See what CMS sees in your claims data before they audit you. Protect your shared savings with compliance intelligence built for MSSP and ACO REACH programs.
The Challenge
You discover FW&A issues when CMS tells you about them—after the damage is done to your shared savings calculation.
Millions of claim lines across your attributed population. Most ACOs lack the tools to analyze their own data and surface actionable insights.
Fraudulent billing by suppliers in your network inflates your benchmark spend and erodes shared savings before you know it's happening. The OIG actively oversees ACO compliance—without proactive monitoring, you can't demonstrate "reasonable diligence."
Hundreds of participating providers with varying coding practices. Manual review can't keep pace with claim volume.
CMS benchmarks get tighter every year. Network leakage and high-cost outliers erode the savings you've worked to achieve.
Orphan DME claims and skin substitute billing schemes inflate your costs—and you're on the hook when CMS identifies them.
ACO program integrity is one piece of a broader compliance obligation. The same claims feed that protects shared savings also powers the compliance program CMS and OIG increasingly expect — risk assessment, monitoring, audit readiness, investigation, and corrective action all running on one platform.
Built for ACOs
Total cost of care management and FW&A program obligations are the two things CMS holds every MSSP and REACH ACO accountable for. Both run on claims data — so we've built the tooling for both.
Track spend against your CMS benchmark as claims arrive — not months after reconciliation. Attribute variance to the providers, specialties, settings, and members driving it. Surface network leakage, utilization shifts, and high-cost trends while there's still time to act — so shared savings isn't a year-end surprise.
Orphan DME, skin substitute schemes, billing outliers, and provider anomalies package into structured reports with detection logic, dated findings, and a full evidence trail. Meet the FW&A obligations in your MSSP or REACH Participation Agreement without manually assembling submissions to CMS, OIG, or MFCU.
Use Case
Your participating providers have different coding and billing practices. Some leave RAF on the table with unspecified diagnoses. Others may be upcoding or exceeding MUE limits. Manual review can't keep up.
Book a demo and we'll show you Pamastay with sample ACO data—or connect your own data for a pilot.
Schedule a Demo