Fraud, Waste, Abuse and Error

Auditing for provider Fraud, Waste, Abuse and Error, is a core component of cost containment. It involves detecting and correcting provider error; overbilling and ‘creative’ billing techniques to make sure you are only paying for legitimate claims.

Leading Edge audit specialists are constantly monitoring for the newest, “creative” and aggressive billing techniques providers and medical billers may use. We regularly update the rules in each plan’s audit engine. Our team also has a deep knowledge of medical and pharmacy coding.

The team corrects every flagged claim immediately. When there is a major issue, we meet with our client to review our findings, educate them on the issue and make recommendations on how to remedy. We then go to the network for permission to speak with the provider directly to correct the error or overbilling issue.

Are Your Claim Being Audited In Real-Time For FWA&E?

Our FWA&E audit engine closely examines every medical claim in real time. Retrospective, randomized audits deployed by most companies catch only a percentage of FWA&E issues.

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Short Case Studies :

Wide awake to anesthesia billing.

An independent audit saved a company a tidy sum. In one instance, our audit caught a code billing for a colonoscopy that included the anesthesia built-in to the charge. However, the provider also billed for anesthesia separately. The reason was a technical flaw that resulted in over-billing. The network administrator agreed, changed its billing code and reimbursed our client.