In order to ensure their payments to providers are accurate, payers employ a variety of solutions including: data mining, clinical auditing, and special investigations units (SIUs).
Each of these payment integrity solutions and more were initially created to address a specific improper payment issue. However, just as claim FWA continually shifts over the years, so too does the focus, responsibilities, and tactics of these departments.
Over time, each area’s natural evolution to keep pace with claim FWA carried the unintended side effect of generating both redundancies and blind spots for the payer. Viewed as a whole, it is clear that payment integrity efforts are increasingly disjointed, inefficient, and unable to handle the complex FWA schemes we encounter today. Unless we facilitate a paradigm shift in how we support all of the stakeholders involved, we risk further diminishing returns from our efforts.
We invite you to join us for a complimentary webinar where our experts will discuss how to foster a culture of cross-department collaboration, align payment integrity efforts, and achieve greater results more efficiently.
Specific topics will include: