Fraud & Abuse Detection & Resolution Medical Risk Management Programs. $250B of waste in Healthcare. Fraud and abuse, creative billing schemes, claim system deficiencies, lack of good and aggregated data, and transparency are all prime drivers.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Fraud & Abuse Detection & Resolution
Medical Risk Management Programs
$250B of waste in Healthcare
Fraud and abuse, creative billing schemes, claim system deficiencies,
lack of good and aggregated data, and transparency are all prime drivers
Claims Systems have been designed for an environment that creates efficiencies in cutting checks with strong capabilities in managing Eligibility and Benefit Plans. Applied Risk Management requires a new dynamic!
The big Carriers often do not apply the best capabilities to control costs in order to maintain discounts in their Networks – the result can be employers end up paying more!
Nobody Matches the Power and Control of the Cypress Medical Risk Management Program!
Employers Can Expect a reduction in OVERALL
claim costs of 5% - 10% through these efforts.
CYPRESS’ PROVIDER INTEGRITY AND FRAUD PREVENTION PROGRAM
REDUCES OVERALL PAID CLAIMS AN AVERAGE OF 0.25% - 1%.
Claim Line Analytics Include:
CYPRESS’ INTELLIGENT CLAIM SURVEILLANCE PROGRAM REDUCES OVERALL
PAID CLAIMS AN AVERAGE OF 0.5% - 1.5%.
- License Verification- Patient Interview- Medical Record Review
- Document Analysis- Clinical Review- Coding Review
CYPRESS’ PRE-PAYMENT INVESTIGATIONS REDUCE
OVERALL CLAIM COSTS BY 1% - 3%
CYPRESS’ AUTOMATED CODE EDITING CAPABILITIES REDUCE
CLAIM COSTS BY 1% - 4% OVER TRADITIONAL EDITING SOFTWARE.
CYPRESS’ PROVIDER R&C NEGOTIATION PROGRAM REDUCES OVERALL
CLAIM COSTS BY 1% - 3%