While existing methods of identifying waste and abuse will find some of the occurrences, they won鈥檛 pick up all because some bad actors have modified their existing billing methodologies to capitalize on the new opportunities. According to , a white paper published by CMS, 鈥渋n fiscal year 2020, the Department of Justice (DOJ) opened 1,148 new healthcare fraud investigations, consistent with the number of annual investigations observed over the past decade.鈥� The paper noted that because schemers adjusted their tactics during the pandemic, efforts to prevent and mitigate fraud, waste and abuse must also adapt.

Lab testing for COVID-19 and other infectious diseases is one area ripe for waste and abuse. The following are examples involving infectious disease claims from laboratories:

• To investigate the surge of fraud that occurred during the pandemic, the Department of Justice created a special task force. One of several schemes they uncovered involved 鈥攎ore than $125 million of which involved fake claims during the pandemic for COVID-19 and respiratory pathogen tests.
• In Georgia, a pled guilty to felony charges and the owner, along with the clinical laboratory that he owned, agreed to pay $14.3 million to resolve claims related to kickbacks and unnecessary testing.

Waste and abuse relating to COVID-19 and other infectious diseases is becoming so widespread that in a . Long before the webinar took place, 成人视频 enhanced our procedures for identifying related waste and abuse.

To see what we鈥檙e doing to identify waste and abuse related to infectious disease claims, download our white paper titled 鈥�Innovations in Payment Integrity: Stopping the Spread of Waste and Abuse Related to Infectious Disease鈥� and don鈥檛 forget to ask your payment integrity vendor what they are doing.

As anyone who follows the industry knows, and as the same Texas study concludes, this is problematic because networks are generally more cost-efficient, and can facilitate better return to work and functional outcomes for injured workers.

Despite these obvious advantages, many states prohibit employers from directing injured workers to in-network providers. And even in states like Texas and California that do allow employers to direct employees to provider networks for a period of time and under certain circumstances, out-of-network bills are still a big driver of medical costs. In Texas, the 2022 Workers鈥� Compensation Network Report Card shows, per-claim medical costs for non-network bills were about 12% higher 18 months after injury than costs for network bills.

Top five considerations for property and casualty payors

Given this situation, property and casualty payors must take care in choosing an out-of-network solution. Here are our top five considerations when choosing an out-of-network solution for your workers鈥� compensation or auto medical bills.

1. Does the solution enhance traditional workers鈥� compensation and auto medical bill review processes?

Many managed care companies rely solely on bill review to reprice medical bills to a Usual & Customary rate or a state-mandated fee schedule. Our services can enhance traditional bill review processes in order to capture more savings, without disruptions. 成人视频 takes a multilayered approach to out-of-network property and casualty bills. This approach includes:

• Data iSight, an alternative to Usual & Customary or Medicare-based repricing methodologies
• Advanced Code Editing, designed to enhance traditional bill review processes with advanced analytics, physician-developed code rules and expert clinical reviews
• Negotiation 成人视频, which secure signed agreements with providers

2. Is the repricing based on apples-to-apples comparisons?

In our experience, providers often object to Usual & Customary or Medicare-based pricing methodologies, saying the resulting reductions don鈥檛 allow them to make a profit. They may say that a procedure costs more at their facility because they operate in a rural area. Or they may say their costs are higher because they train physicians. 成人视频 limits these objections by using data from similar facilities, bills or professionals. This results in 89%-98% of providers accepting our reductions. Better still, savings typically ring up to 73% off billed charges. In 2022 in states without a state fee schedule (Missouri and New Hampshire) and for certain bill types (New Jersey and Arizona), Data iSight achieved $119,442,538 in savings below the bill review repriced amount. The bill review repriced amount includes both Usual and Customary and fee schedule repricing.

3. Is it backed by data?

Providers may not accept repriced bills if they do not understand how the amounts were calculated. That is why managed care services companies should not operate in a 鈥渂lack box鈥� pricing mode, as many do. Instead, a vendor must be able to explain their pricing methodology, citing the data used to develop their repricing rules. 成人视频 uses a database of over 1 billion paid Health Care Finance Administration (HCFA) bill lines. We also use publicly available sources for facility data.

4. Is the solution informed by clinical expertise?

When choosing an out-of-network repricing solution, you should ask whether physicians participated in the development of the solution. Do they intervene, when necessary, in validating any repricing findings? 成人视频 relied on the expertise of physicians when developing our Advanced Code Editing solution鈥檚 rules, or 鈥渇actors,鈥� which power our analytics. In addition, board-certified physicians or expert coders review findings, when necessary.

