In these uncertain times, one thing is clear; the COVID-19 pandemic will have repercussions in the medical claims and payment world for months if not years to come.
Here are just a few of the ways that COVID-19 could increase instances of medical claims fraud, waste, and abuse:
- Relaxed regulatory and reimbursement environment
- Loosening of telemedicine guidelines
- Changes in preauthorization procedures
- Identity Theft
- Authorized Provider acceptance changes (Medicare/Medicaid)
- Increased coding complexity
- Provider financial pressure
What do you need to protect yourself from COVID-19 Induced FWA?
- Advanced AI to pinpoint healthcare claims that contain fraud, waste, and abuse
- Ability to instantly adapt to changing billing patterns
- Ability to immediately identify unusual provider behavior
- Tools to identify unusual patient behavior
- Power to examine claims Prepay and Post Pay
- A vehicle to engage and communicate with the Patient to validate medical claims information