Deerwalk Plan Analytics Version 10.3 Introduces Content to Help Identify Potentially Fraudulent Provider Billing
Deerwalk's latest release incorporates new fraud, waste, and abuse content and continues the phased rollout of our application redesign
Below are the key highlights from this month’s release of Deerwalk Plan Analytics:
- FRAUD, WASTE, AND ABUSE CONTENT
- USER INTERFACE REDESIGN
- NEW DATA ENRICHMENT
- CREATE MODULE ENHANCEMENTS
- EXPANDED CONTENT SHARING
1. FRAUD, WASTE, AND ABUSE CONTENT
We place a substantial amount of trust in physicians to conduct business operations in compliance with ethical standards, policies, and regulations, but sometimes instances arise where certain practices introduce reason for concern. A few examples include: (1) billing for services that were never rendered or billing at a higher rate than is justified, (2) overutilization of services and resource misuse, and (3) excessive or improper use of services or actions that don't align with acceptable business or medical practice. Behaviors that fall under these categories may constitute fraud, waste, and abuse and should prompt further investigation to ensure the health and welfare of your members.
Because Medicare and other Federally-funded healthcare programs rely on physicians to administer appropriate, medically necessary services, and submit accurate claims for Medicare-covered healthcare items and services, the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services can exclude providers from receiving payment under these programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud. As part of this "Exclusions Program," the OIG maintains a List of Excluded Individuals/Entities (LEIE) that contains all currently excluded individuals and entities.
To support you as you manage your population(s) and work to ensure members receive optimal care, we've incorporated logic that cross-references each provider in your medical claims data with the exclusion list and flags them accordingly. You can use this data to monitor suspicious activity and inform decisions around where to direct member care or critically examine interactions between the health plan and potentially fraudulent providers.
You now have the option to make the following data fields accessible within Deerwalk Plan Analytics:
- "Excluded Date" reflects the date the provider was added to the LEIE.
- "Exclusion Status" indicates the provider's latest status on the LEIE.
- "Exclusion Type" displays a code that indicates the specific reason for the provider's exclusion.
- "Exclusion Type Desc" describes the reason for the provider's exclusion.
- "Breach Status" indicates whether or not the provider serviced the claim in compliance with OIG regulations.
2. USER INTERFACE REDESIGN
With this release, we continue to roll out our phased application redesign to improve both the usability and look-and-feel of Deerwalk Plan Analytics.
- We've increased font sizes for better readability, making it easier to navigate and focus on certain areas of the application.
- We've made changes to the Member Search Module, which allows you to analyze and report on your population(s) by running custom queries to generate lists of members that meet the input filter criteria. In addition to reorganizing less frequently used menu actions to simplify the module's graphical interface, we've added new buttons and icons that make it easy to view and edit your selected filters to adjust search queries for dynamic reporting and analysis.
3. NEW DATA ENRICHMENT
Deerwalk takes in data from many diverse sources and runs it through a series of scrub and enrichment processes to deliver insights that help you manage the health and risk of a population. These data scrub and enrichment processes provide you with enriched data (represented by fields within Deerwalk Plan Analytics) that can be easily searched or reported on from within the application.
You can now access these new fields from the Member Search Module:
- “Compliant Quality Metrics Count” and “Compliant Quality Metrics List” fields make it easy to report on a member’s compliance with Quality Metrics.
- “Lifetime Paid” and “Period Paid” fields are available for both dental and vision claims.
- The "Specific Therapeutic Class” field contains an array of therapeutic classes of the drugs consumed by a member.
4. CREATE MODULE ENHANCEMENTS
Always working to improve and expand upon our custom report and dashboard creation functionality, we’ve made some updates to the Create Module.
- We’ve added an option that allows you to sort any user-created chart or table by a string field. This makes it easier to compare tables or charts side by side as the resulting data can be displayed in the same order. For example, you can now sort by “Age Group” from youngest to oldest or oldest to youngest.
- We've expanded the options for how you choose to summarize and report on the "Member" data type, including the option to sort by the number of chronic conditions a member has.
5. EXPANDED CONTENT SHARING
We've added a “Content Sharing” section that gives administrative users the ability to share cohorts between users with varying levels of access. This expansion includes new options to give administrative users greater control over content availability for filters, templates, bundles, census reports, and plan designs.
Schedule a demo to learn more about how to use Deerwalk Plan Analytics and the latest features.
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