Government audit
Corporate integrity agreements
and audit support
When an organization operates under a corporate integrity agreement, the reviewing entity has to be independent of the organization under obligation, and has to prove it to a regulator rather than to a client.
The requirement
A corporate integrity agreement typically obligates an organization to retain an independent review organization to examine claims, coding or medical necessity on a defined schedule, and to report findings on terms the organization does not control. The reviewing entity's independence, methodology and documentation are all subject to regulator scrutiny.
FOCUS has expanded into government audit work, specifically supporting corporate integrity agreements.
What FOCUS brings
Documented independence
URAC accreditation as an Independent Review Organization, with conflict screening applied at the case level rather than the engagement level.
Clinical depth
Board-certified physician reviewers across behavioral health, medical and pharmacy, which matters when a sample crosses service lines.
An auditable record
Determinations are produced inside a HITRUST CSF certified system that retains the sample, the criteria applied, the reviewer credentials and the reasoning. Regulators and monitors do not accept conclusions without a record behind them.
Federal contracting
Ready to review the FOCUS way?
Tell us your specialty mix, turnaround requirement and level of review, and we will tell you plainly whether FOCUS is the right panel for it.
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