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Program Integrity
HMS has a thorough working knowledge and is amply qualified to evaluate health care services to confirm that providers have actually delivered the service(s) for which a claim was submitted. Our staff has experience in review of all types of health claims, including inpatient, outpatient hospital, physician office, and other claim types. We are also knowledgeable of the various payment methodologies, such as inpatient prospective payment systems, fee-for-service systems, and capitated payment systems. HMS assists the federal government in validating that federal funding is used in accordance with required regulations and rules.
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