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FRAUD, WASTE, AND ABUSE PREVENTION

Get more bang for your buck with claim editing analytics

Remember the infomercial tagline, “Set it and forget it!”? That might be what you would look for in a rotisserie grill, but if it describes what you’re doing with claim editing, then you’re leaving a lot of savings on the table.

 
Claim editing is a powerful tool to help payers control costs. Plans can identify claim coding or payment policy violations by applying comprehensive editing rules before they pay healthcare claims. Only by continually applying post-implementation analytics to your claim data, however, can you optimize the value that your claim editing system or systems deliver.
 

Did you know that for some health plans, nearly 30 percent of claims with modifier 59 are billed incorrectly? This can lead to millions of dollars in overpayments and medical loss. Applying analytics can help you identify the most common code combinations contributing to waste and ensure that related services are clinically validated prior to payment. 

 

There’s money in the data—and we’ll help you find it.

 

I invite you to join me for Cotiviti's on-demand webinar, “Grow your pre-pay savings: leveraging analytics to get more bang for your buck.” Debi Behunin, our vice president of clinical performance management, discusses: 

  • Analytic techniques you can use to optimize claim editing outcomes
  • The highest-value code edits to turn on in your system
  • The market trends that impact payment integrity

 

Don’t miss this chance to boost your pre-pay savings by flipping the switch on the most valuable edits for your business.

 

Watch the on-demand webinar

WRITTEN BY

Jon Edwards
Jon has more than 12 years of experience delivering strategic analytic solutions and advisory services to help payers, employers/brokers, and providers advance the delivery and administration of value-based healthcare. As AVP of analytics and consulting, Jon currently leads the development of analytic solutions to optimize value delivered to Cotiviti's largest Payment Accuracy clients. He employs a multi-disciplinary team that leverages advanced analytics, clinical expertise, and payment integrity knowledge to identify opportunities to drive incremental medical cost savings, reduce administrative costs, and improve workflow efficiency for leading payer organizations. Prior to Cotiviti, Jon spent ten years with Accenture’s Management Consulting Healthcare practice.

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FRAUD, WASTE, AND ABUSE PREVENTION

Get more bang for your buck with claim editing analytics

Jon Edwards

Jan 17, 2018

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