Speak with anyone involved in identifying claim overbillings/overpayments and the message is clear: the rate of change in payment integrity is accelerating with no signs of slowing down anytime soon. In years past, tactics like coordination of benefits or retrospective claim auditing could reasonably address the majority of overpayments a health plan encountered.
Now, due to a variety of factors including advancements in fraud, waste, and abuse schemes, increased complexity of claim adjudication, and regulatory/external pressures, the stakes have been considerably raised. Unless your organization can keep up, fraud, waste, or abuse can quickly snowball to jeopardize the sustainability of your organization.
Fortunately, largely due to advancements in technology, the approach to payment integrity has progressed so that pinpoint correction of inaccurate claims on a daily basis with minimal errors is an achievable reality.
However, these advancements come with their own risks and challenges. Overinvestment in the latest gizmo that promises an impressive ROI often means neglecting smaller but steady improvements to established programs. On the other hand, overreliance on familiar solutions often leaves an organizational blind spot that can be exploited by bad actors without your knowledge.
Striking the right balance between fortifying established positions and pushing into new territory can be tricky. We invite you to join us for an hour-long webinar where our experts will discuss how to foster a pragmatic approach to payment integrity consisting of both retrospective and prospective tactics.
Specific topics will include:
- Surveying the Route: Payment Integrity Trends and Challenges in 2018
- Planning the Expedition: Learning the Latest Innovations for Key Tactics
- Longitudinal Data Mining
- Post-payment Auditing of Outpatient & Ancillary Claims
- Applying Medical Record Reviews to Prepayment Auditing
- Provider Behavior Modification
- Starting the Journey: Enacting Change at Your Organization
- Recovery -> Avoidance -> Prevention
- Audience Q&A
Vice President, Business Optimization, SCIO Health Analytics
Manager, Product Management, SCIO Health Analytics