Client: Centers for Medicare & Medicaid Services (CMS)

Status: In progress

Services: Database Management and Organization, Healthcare Analysis, Compliance and Integrity Analysis, Managerial and Analytic Support 

Key Work Areas: Compliance and Generally Accepted Government Auditing Standards (GAGAS) audits, healthcare industry and provider assessments, fraud and waste research and analytics, artificial intelligence/machine learning, database compilation, civil monetary penalty models, regulatory support, cross-contractor collaboration

The Centers for Medicare & Medicaid Services (CMS) engaged Econometrica to provide support on the Value Incentives and Quality Reporting (VIQR) Appeals project. CMS quality reporting is a requirement for healthcare entities required by law. VIQR appeals support gives CMS the bandwidth to focus on policy development rather than individual appeals.

Econometrica was able to streamline the appeal review process, allowing for timely resolution of quality and payment appeals. Econometrica’s efficiency limited over-utilization of government resources and ensured the payments were proportional to healthcare performance metrics. Additionally, Econometrica facilitated communication between healthcare providers (hospitals, skilled nursing facilities, home health care providers, and post-acute care services), CMS and other stakeholders regarding quality measures and federal standards of care.

Client: Centers for Medicare & Medicaid Services (CMS)

Status: In progress

Services: Database Management and Organization, Healthcare Analysis, Compliance and Integrity Analysis, Managerial and Analytic Support 

Key Work Areas: Compliance and Generally Accepted Government Auditing Standards (GAGAS) audits, healthcare industry and provider assessments, fraud and waste research and analytics, artificial intelligence/machine learning, database compilation, civil monetary penalty models, regulatory support, cross-contractor collaboration

The Centers for Medicare & Medicaid Services (CMS) engaged Econometrica to provide support on the Value Incentives and Quality Reporting (VIQR) Appeals project. CMS quality reporting is a requirement for healthcare entities required by law. VIQR appeals support gives CMS the bandwidth to focus on policy development rather than individual appeals.

Econometrica was able to streamline the appeal review process, allowing for timely resolution of quality and payment appeals. Econometrica’s efficiency limited over-utilization of government resources and ensured the payments were proportional to healthcare performance metrics. Additionally, Econometrica facilitated communication between healthcare providers (hospitals, skilled nursing facilities, home health care providers, and post-acute care services), CMS and other stakeholders regarding quality measures and federal standards of care.

Client: Centers for Medicare & Medicaid Services (CMS)

Status: In progress

Services: Database Management and Organization, Healthcare Analysis, Compliance and Integrity Analysis, Managerial and Analytic Support 

Key Work Areas: Compliance and Generally Accepted Government Auditing Standards (GAGAS) audits, healthcare industry and provider assessments, fraud and waste research and analytics, artificial intelligence/machine learning, database compilation, civil monetary penalty models, regulatory support, cross-contractor collaboration

The Centers for Medicare & Medicaid Services (CMS) engaged Econometrica to support Open Payments Program Analytics in providing transparency regarding financial relationships in healthcare. By conducting database collection, analysis, and audits, the Econometrica Team was able to analyze the relationships between pharmaceutical and medical device manufacturers/distributers and their healthcare provider counterparts (e.g., physicians, non-physician providers, and teaching hospitals).