Theres no room for waste in healthcare today much less billions of dollars of waste.
But thats what is happening, according to industry experts who estimate vast sums are being lost to inefficient processes and overpayments. This revenue, if recaptured, would immediately drop to healthcare payers bottom line and quickly plug a significant drain on resources.
SCIOinspire can supply subject matter specialists to provide end-to-end recovery services or augment clients' existing programs.
To combat this unnecessary outflow, SCIOinspire offers proven claim overpayment recovery and prevention programs. In addition, it delivers specialized strategies that target select areas of claims payment that often have a disproportionately adverse effect on payers' efforts to manage costs. Unique audit programs and analytic tools assess the accuracy of billing and reimbursement practices related to high-cost specialty pharmaceuticals and implantable devices, for instance, as well as E&M coding evaluation. Further, SCIOinspire uncovers claim submission and payment patterns that warrant a closer look.
This two-pronged approach dramatically improves accuracy and, ultimately, recovery rates. Once identified, SCIOinspire flags and reports areas of concern, providing clients with valuable information to prevent future overpayments.
Payers increasingly struggle with:
- Rising expenses associated with specialty pharmaceuticals and implantable devices
- Increase in provider fraud and abuse
- Variations in medical and pharmaceutical benefits
- Variations in allowed places of service and provider types
- Limitations inherent to adjudication systems
- Incorrect fees loaded into payment systems
- Errors made during manual reviews and audits
- Lack of comprehensive identification and recovery solutions
SCIOinspire helps improve identification, recovery and prevention efforts via:
- Comprehensive, ongoing review of specialty claim and E&M payments
- Functionality to flag and report systemic overpayments
- Fully customizable program
- Cost-effective implementation and administration
- Installation as a complement to existing claims audit and recovery efforts
- Incremental financial results, beyond existing cost containment activities
