Cost Management Consulting
Audit Design
Many healthcare payers think their current overpayment prevention policies are adequate. However, dishonest providers continuously find new and ingenious ways to obtain inappropriate payments, costing these healthcare payers millions.
WayMark Associates can assist your organization in uncovering and reducing overpayments in a number of key areas by combining strategic cost management consulting with analytical solutions:
• High-Cost Plastic Surgery Procedures
Plastic surgery procedures are very expensive and many must be repeated periodically. The temptation to submit erroneous or invalid claims for these procedures is irresistible to dishonest providers, who have realized it is a highly lucrative practice.• Durable Medical Equipment
Healthcare payers frequently overpay for items billed by disreputable DME companies. Common examples include billing for oxygen tanks never provided and billing standard wheelchairs as “custom” motorized versions.Schemes in these and other areas are often missed by standard overpayment prevention procedures payers and by many main line audit vendors.
With significant experience in identifying provider, vendor and other abuse, WayMark Associates helps its clients improve and monitor their overpayment prevention efforts by identifying and recovering overpayments otherwise missed in these areas. We not only identify and recover overpayments – we’ll help you prevent overpayments in the future.
SIU Design and Productivity Improvement
WayMark Associates’ principals have over 25 years of healthcare industry experience, with more than 15 years in leadership positions in fraud and abuse detection. We apply this knowledge and experience to help our clients improve the performance of their own Special Investigations Units (SIU), or set one up if it does not yet exist. Our services in this area include:
• Process Improvement
We will review your current processes and procedures to help you improve productivity and response times, making your existing resources more efficient.• Improving Data Analytics
Discovering and analyzing new areas of fraud and abuse is the life blood of a successful fraud and abuse operation. We can discuss the pros and cons of various approaches and advise on concrete changes that will supercharge your process.• Navigating Regulatory & Legal Matters
Healthcare is already one of the most regulated industries in our country, and new issues arise every day. We can assist you in managing compliance and other proactive matters to improve performance in this area.
