Advanced analytics applied by an automated claim editing system are crucial for identifying claims that are potentially wasteful or abusive, but many still require detailed review by a seasoned clinician. We perform this review through a process called clinical validation—and doing it well requires both clinical expertise and coding competence. Having one without the other is like flying a plane with only one engine: it can be done, but results are not optimal.
I hope you can watch our on-demand webinar, “clinical expertise and coding competence: the twin engines of clinical validation.” I'm joined by Heather Groesbeck, BSN, RN, CPC, as we demonstrate clinical validation techniques that can drive 1 percent or more savings off annual medical spend by adding a second line of defense to automated claim editing.
You’ll learn about:
Analytic techniques to identify suspect claims
The key items that a clinician looks for in the claim data
The regulatory changes ahead, and the ways in which they could affect claim payment
Make sure your pre-pay claim editing strategy can handle the turbulence with twin engines—watch our on-demand webinar today.
As a clinical consultant who has spent nearly 20 years in healthcare, John Neumann provides subject matter expertise for Verscend’s Payment Accuracy solutions. He works closely with the Verscend sales, product, account management and technical integration teams to ensure a smooth transition from sales to implementation, and provides ongoing consultative support. His experience as a registered nurse, certified coder, and cost containment expert bring a unique perspective and proven solutions that have been deployed in organizations ranging from large regional health plans to small third-party administrators. John also served honorably for six years in the United States Marine Corps.