InRule® for Healthcare

Healthcare is driven by rules and regulations. Non-compliance with government coverage determinations and private payer reimbursement rules increases costs and reduces margins at every point in the revenue cycle. The traditional methods of ensuring compliance to healthcare rules and regulations — such as CMS Medical Necessity rules are complex, time-consuming, highly subject to error, and expensive. According to the National Health Insurer Report Card, claims payments are often late and insurers reported the correct contracted payment rate only 62% to 87% of the time.