The moment that President Lyndon Johnson signed the law establishing Medicare and Medicaid in the early 1960s, some unethical health care providers began scheming on ways to defraud the system through overutilization and misuse.
By the 1980s, large providers such as hospitals, PPOs, and others formed Utilization Review Committees, to review cases with high expenses that might have been treated for a lower cost, or a shorter stay. At first these committees were educational, but later, as Medicare, Medicaid, and private insurance companies continued to squeeze for lower costs, they began referring certain providers (doctors, therapists and others) to higher levels such as the Medical Board of hospitals for over-utilization and/or misuse of patient care assets.
Today,
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Users of this Software as a Service (SaaS) program include,
Accountable Care Organizations;
Third Party Administrators;
Insurance Companies;
Consulting Companies;
Hospitals;
Self-insured groups; and
More
The DSS program uses state of the art claim scrubbing, flagging, and medical analytics that offer users an automated approach to detecting what might be considered utilization over-use, fraud or misuse.
Ansera uses the pre-eminent sharing platform built by Salesforce world renowned for its outstanding cloud-based services.
Using Ansera DSS offers subscribers numerous benefits that include,
Avoid penalties for non-compliance
Reduce appeals and customer service volume
Improve accuracy and implementation of codes and payment policies to speed and help coordinate payments
Enhance research, analytics, and longitudinal reporting
Decrease errors and the risk of improper payments
Enable better monitoring for fraud, waste, and abuse
Support foundational healthcare