Thanksgiving is a time of bounty – for feasting, family, and giving thanks. It is a cornucopia of delicious food and cherished traditions. But for insurance companies, it can also be a stark reminder that while the holiday means time away from work, there are always those who never take time off and are constantly looking to sneak payments for inappropriate claims.
What to Look For
Imagine your insurance company as the host of the ultimate Thanksgiving dinner. The menu was thoughtfully planned, and a magnificent spread was prepared (your medical policies and claims editing system). The guests (policyholders and members) are eager to partake. However, not all guests play fair. Some might try to sneak some extra cranberry sauce, while others might try to pass off a store-bought pie as homemade. In the world of insurance, these are the fraudsters, and their actions can leave your company with a much lighter feast. Fraud is not just a minor inconvenience; it is a colossal drain on resources. It leads to increased operating costs, higher premiums, and even reputational damage.
Additionally, the importance of collaboration and information sharing cannot be stressed enough. Opportunities like the NHCAA Annual Training Conference (that many of us have just returned home from) provide a valuable environment to share trends, ideas, successes, and failures. Similar to how many regions of the country have different tastes/traditions for Thanksgiving sides, healthcare fraud trends vary also. It seems a little cruel to mention weight before Thanksgiving but remember ‘an ounce of prevention is worth a pound of cure.’
HCFS Has You Covered
Combating improper billing is a multi-pronged approach. Payers need to leverage advanced data analytics to identify suspicious billing patterns and inappropriate number of services. If you are using the HCFSPlatform™, we’ve got you covered. Our Artificial Intelligence (AI) models can identify spikes and other anomalous billing patterns. We can also help identify new provider billing patterns to potentially catch any inappropriate billing quickly.
Employee training and public awareness campaigns are also integral to the healthcare fraud fight. We are your go-to data source for healthcare fraud, waste, abuse, and error trends, providing regular webinars and educational materials updated with the latest advances in the industry. HCFS is a huge proponent of education and training regardless of whether someone is a client of ours or not. We are here for the betterment of the entire FWAE industry.
HCFS wishes you and yours a joyful Thanksgiving filled with rest, reflection, and abundant blessings. The commitment of the entire healthcare FWA community allows everyone to work alongside each other to achieve the goals of crushing fraud.
If you’re not using the HCFSPlatform™ and you’re interested in knowing more, email us at [email protected].
If you have questions or comments, you may email us at [email protected].
HCFS is solely dedicated to providing an efficient, user-friendly solution that incorporates Artificial Intelligence, Pre-pay, Post-pay, Querying, Case Management and Shared Analytics all in ONE integrated platform. Ask about AUDITPLUS – auditing, SVRS, record retrieval and more! Ask about our HCFS Services (record reviews, data mining, you name it!) Click here if you want to see a demo!