
Digital Employees
For organizations, the key to success in the digital age ...
When agencies successfully embrace digital transformation, they become more customer-centric, agile ...
When agencies successfully embrace digital transformation, they become more customer-centric, agile ...
When agencies successfully embrace digital transformation, they become more customer-centric, agile ...
In this video, CGI professionals discuss how CGI has supported ...
The Presidents Management Agenda (PMA) has inspired many a spirited conversation since it was released in March 2018, and with good reason. The measures it has introduced—intended to modernize the federal government in 14 key areas that enhance its ability to deliver mission outcomes, provide excellent service and effectively steward taxpayer dollars—have already had wide-ranging, positive impacts.
Two points specifically called out in the PMA’s cross-agency priorities—implementing better technology and processes to get payments right the first time and reducing associated costs should an incorrect payment be made—are vital to helping solve challenges government-wide.
For example, criminals have many routes by which they can steal from the healthcare system, from old-fashioned insurance fraud to sophisticated cybercrime techniques. The Global Health Care Anti-Fraud Network (GHCAN) reports that as much as $260 billion—approximately 6 percent of global health care spending—is lost to fraud each year. These losses drive up the costs of care and take away funds that otherwise could be used to treat patients.
With that in mind, here is a closer look at the key areas in the medical claims transactions process that healthcare payers can look to address using advanced technology and best practices:
CGI’s end-to-end fraud, waste and abuse solution, CGI ProperPay, incorporates these capabilities through years of industry experience, from serving as one of the four permanent Medicare Recovery audit contractor firms, covering seven states and 8.5 million beneficiaries, and from performing reviews and audits on behalf of federal, state and commercial payers. Our claims audit and recovery services have been used to audit approximately 30 million covered lives.
Using our solutions and services, CGI has recovered more than $2.8 billion in improper medical and pharmacy payments for these clients, and regularly helps them achieve cost savings rates in excess of 40 percent (with an appeal uphold rate of greater than 93 percent).
At the Healthcare Information and Management Systems Society (HIMSS) Conference in Orlando, Florida, on February 14, I will be presenting a session titled “Protect Scarce Medical Dollars Using Social Media Monitoring.”
While no solution will ever completely eliminate fraud, waste and abuse in healthcare, we offer a holistic approach to helping keep it in check. For more information please, visit our HIMSS19 event page.
For more on ProperPay, download the brochure "CGI ProperPay: Fraud, Waste and Abuse Solution and Services for Healthcare Payers."
David Ott is a leader in CGI Federal’s Healthcare Compliance organization, working in the Healthcare Payer Account Line of Business and guiding business development growth.
Add new comment
Blog moderation guidelines and term of use