Expanding Frontiers: The State of Payment Integrity in 2018

Is fraud, waste, or abuse snowballing too quickly to jeopardize the sustainability of your organization?

You are not alone.

Speak with anyone involved in identifying claim overbillings/overpayments and the message is clear: the rate of change in payment integrity is accelerating with no signs of slowing down.

Advancements in fraud, waste, and abuse schemes, increased complexity of claim adjudication, and regulatory/external pressures, are making age-old tactics like coordination of benefits or retrospective claim auditing insufficient. Fortunately, advancements in technology are making pinpoint correction of inaccurate claims on a daily basis with minimal errors an achievable reality.

However, these advancements come with their own risks and challenges. Overinvestment in technology promising an impressive ROI often means neglecting smaller but steady improvements to established programs. And, overreliance on familiar solutions often leaves an organizational blind spot that can be exploited by bad actors.

So, how do you strike the right balance between fortifying established positions and pushing into new territory?

Join our complimentary webinar to listen to SCIO experts, Monique Pierce, VP Business Optimization and Leslie Strader, Manager, Product Management discuss how to foster a pragmatic approach to payment integrity consisting of both retrospective and prospective tactics:

  • Surveying the Route: Payment Integrity Trends and Challenges in 2018
  • Planning the Expedition: Learning the Latest Innovations for Key Tactics
    • Longitudinal Data Mining
    • Post-payment Auditing of Outpatient & Ancillary Claims
    • Applying Medical Record Reviews to Prepayment Auditing
    • Provider Behavior Modification
  • Starting the Journey: Enacting Change at Your Organization
    • Recovery -> Avoidance -> Prevention
  • Audience Q&A

We look forward to your attendance!

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Monique Pierce
Vice President, Business Optimization

Leslie Strader
Manager, Product Management