When we say "invite the conversation" there are some things that you should keep in mind and prepare to share about the FWA Program and how it contributes to the organization. Do you know what those are? In this video, Jess let's you in on a few things that you should be ready for when you invite the conversation.

Transcript:

Inviting the Conversation: What To Keep In Mind

In previous videos, we have talked about reimagining the value of the Special Investigations Unit (SIU), which is part of what we are trying to accomplish at Integrity Advantage. We have observed across the board that SIUs are boxed in, and we feel like we really need to take the necessary steps to elevate the value that we bring to the organization. #freetheSIU

We aim to elevate the perspective of what we bring to the table and the value that we can contribute to the organization as a whole. When inviting that conversation with other departments, there are a couple of things that you want to keep in mind.

Their priorities are different from yours.

Unfortunately, sometimes members of the SIU are seen as poking holes or being adversarial to other departments, despite the SIU having the best intentions. If we approach these conversations from the standpoint of kindly reminding others of our expertise, that our priorities are in line with theirs, and explaining how our ideas will not conflict with other departments, we bring an important perspective – we are looking for the fraudster. We look for loopholes, where other departments have a different focus. Your Claims Department may be looking at turnaround time, processing numbers and volume. Clinical areas like Care Management, Utilization Review, Medical Affairs, etc. are looking at patient care. Sometimes when we are thinking about claims volume or we are thinking about patient care, payer organizations will pull out some of the hiccups or the obstacles for members thinking that’s in their best interest, but that’s not always what’s happening. These policies could actually be detrimental to both the members and the organization at large.

We want to remind other departments what we bring to the table- we look at things from a different angle; we think like a fraudster. We have seen things happen where individuals take advantage, and so we want to bring that experience to the conversation. For instance, COVID presented a clear instance where all departments encounter changes to the way claims are processed, and we all had to adapt quickly, for the SIU, we are now having to determine if there is anything to stand on for some of these cases. So, if we put a policy in place that says, “yes, you can do this,” it will make our job that much harder to mitigate those risks and to find cases upon which we can act. Inviting conversations like these to the table will ultimately make those changes. It is a little late now for pre-COVID conversations, but it is a really good time to bring those challenges up and say, “look, had we brought in the SIU and our perspective for payment integrity to the table, we might have done things differently.” Keep in mind when you are at the table that you just want to say, “hey, have you thought about this? Have we thought about how this ramification might impact the casework and recoveries and even prevention of potential FWA in the organization?” So have those conversations, invite other departments into the conversation, and invite yourself into other people’s conversations. Let’s free the SIU.

#FreetheSIU - Elevate it and show everybody exactly what the contribution is that we make to these organizations at a much higher level.