A house united: Integrating pre- and post-pay programs for optimal FWA results
Sponsored by: Cotiviti
Fraud, waste and abuse (FWA) in healthcare comes in all forms—from collusion to unnecessary treatment; from intentional over-coding to honest coding mistakes. As the industry continues to explore prepay interventions, discussions must be had about thoughtful approaches that use both current data and past results to conquer the many aspects of FWA. The goal is to make investigations and recoveries as efficient as possible while progressing beyond simply placing providers on prepay review. Cotiviti subject matter experts on FWA and prepay claims analysis will use recent claim scenarios and case examples to illustrate thoughtfully marrying postpay results with traditional claim-by-claim review and FWA pattern recognition.
After this session you will:
- Learn what it means to deploy claim editing and other prepay programs together without duplicating results or effort
- Explore how machine learning can help you learn from past cases and inform your provider approach
- Discover how to tie simple claim coding errors to true patterns of FWA and see when patterns become better or worse
- Understand the potential lift in savings to your organization and the system