ELIMINATES PHANTOM BILLING FRAUD
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BILLING FOR SERVICE NOT RENDERED 39%
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According to the NHCAA, some of the more common types of fraud committed by providers include: Billing for services never rendered by using genuine patient information, sometimes obtained through identity theft, to FABRICATE ENTIRE CLAIMS or by PADDING otherwise legitimate claims with charges for procedures or services that did not take place
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According to the largest clearinghouse which processes over 5 Billion Claims, fabricated claims, or phantom billing is the largest type of provider fraud and is not addressed by any current anti-fraud solution
6 So.. what solution proves this patient actually showed up for their visit?
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Billing for services never rendered is actually two DISTINCT frauds that require two DISTINCT solutions
INTRODUCING REWARDSMD
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"PADDING" is when the patient actually showed up for their visit and the provider added procedures to effect a higher reimbursement. Padding is addressed by predictive analytics that look for patterns of fraud
4 FABRICATION of a claim is when the patient never set foot in the medical office, essentially a totally fake visit. Fabrication of claims can NEVER be addressed by predictive analytics as claims can be coded correctly and they will never be flagged by an analytic program
When a patient enters the medical office, they use a combination of GPS and biometrics to create a certificate of attendance for every claim.
9 Patients are incentivized with rewards while they are waiting in medical office.