5. What happens if a provider objects to a repriced bill?

With even the best repricing solutions, there will be times when a provider will object to a repriced bill. You should ask your vendor what happens in these instances. Does the vendor have a team that can jump into action? 成人视频鈥檚 reference-based pricing and negotiation service teams have over 400 negotiators, clinicians and support staff. They secure 31% to 37% average savings below bill review, depending on the bill type.

With these five questions answered, you should be well on your way to finding the right out-of-network solution for your workers’ compensation or auto medical bills.

It does not matter how many times we uncover healthcare claim schemes, the聽things 成人视频鈥檚 Payment Integrity team finds in healthcare claim data leave us shaking our heads. We鈥檝e compiled another round of intriguing patterns鈥攁nd subsequent law enforcement impact鈥攐ur team identified as they dug into healthcare claim data.聽While we try to present the findings in a humorous way, we鈥檙e well aware of how serious they are for both their potential impact on patients as well as healthcare payors.

It didn鈥檛 take a brain surgeon to determine something was off.

We received numerous claims from doctors using a 鈥渂rain health鈥� device named eVox, manufactured by Evoke. This is a skull cap patients wear while brain functions are tested in 20-60 minute office visits. When Evoke released the device, they suggested general practitioners should bill with six different codes. However, the recommended codes require a longer testing time in a specialized environment, such as being in a soundproof or dark room. Furthermore, only certain types of specialists can administer tests with these codes. CMS said none of the codes were appropriate. Proper billing for use of the device involves only one code.

成人视频 noticed several claims with multiple lines of billing codes for the device and took a closer look. Some physicians were billing with the six codes promoted by Evoke. We identified 934 claims with a total of $1.4 million in charges, impacting 335 patients, that were incorrectly coded.

Coincidentally, soon after we identified these claims we learned the U.S. Attorney Office of Eastern PA was litigating Evoke and its founding CEO for promotion of the billing codes.

They call it a panacea. We call it snake oil.

A Texas medical clinic claims a miracle infusion treatment can relieve symptoms of metabolic syndrome, rheumatoid arthritis, Parkinson鈥檚, gout, macular degeneration, and Crohn鈥檚 disease. But wait, there鈥檚 more. The physician using the treatment says it also improves energy levels, sleep, inflammation, psoriasis, neuropathy, kidney failures, MS, and more. This treatment, dubbed 鈥淧hysiologic Insulin Resensitization (PIR), is administered in three-hour sessions, up to twice a week, where doses of insulin and saline are pumped into patients via an IV every 4 to 8 minutes and offset with glucose given as sugar water, pretzels, or Coke.

Payors, including Medicare, reimburse PIR at approximately $500 per session. According to the CEO of a Texas hospital that offers the treatment, it鈥檚 wildly profitable. In fact, physicians using the treatment advocate for its use in every U.S. hospital. However, no credible clinical trials have confirmed PIR鈥檚 effectiveness, and a past president of the American Diabetes Association has implied PIR is fraught with deception, with a focus on making money. CMS has even refused to reimburse the code representing this treatment. To get around this, it鈥檚 now billed with a code representing infusions.

成人视频 identified more than 15,000 claims billing for PIR, representing $5.2 million in charges and impacting 201 patients. We recommend our clients do not pay these claims.

Greasy palms handled these claims.

A group of Missouri and Texas physicians and medical practices were charged with accepting kickbacks for referring patients to specific laboratories for testing. These physicians and facilities violated the , which prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid, and other federally funded healthcare programs. The Statute is intended to ensure that medical providers鈥� judgment is based on the best interests of their patients.

成人视频 identified more than 251,000 claims with lab testing services from these providers, representing $130 million in charges and affecting approximately 32,000 patients.

The Department of Justice has financially penalized this group of physicians and facilities for the illegal kickbacks.

Learn more about鈥扇耸悠碘�檚 Payment Integrity services鈥痑nd let us find out what鈥檚 hiding in your claim data.

As a part of 成人视频鈥檚 Payment Integrity service, we review claims to ensure there are no billing errors and that the charges make sense. When we find mistakes or suspicious charges, we investigate. Below we share some eye-popping findings from our Payment Integrity team鈥檚 investigations.

