Software provides compliance help
Program even insures against billing errors
As the federal government’s campaign against questionable health claims has grown, so has the number of compliance products and services offered to providers.
For instance, the Medaphis Corporation of Atlanta recently introduced ComplyCare Compliance Monitoring, a system that will edit provider claims for possible compliance problems before they are submitted for payment.
ComplyCare is based on a proprietary database of more than 60 million claims powered by IBM’s Fraud and Abuse Management System. According to company officials, the system is capable of comparing 100% of a physician group’s claims with claims in the firm’s database.
"ComplyCare is a potentially important compliance tool for practices of most sizes and types," says Terry Peltes, vice president for physician management services at Medaphis. "We provide our clients with a CD containing information and reports that can help physician groups look at their practice similar to how private payers and the government do to spot questionable billing and behavior patterns."
Armed with this information, practices can then try to resolve potential compliance issues in-house, or bring in outside consultants.
Another innovative aspect of the program is that physician groups signing onto the service are eligible for a unique billing errors and omissions insurance program available through a Medaphis strategic partner, the Graham Com pany in Philadelphia.
The billing insurance plan "provides physicians with protection against civil fines and penalties imposed by the federal, state, or local government and against penalties or liens sought by commercial payers," says Graham spokesperson Tony McIntyre. "The program even provides coverage for potentially substantial defense and claim audit costs."
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