Be Proactive – Not Reactive.
Overpayments of Evaluation and Management (E&M) claims, from coding errors, fraud, or abuse, cost health plans an estimated $36 to $60 billion per year and represent up to 3% of Medical Loss Ratios (MLR). A recent government audit released in November 2009, reported that Medicare and Medicaid paid more than $50 billion in suspect claims in 2009. With so much money at stake, health plans need to audit and control E&M claims. Excelsior can help you develop a plan to efficiently and cost-effectively manage E&M claims by applying automated audit tools, data mining techniques, and knowledge base analytics to the audit process. We help health plans:
- Quickly identify incorrectly billed claims;
- Detect fraud & abuse vs. coding errors;
- Educate providers on proper coding;
- Reduce future claims costs.
We can develop comprehensive E&M claims audit programs to identify areas for cost recovery and sustain cost reductions. You can focus on improving overall plan efficiency and providing the most cost-effective healthcare for your members.
This is only one of the ways in which Excelsior Solutions can provide measurable cost savings. We also offer expertise in:
Discover how Excelsior Solutions can deliver SIGNIFICANT AND MEASURABLE COST SAVINGS for your organization. Contact us today for a FREE, confidential and no-obligation consultation.