The Fountain of Youth exists and it鈥檚 located in a doctor鈥檚 office. 

That鈥檚 what claims data from a specific doctor would have you believe. The provider ordered countless tests and performed multiple procedures time and time again to combat 鈥渁nti-aging.鈥� Each test/procedure costs between $12,000 to $18,000.  Our algorithms flagged the claims for excessive testing and the extraordinary number of procedures performed, and our medical experts confirmed the tests and procedures were inappropriate. We are in the process of removing this provider from 成人视频鈥檚 networks. Sadly, there is no evidence the Fountain of Youth has been located.

There鈥檚 a diagnostic test for fibromyalgia, but apparently only one medical laboratory knows about it.

Currently, there is no lab or imaging test to diagnose fibromyalgia. Doctors diagnose the condition by ruling out other causes for fibromyalgia鈥檚 symptoms, which are primarily pain and fatigue. That鈥檚 why we were surprised to find a medical laboratory advertising a fibromyalgia test. We became aware of the provider after receiving almost 500 claims with charges of approximately $10,000, all with the same diagnosis of immunodeficiency diagnoses. This caught our attention because it鈥檚 a rare disorder with only 1 case out of 50,000 worldwide.

The same 15 immune system tests were repeatedly billed on multiple claims. 成人视频 investigated and found the  provider was billing the 15 tests, but calling it a Fibromyalgia Test. Worse, none of the patients in the claims we reviewed had the diagnosis reported by the provider. If a test for fibromyalgia is ever developed, we believe it will be big news and not a secret kept by one medical laboratory.

It turns out past life regression cures some sick patients.

Investigating questionable charges led us to a provider who advertises that some illnesses may have originated in a past life, and past life regression may cure them. The provider also claimed to be able to contact the dead. We became aware of these assertions because the provider filed multiple claims with charges of $2,000 each for office visits that included an electroenchephalogram (EEG).

EEGs are used to detect seizure activity and localization of seizure activity, and trained EEG technicians typically perform them. Neurologists interpret the results. The provider鈥檚 credentials did not include any EEG technical or neurology academic or practical qualifications. These claims were repeatedly filed for the same patients, and some patients received multiple EEGs within 1 or 2 week time frames. This caught our attention, so we investigated. The provider admitted to not performing the EEGs. She billed for them because what she actually did was not reimbursable. We have removed this provider from 成人视频鈥檚 networks.

Learn more about 成人视频鈥檚 Payment Integrity services and let us find out what鈥檚 hiding in your claim data.

How would your PI vendor answer the following

The following questions can help separate the wheat from the chaff.

1. How do you engage with providers?
   If not careful, payment integrity vendors can create provider abrasion and damage the relationship between payors and providers. Your vendor should have a long history of working with providers in an amicable manner.
   
   
2. Does anyone on your team have experience working for a payor directly?
   The best healthcare payment integrity vendors will have a deep understanding of your business objectives and knowledge of the challenges you face.
   
   
3. How do you communicate with clients and what is your average response time?
   Open, frequent and regular communication is a hallmark of a quality PI vendor and should be something that you demand.
   
   
4. What is your medical cost containment strategy and do you treat your clients as partners?
   It is imperative that your vendor has a payment integrity philosophy that matches yours in terms of balancing savings versus appeals and administrative burdens. The vendor also needs to think of themselves as your business partner, not your vendor.
   
   
5. How flexible is your solution?
   It鈥檚 important to determine whether your vendor is willing and able to customize their solution to fit your specific needs. You don鈥檛 want a vendor that touts a one-size-fits-all approach.
   
   
6. What is your appeal rate?
   The appeal rate should be below 2%. And the vendor should handle those appeals while giving you total transparency to the process.
   
   
7. What is involved in implementation?
   The implementation process should be fast and simple and not one that ties up significant resources throughout your organization.
   
   
8. How do you keep the data we send you safe?
   Protected health information (PHI) is a hot commodity on the black market. Make sure your vendors have protocols and systems in place to keep it safe.
   
   
9. Are billing errors identified by technology or manually?
   High-end solutions leverage a combination of technology and medical professionals such as coders and physicians to identify errors. The errors are detected by automation, and a medical expert reviews suggested edits to make sure they鈥檙e applicable for the specific medical claim being reviewed by eliminating false positives and false negatives.
   
