medicaid/
Of the $498 million in Medicare overpayments identified in HHS-OIG audit reports issued during our audit period that CMS sustained, CMS reported that it had collected only $272 million (55 percent) and that it had not collected $226 million (45 percent). Further, CMS provided documentation sufficient to support that it had collected only $120 million of the $272 million. CMS did not provide adequate documentation to support that it had collected the remaining $152 million.
“CMS Reported Collecting Just Over Half of the $498 Million in Medicare Overpayments Identified by OIG Audits.” U.S. Department of Health and Human Services Office of Inspector General (July 2022)
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We look forward to connecting with you on how nCite’s audit solution can keep you from leaving money on the table, and help you build trust among stakeholders.
