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Payment integrity solutions that begin and end with you saving. Pay Right. Save Money. HealthCare Insight | A Division of Verisk Health InSIghT A Nucleus Solution Fraud, waste & abuse for facility claims > ® Avoid oveRPayMenT Trauma WITh ouR FaCILITy BILL Experts. Prevent Fraud | Improve Accuracy | Reduce Costs
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Payment integrity solutions that begin and end with you saving. Preventing fraud, waste and abuse with the Clinical Touch.
Pay Right. Save Money.
HealthCare Insight | A Division of Verisk Health
FacilityClaimInSIghT
®
A Nucleus Solution
Fraud, waste & abuse for facility claims >
Prevent Fraud | Improve Accuracy | Reduce Costs
Avoid oveRPayMenT
Trauma WITh ouR
FaCILITy BILL Experts.
22
A comprehensive list of a provider’s overall statistics, licenses, sanction informa-tion and so much more, the Provider Profile packs the perfect information punch.
Elevate your claims payment accuracy, identify fraudulent providers and decrease your facility bill costs.
Prevent Fraud | Improve Accuracy | Reduce Costs
FacilityClaim InSIghT
®
23
Fraud Stats
3% – 10% of the national outlay for facility claims is lost to fraud and abuse. By 2013, losses could exceed $99 billion.
“HCI customers using this service consistently realize facility claim savings of 15% – 30%.”
– Darin Johnson, MBAHealthCare Insight
www.hcinsight.com
Fraud Projections for Facility Claims 2010 – 2013 / 3 – 10% loss
The
Problem
(In B
illio
ns)
$83.0
$87.7
$93.2
$99.3
$24.9$26.3
$28.0$29.8
10% Loss
3% Loss
Results
> Reduce expenditures up to $4 PMPM
> Improve claims payment accuracy up to 10%
> Decrease targeted claim costs up to 20%
Features
> Prepayment analysis on 100% of facility claims
> Clinical review on all suspect claims and providers
> Code Validator Pro® — Rules-based editing
> Fraud Finder Pro® — Provider profiling and scoring
> Highly customizable rules and parameters
> 24-hour turn-around after receipt of records
> Signed agreements to eliminate balance billing
> DRG audit, validation and repricing services
> Claims adjustment based on state and payor standards
> Fee negotiation by highly trained professionals
> Forensic line-item analysis of high dollar claims
Next StepsContact us for a complimentary Cost Reduction Analysis.Call 1.877.619.5557 or email [email protected] today.
2010 2011 2012 2013
The
Solution
36 Prevent Fraud | Improve Accuracy | Reduce Costs
CLINICAL REVIEW BY MDs, RNs & DDS’ >
PREPAYMENT SaaS SOLUTION >
TOTAL PAYOR CUSTOMIZATION >
REAL-TIME CLAIMS PROCESSING >
DETAILED AD-HOC REPORTING >
APPEALS SUPPORT & RESPONSE >
IMMEDIATE REALIZATION OF ROI >
SOLUTIONS FOR ALL PAYOR TYPES >
Why you’LL Like Us.
MeMBeRShIPS & aCCReDITaTIonS
P Phone 877.619.5557
F Fax 801.285.5801
E Email [email protected]
W Web www.hcinsight.com
R HCI Fraud Resources www.profilermag.com www.stophealthcarefraud.com
S Connect With HCI Twitter | Facebook Linkedin | YouTube
M Mail HealthCare Insight 10897 S. River Front Parkway Suite 200 South Jordan, UT 84095
hoW To Contact Us.
© 2010 HealthCare Insight – A Verisk Health Company. HealthCare Insight, PhysicianClaim Insight, DentalClaim Insight, FacilityClaim Insight, PharmaClaim Insight VisionClaim Insight, Code Validator Pro and Fraud Finder Pro are registered service marks and trademarks of HealthCare Insight. All other product or corporate names are trademarks or registered trademarks of their respective companies. Fraud loss figures based on Centers for Medicare & Medicaid Services (CMS) spending projections and National Health Care Anti-Fraud Association (NHCAA) loss estimates.
HealthCare Insight10897 S. River Front ParkwaySuite 200South Jordan, UT 84095
Phone 877.619.5557Email [email protected] www.hcinsight.com