   
10. Are you able to explain the edits you make to providers?
    Healthcare payment integrity vendors can minimize provider abrasion by making edits they can explain. This doesn鈥檛 mean making simple edits. It means being able to talk about any and all edits in clinical terms. Physicians involvement in the payment integrity process provides a significant advantage. They鈥檝e been in similar circumstances as the treating physician. They can translate industry codes into clinical situations, and they can determine if a clinical situation is realistic or not. They鈥檒l also have an understanding of what the provider may object to and be able to explain why the objection doesn鈥檛 apply.

Outstanding PI vendors have good answers

These considerations are less obvious than functionality, and they鈥檙e where the outstanding payment integrity vendors separate themselves from the mediocre ones. If you’re looking for a Payment Integrity vendor, contact 成人视频.

What do payment integrity solutions do?

There are several types of payment integrity solutions.  Overall, they ensure a claim is paid correctly by verifying:

• The responsible party pays the claim.
• The claim is properly coded.
• The claim is coded in a way that is applicable to the diagnosis.
• The claim is paid in accordance with health plan policies.

A comprehensive payment integrity solution typically consists of several different services that together accomplish all of the above.

When are payment integrity solutions used?

Payment integrity solutions can be used before or after a claim is paid.  An advantage of using a prepayment solution whenever possible is that not only does the solution generate savings by correcting the issue before a claim is paid, it also eliminates the need to allocate resources to re-process claims and/or recover overpayments if an error is found after the claim is paid.

An important consideration for a post-payment integrity solution is whether the solution helps the payor to avoid the same issue from occurring in the future. That is, once an issue is identified post-payment, the root cause should be corrected and then, ideally, also captured in a prepayment solution so that the issue doesn鈥檛 lead to future overpayments.

Payment integrity solutions work together

 If you鈥檙e already using a payment integrity solution, it鈥檚 important to know that adding a new one to your claim processing doesn鈥檛 necessarily mean eliminating the one you鈥檙e already using. Payment integrity solutions from different vendors can work together. Many healthcare payors use a stacked approach, putting one solution behind the next to catch more errors.

Learn about 成人视频鈥檚 Payment and Revenue Integrity services here.

Without question, the single greatest challenge facing the U.S. healthcare system is rising costs. The U.S. spent a staggering  in 2019, the latest year for which federal data is available. Despite a massive undertaking by the industry to drive efficiency, healthcare trends show that spending continues to soar. With an average annual growth rate of 5.4%, the  predicts that by 2028 healthcare spending will reach $6.2 trillion, nearly 20% of our GDP. 

Fueled by the proliferation of chronic illness, our aging population, rising health wages, and the growing complexity of the healthcare system, U.S. spending outsizes and outpaces all other nations. Yet even with the greatest investment in healthcare, America  when it comes to health outcomes. We are facing a true cost crisis that impacts all players in the healthcare ecosystem. Consumers are paying more than they can afford, employers and the U.S. government are struggling to keep pace with rising costs, and both payors and providers are seeing profits squeezed. Our spending trajectory is no longer sustainable and must be better aligned to improve health outcomes. 

Short of overhauling the entire health system which is practically impossible, there is no easy solution or silver bullet to curtail rising costs. Instead, it will take a combination of forces chipping away at the margins to make healthcare more affordable. Here are five trends we鈥檙e watching in 2022 with the potential to lower costs, improve outcomes, and make our health system more sustainable over time. 

#1: The Consumerization of Healthcare Will Drive Down Costs

Until recently, healthcare has been immune to the forces of consumerism that have disrupted every other major industry. Catering primarily to payors and employers who have largely covered the cost of care, providers haven鈥檛 had to compete directly for consumers based on price and outcomes. But as consumers take on a far greater share of the cost burden, that is about to change. 

Out-of-pocket costs for healthcare have grown substantially, from higher premiums and deductibles to more expensive drugs. With increased skin in the game and digital expectations shaped by their experiences with other industries, a new generation of health consumers are bringing higher expectations for convenient, affordable, quality care on their terms. They want greater price transparency, better digital tools, and the ability to get care when and where they want it. In fact, the  shows consumers will increasingly choose medical providers who offer digital capabilities. This healthcare trend has only been accelerated by the pandemic, which quickly acclimated patients to virtual care platforms, digital communications, and new convenient care settings. 

