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Controlling fraud, abuse and waste could help fund health reform priorities
Advocates for improving health insurance coverage access and affordability believe that curtailing waste, fraud and abuse could help slow the growth of overall health care costs (which are predicted to double by 2018), ensure that spending is focused on providing appropriate health care services, and restore confidence in the system.
Helping to curtail inappropriate payments could save a great deal of money. The National Health Care Anti-fraud Association (NHCAA) estimates that 3% of all health care spending is lost to health care fraud; with the figure even higher in public health programs. The Federal Bureau of Investigation has estimated fraudulent billings to health care programs, both public and private, at between 3% and 10% of total health care expenditures.
"Regardless of which estimate is used -- and to be honest, both of these may be a bit conservative -- there is no question that there is money to be saved by preventing health care fraud, abuse and waste," said Gerry Hill, senior project manager, Fraud and Abuse Protection, at Ingenix. Click here to continue reading this article online. (11/04)
Proactive approach to payment, error detection improves payment accuracy for payers and providers
Organizations that pay for health care services face intense competitive pressures to control premiums. At the same time, they are focused on ensuring that their members receive the best possible care and that physicians receive fair, timely payments. Juggling these goals while managing costs has become even more difficult during the economic recession.
In the past, payers focused cost control efforts on identifying and recovering overpayments or erroneous payments. However, Dean Farley, vice president of Ingenix Consulting, says a prospective or pre-payment approach to managing payments and controlling costs will facilitate better results throughout the system.
"Everyone in health care has a vested interest in ensuring that those who need medical care receive it and that those delivering it are paid promptly," Farley stated. "When providers know in advance what they will be paid for treating specific conditions or patients, they have additional incentives to achieve better outcomes and deliver care as efficiently as possible." Click here to continue reading this article online. (10/21)
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