Stop by booth #221 at the National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference, which runs from Oct. 17-19, to talk with our SMEs about CGI ProperPay, our end-to-end fraud waste and abuse solution.
ProperPay incorporates FWA capabilities informed by years of industry experience, from serving as one of four permanent Medicare Recovery audit contractor firms, and from performing reviews and audits on behalf of federal, state and commercial payers.
Using our solutions and services, CGI has recovered more than $2.8 billion in improper medical and pharmacy payments regularly helping clients achieve cost savings rates in excess of 40 percent (with an appeal uphold rate of greater than 93 percent). As a Medicare Recovery audit contractor from 2009 to 2017, CGI covered seven states and 8.5 million beneficiaries.
CGI Federal’s David Ott, and Dr. Bob Haskey are leading a breakout session titled “Logical analysis of emergency services supported through a holistic approach” on Thursday, October 17, from 11:15 am – 12:00 pm.
As the healthcare industry continues to make significant investments in innovations to combat fraud, waste, and abuse, a health plan’s ability to identify and address outliers in their claim’s data is essential to the health plan’s success. Legitimate emergency services are presenting a variety of billing practices and thus, opportunities for waste and abuse in the system. Coding for these services can be complex, involving ICD-10-CM, HCPCS, AMA CPT, and Revenue Codes, and in certain combinations can substantively overstate a situation, resulting in unnecessarily high reimbursements. This presentation will show how each element in the episode is subject to abusive billing and how to discover the variances. Join this session to learn more about conducting a logical analysis of emergency services as a necessary safeguard through a more holistic approach to combat waste and abuse.