Not only are consumers demanding more from the healthcare system, but they are also taking a more active role in managing their own health. In fact, a recent study from Wolters Kluwer Health shows 86% of consumers believe proactivity on their part is critical in ensuring high-quality care and outcomes. These empowered, price-conscious, digitally savvy patients will transform the future of healthcare as the industry innovates and adapts to deliver more patient-centric experiences. We expect this disruption will drive spending downward as providers compete more aggressively for patient loyalty and lower-cost delivery models emerge. Moreover, as patients take a more active role in their health, cost savings can be achieved through a healthier population. 

While the greatest impact of consumerization will initially be felt in the self-pay market, payors and providers must act now to align their experience to the expectations and needs of the next generation of health consumers. Taking a more patient-centric approach now means being more competitive now and in the future. 

#2: New Transparency Measures Will Put Pressure on Pricing

Given the cost of care and Americans鈥� increasing financial worries over health-related bills, it鈥檚 not surprising most want to know what they will pay before receiving care (just as they do for every other service they purchase). A recent  found 75% of patients now seek cost information before receiving care. Unfortunately, until now, that data has not been easy to find. Medical costs vary widely by location, provider, and coverage type, making it difficult for patients to understand their true costs and to comparison shop. 

Sweeping bi-partisan healthcare reforms aim to change that in 2022. In an effort to make healthcare more affordable, lawmakers are banking on a series of new transparency regulations to drive down costs by arming consumers with better pricing information. Reform measures including the , the , and the  make it easier for consumers to understand how much they will pay, compare costs, and make smarter provider selections. 

Despite significant industry hurdles to adopt these new transparency measures, widely available pricing information is expected to drive competition between providers and give patients the necessary resources to manage health costs proactively. 

Payors must act fast to ensure they are ready to comply with these new measures. It will also be essential to engage members in the adoption of pricing tools as they become available. While regulation will make more data available, it is unlikely to move the needle on the cost of care if consumers don鈥檛 use the information to make better spending decisions. 

#3: Cost Management and Payment Accuracy Innovations Will Cut Wasteful Spending

Waste is one of the most significant contributors to the high cost of healthcare, accounting for 20 to 30 percent of all spending. Fraud, abuse, and billing inaccuracies significantly drive up the cost of care, but new efforts and innovations in artificial intelligence and machine learning could turn the tide on this healthcare trend if they are widely adopted. Using advanced data and analytics to fuel negotiations, prevent and detect fraud, and manage claims, 成人视频 alone drove nearly $20 billion in savings for our customers last year. 

We expect to see the adoption of new cost management strategies accelerate in 2022, especially in using AI to curb administrative waste. While the benefits of AI are clear, the healthcare industry still lags behind the curve, with only . Bullish on its potential, leaders across healthcare are stepping up to accelerate their efforts, investing in new technology, partners, and staff that can leverage data and analytics to solve their most pressing cost challenges. In fact,  in AI in the last year. 

AI, machine learning, and advanced analytics also can fight one of the industry鈥檚 biggest cost management challenges – perception. For too long, cost management has been viewed as a negative practice, putting members, payors, and providers at odds with each other, when in fact, it is an essential solution to keep healthcare affordable. Through the use of predictive analytics, much of the abrasion that came along with traditional payment integrity solutions can be avoided. Advanced pricing data can be used to determine fair and reasonable rates that are a win for providers, payors and patients. 

As payors look to maintain profitability without raising premiums, proactive member engagement, member wellness initiatives, and effective utilization management should be a critical piece of any strategy to fight rising industry costs. Cost management is imperative to making our health system sustainable, and when done correctly, can actually lead to better health. It鈥檚 time for it to be seen as a positive force instead of a deterrent to quality care.

#4: Lower Cost Care Models Will Proliferate

Battered by high costs, it鈥檚 no surprise employers, the federal government, and consumers are looking for new healthcare options and are experimenting with a host of new payment models, care delivery channels, and innovations they hope will improve care and make it more affordable. With a focus on well-being, new care models are emerging and quickly transforming the future of healthcare as we know it. Where 80% of today鈥檚 health spending goes toward care and treatment, it鈥檚 estimated that by 2040,  and well-being, and the market is quickly shifting in that direction. 

Just as they were a driver of our current health system, employers looking to maintain a healthy and productive workforce are key drivers of this change. Facing , employers are finding alternatives to traditional health plans, encouraging the adoption of wellness programs, steering employees to lower-cost options and centers of excellence, and in some cases, even entering into the healthcare business directly to provide employees convenient and affordable options. Onsite clinics, fitness programs, and a greater emphasis on mental well-being are all on the table. As it foots the bill for aging populations and increasing numbers of Americans not covered by employers, the federal government is also putting more emphasis than ever on keeping patients well, resulting in the widespread adoption of value-based care. 

