Payment integrity solutions that begin and end with you saving. Pay Right. Save Money.
Preventing fraud, waste and abuse with the Clinical Touch. HealthCare Insight | A Division of Verisk Health
A Nucleus Solution
FacilityClaim INSIGHT
速
Fraud, waste & abuse for facility claims >
Avoid Overpayment Trauma WITH OUR FACILITY BILL Experts.
Prevent Fraud | Improve Accuracy | Reduce Costs
FacilityClaim insight
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Elevate your claims payment accuracy, identify fraudulent providers and decrease your facility bill costs.
A comprehensive list of a provider’s overall statistics, licenses, sanction information and so much more, the Provider Profile packs the perfect information punch.
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Prevent Fraud | Improve Accuracy | Reduce Costs
THE
THE
Problem
Solution
Fraud Stats
Results >> Reduce expenditures up to $4 PMPM >> Improve claims payment accuracy up to 10% >> Decrease targeted claim costs up to 20%
3% – 10% of the national outlay for facility claims is lost to fraud and abuse. By 2013, losses could exceed $99 billion.
$99.3 $93.2 $87.7
(In Billions)
$83.0 $28.0
$29.8
$26.3 $24.9 2010
2011
2012
2013
Fraud Projections for Facility Claims 2010 – 2013 / 3 – 10% loss
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
10% Loss 3% Loss
Next Steps Contact us for a complimentary Cost Reduction Analysis. Call 1.877.619.5557 or email info@hcinsight.com today.
“HCI customers using this service consistently realize facility claim savings of 15% – 30%.” – Darin Johnson, MBA HealthCare Insight www.hcinsight.com
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Why you’ll
Like Us.
CLINICAL REVIEW BY MDs, RNs & DDS’ >
Detailed ad-hoc Reporting >
PREPAYMENT SaaS SOLUTION >
Appeals Support & Response >
TOTAL Payor CUSTOMIZATION >
IMMEDIATE REALIZATION OF ROI >
Real-Time Claims Processing >
Solutions for all Payor Types >
memberships & Accreditations
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Prevent Fraud | Improve Accuracy | Reduce Costs
how to P
Phone
877.619.5557
S
F
Contact Us. Fax
801.285.5801
Connect With HCI
Twitter | Facebook
Linkedin | YouTube
M
E
info@hcinsight.com
R
W
Web
www.hcinsight.com
HCI Fraud Resources
www.profilermag.com www.stophealthcarefraud.com
HealthCare Insight 10897 S. River Front Parkway Suite 200 South Jordan, UT 84095
© 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 Insight 10897 S. River Front Parkway Suite 200 South Jordan, UT 84095
Phone 877.619.5557 Email info@hcinsight.com Web www.hcinsight.com