Healthcare expenditures in the US were $2.7 T in 2011, which is close to 18% of US GDP. A review of US healthcare expenditures shows that 30 cents of every dollar spent on medical care is wasted. This adds up to $750 B annually. Americans spend more on health care than citizens of any other country, up to 1.5 times more per person, yet the US ranks 50th in life expectancy and 47th in infant mortality. $1 out of every $7 spent by Medicare is lost to fraud. New tools and approaches are needed to address the fundamental cost-efficiency challenges of the US healthcare system. One of the first steps needed to reduce medical expenses is to fight overbilling and fraud. According to the annual National Health Insurer Report Card published by the AMA, 19.3% of medical claims processed by the nation’s largest commercial health insurers are inaccurate.
- MedinClaim arrives just in time to cope with the increased pressure that the ACA is placing on insurers.
- MedinClaim provides a single, integrated solution that addresses all medical claims processing under a tightly-coupled interface and provides a 360-degree view of the adjudication process.
- The totally automated system uses a centralized database to store data on the insured, claims, plans, providers, codes, and every item of information needed for claim adjudication. As part of the database it maintains a repository of EMRs into which it captures data from CCDs and where it accumulates historical information about the insured, making it possible to cross-check claims across different plans, types of insurance, and providers.
- Accurate processing begins with clean and consistent data. Strict data validation and continuous cross-checking against data in the EMRs ensures that MedinClaim outputs are based on unimpeachable inputs.
- The product was developed in a country where Obamacare style medical insurance has been the standard for decades, and where an enormous amount of experience has accumulated in addressing the complexities of a mixed system of private and public payers and providers. It was designed from the ground up to serve the type of market that is currently developing in the US, and it leapfrogs all the problems that plague existing solutions: lack of integration between medical, logistical, and insurance components, error-prone and slow manual processing, and the absence of adequate fraud and overpayment protection.
- MedinClaim has developed a unique rule-based engine that leverages medical and insurance intelligence to verify that services billed match benefits and to detect every known type of fraud: billing for services not provided, performing unnecessary procedures and tests, unbundling claims, double-billing, up-coding, miscoding, and more.
- MedinClaim has reached payout reductions of over 20%, in its installations in Israel, a market world renowned for its cost efficiency in health care. Such experience can be utilized to enable payers in international markets to gain a competitive advantage, especially in a period of austerity.
- MedinClaim can work as a standalone solution. Alternatively, you can integrate selected MedinClaim modules with your legacy system, either using full connectivity or layered on top of your existing system. The MedinClaim add-on will expand your system’s capabilities with expert medical and insurance knowledge to reduce payouts.