With so much on the line, healthcare incumbents, as well as new market disruptors, are rushing to bring new solutions to the market. In addition to new payment models, we are seeing widespread shifts in how and where care is delivered. Telehealth, which catapulted into the spotlight as a result of the pandemic, is here to stay as an efficient and effective delivery channel. Retail clinics and quick care centers are replacing traditional medical offices and giving consumers the convenience they want at a lower price tag. And direct-to-consumer offerings are taking off, giving consumers affordable access to address common health needs from birth control to mental health. Even hospitals are taking a back seat, increasingly used only as a last resort for urgent health needs. Care will be decentralized, and patients, previously hospitalized, will increasingly be cared for from home. 

With demands for more affordable plans, payors will continue to adapt and embrace new models, innovating new reimbursement strategies that support a transition from a fee-for-service system to a model that rewards total wellness. Working closely with providers, payors will need to redefine the value of care and effective reimbursement strategies that reward and incent for healthy patients. Plans that continue to elevate the member experience, engage members in wellness programs, embrace new care delivery options, and offer more flexible, affordable networks, will be well-positioned to succeed in this rapidly changing environment. 

#5: Greater Collaboration Will Drive Efficiencies Throughout the System

Our healthcare system faces vast challenges in the years ahead. Delivering efficient, affordable solutions to meet increases in the demand for care, produce better patient outcomes, rise to new consumer expectations, and create fairness for all parties – patients, payors, and providers – is a tall order. However, a movement toward greater collaboration between all players could help pave the way, and we are starting to see signs that it is underway. Changes in care delivery models, greater interoperability, the digitization of healthcare, and more engaged consumers are fostering an era of collaboration not previously seen, in which patients, their providers, and their health plans all work together to improve outcomes and lower costs. 

A shift to value-based care models is accelerating this healthcare trend. As payment becomes intertwined with patient outcomes and satisfaction, we continue to move away from a transactional model toward a patient-centric system of care in which providers and payors share an interest in keeping patients healthy. The movement will drive better coordination between providers as they are incented to work together to proactively manage patients’ overall well-being, resulting in the more efficient and effective use of our healthcare dollars.

Once a roadblock to collaboration, technology platforms will also transform how the industry works together to deliver the future of care. 2022 will bring continued innovation and investment to build platforms and solutions that improve workflows, break-down silos, and drive efficiency through collaboration. Though much still needs to be done, improved interoperability allows care teams to see the complete picture and reduce duplicate or unnecessary procedures. In addition, increased digitization empowers patients to take a more active role in managing their care. With the proliferation of electronic medical records, patient portals, apps, and digital health tracking tools, it is easier than ever for patients to communicate with their providers and share information across their care teams. 

Collaboration is the only way forward if we are to bring necessary cost savings to our health system. Payors have a key role to play and will need to work closely with providers toward shared goals that benefit patient outcomes and increase efficiency. While several new regulations will force deeper collaboration between payors and providers, those that can proactively seek collaborative partnerships with their provider networks and members will be better positioned to reap the benefits, driving bottom line savings through reduced administrative costs and improved patient outcomes.

At 成人视频, our mission is to make healthcare more efficient, affordable, and fair. While there are no easy answers to tackle the mounting cost challenges facing our industry, we are eager to see how each of these healthcare trends contributes to a more sustainable future in 2022 and beyond. We鈥檒l continue to do our part, working with our partners across the industry to inspire change and innovate new cost-saving solutions. 

Contact us today to learn more about what these healthcare trends mean for your business and how 成人视频 can help you adopt cost-saving strategies in 2022. 

When eligibility errors occur, they affect many payment integrity areas such as coordination of benefits (COB), subrogation, and Medicare secondary payer (MSP) validation. Failing to address these issues leads to incorrectly paid claims, improper reimbursements, or claims that shouldn鈥檛 be paid at all鈥攃osting your health plan millions.

This infographic identifies the top three causes of eligibility errors and illustrates how a connected payment integrity approach can help.

Interested in learning more about eligibility data and how a connected payment integrity approach can help? Contact us today!

Previously published on the former Discovery Health Partners website.