Operational FWA Support & SIU Outsourcing
Your budgets, staff and strategies may change, but your need for results will not. Our analysts, investigators, clinical and coding staff are fully trained and ready to multiply your teams’ productivity. We are not a one-size-fits-all shop or a staffing firm. We understand what it takes to meet the ebbs and flows of your business. Our business was built on a foundation of being in your shoes. Whether you need support for medical, dental, behavioral health, pharmacy or facility claims, we give you what you need, when you need it.
Outsourced FWA support gives you benefits including flexibility, diverse expertise and higher ROI.
Lead Generation
Nothing depletes an investigator’s morale like unvetted cases filled with administrative work and no ROI. Reactive case work from an endless string of hotline calls and referrals will do just that. Let us upgrade the quality of cases handed off to your team by generating and vetting cases before they are assigned to an investigator. Focusing on proactive lead detection escalates ROI and significantly improves the engagement of your investigators and medical review staff.
Investigations
Too many cases but not quite enough to substantiate a full-time employee? Feeling like you could use some overflow help? We’ve got your back. Whether you need someone to manage a full or partial case load, or could just use help cleaning out the back log, we have skilled healthcare fraud investigators with experience performing all types of investigations, supporting many lines of business and claim types. With minimal ramp up time, our team fits right into your process and can even help train internal staff, if needed.
Medical Record Review
Medical record reviews are a critical piece of the investigative process and can make or break a case. But they are often a big lift on the SIU due to the unique skillset needed. Integrity Advantage performs medical reviews that are thoroughly documented, without assumptions or bias, supported by regulations and delivered to the investigator in a way that is clear and reliable. You can trust our team’s experience with coding guidelines and regulatory research as well as our ability to articulate findings professionally.
Statistically Valid Random Samples
If you have not leveraged statistically valid random sampling (SVRS) to alleviate the administrative burden on your providers and your medical record review staff, you may not be operating efficiently. Statistical sampling is an industry recognized sampling method used in investigations. When done and documented properly, can exponentially increase your overpayments. Our team has helped organizations understand the benefit of using sampling in improving the efficiency of their FWA process.
Reporting Support
Reporting, whether for internal business needs or state / Federal requirements, is a common pain point. Our team, with backgrounds in database structure, analytical tools and business intelligence reporting, create and streamline a process for you that will be effective, cultivating an ease of reporting. We work with you to understand your data elements, validate your stored information to ensure you’re recording necessary details accurately and completely, and personalize your output to leverage the reporting tools you have on hand.