Whether you’re targeting higher ROI, improved efficiency, or compliance with regulatory requirements,
we help you hit the mark.
Program Assessments & Consulting
We’ve built our diverse knowledge base through decades of doing. Our experience providing support to dozens of plans across all lines of business, geographical regions, and varying enterprise priorities give our clients a tremendous advantage. We are a trusted advisor, providing objective perspectives and offering solutions for real challenges faced by the payment integrity industry.
Consulting
Having objective and unbiased perspective from an experienced advisory partner makes all the difference. Our comprehensive knowledge of FWA paired with a vendor-neutral angle elevates your program or initiative. Our rockstars help eliminate distractions hindering productivity by focusing attention on how to solve your FWA challenges.
Program Assessment & Development
All good builds start with a solid foundation. We’ve been there. Whether you are building your FWA program from scratch or revamping / enhancing an existing one, we assist in creating a strategic blueprint that you can use for your path forward. We can also assist in implementing any changes arm-in-arm with you.
Risk Identification / Mitigation
Mitigating a risk you have yet to identify is hard. Conducting an FWA risk assessment for your organization makes it easier. This is the first step in implementing an actionable work plan that sets the stage for your program’s success. Our customized risks assessments help take the guesswork about where you need to focus your FWA program efforts and, when well executed, lead to great success.
FWA Compliance
Regulatory entities have their own set of compliance expectations, which continue to evolve, making it difficult for organizations to keep up. Whether you are looking to audit adherence to these guidelines or ensure that you are able to demonstrate compliance through process and documentation, we can help.
Let’s discuss how we can put our expertise to work for you.
Operational FWA Support & SIU Outsourcing
Your budgets, staff and strategies may change, but your need for results will not. Our analysts, investigators, clinical and coding staff are fully trained and ready to multiply your teams’ productivity. We are not a one-size-fits-all shop or a staffing firm. We understand what it takes to meet the ebbs and flows of your business. Our business was built on a foundation of being in your shoes. Whether you need support for medical, dental, behavioral health, pharmacy or facility claims, we give you what you need, when you need it.
Outsourced FWA support gives you benefits including flexibility, diverse expertise and higher ROI.
Lead Generation
Nothing depletes an investigator’s morale like unvetted cases filled with administrative work and no ROI. Reactive case work from an endless string of hotline calls and referrals will do just that. Let us upgrade the quality of cases handed off to your team by generating and vetting cases before they are assigned to an investigator. Focusing on proactive lead detection escalates ROI and significantly improves the engagement of your investigators and medical review staff.
Investigations
Too many cases but not quite enough to substantiate a full-time employee? Feeling like you could use some overflow help? We’ve got your back. Whether you need someone to manage a full or partial case load, or could just use help cleaning out the back log, we have skilled healthcare fraud investigators with experience performing all types of investigations, supporting many lines of business and claim types. With minimal ramp up time, our team fits right into your process and can even help train internal staff, if needed.
Medical Record Review
Medical record reviews are a critical piece of the investigative process and can make or break a case. But they are often a big lift on the SIU due to the unique skillset needed. Integrity Advantage performs medical reviews that are thoroughly documented, without assumptions or bias, supported by regulations and delivered to the investigator in a way that is clear and reliable. You can trust our team’s experience with coding guidelines and regulatory research as well as our ability to articulate findings professionally.
Statistically Valid Random Samples
If you have not leveraged statistically valid random sampling (SVRS) to alleviate the administrative burden on your providers and your medical record review staff, you may not be operating efficiently. Statistical sampling is an industry recognized sampling method used in investigations. When done and documented properly, can exponentially increase your overpayments. Our team has helped organizations understand the benefit of using sampling in improving the efficiency of their FWA process.
Reporting Support
Reporting, whether for internal business needs or state / Federal requirements, is a common pain point. Our team, with backgrounds in database structure, analytical tools and business intelligence reporting, create and streamline a process for you that will be effective, cultivating an ease of reporting. We work with you to understand your data elements, validate your stored information to ensure you’re recording necessary details accurately and completely, and personalize your output to leverage the reporting tools you have on hand.
What type of operational support can we help you with?
Training, Education & Mentorship
We love to train! We believe that training is an essential component of a successful FWA program, not to mention a compliance requirement. Many organizations struggle to keep their team up-to-date on FWA training, due to lack of funding, time and/or expertise. In addition, breaking into this career field is not easy with limited experience. Integrity Advantage creates and delivers customized training to new and seasoned teams and offers individualized training and mentorship programs whether you are trying to just get in or you are planning to move up in your FWA career.
FWA Training Programs
Fraud schemes evolve, technology changes and processes mature - the training needed to keep up must also adapt. We include a range of topics from basic fraud, waste and abuse compliance principles to much more in-depth programs around schemes and investigative techniques. Whether you have a newer team member, a whole seasoned team, or need enterprise-wide training support, our tailored training programs are for you.
Integrity Advantage also provides mandatory enterprise-wide FWA training which covers the principles, examples and regulatory landscape. This training can be tailored specifically for your company or we can provide a general FWA training for compliance with state and Federal requirements.
Annual Mentorship
Were you recently promoted? Are you ready to take the next step in your FWA career? Or have you recently found yourself in-charge of an SIU and could use guidance and support from other accomplished industry leaders? We know how it feels to take on a new role and realize there’s so much more you want to learn. And the truth is that while no one knows everything about healthcare fraud and how it will continue to evolve, our mentorship program connects you with experts in the field that can help you in that next step regardless of whether you are an individual contributor or leading a team.
Our individualized mentorship program gives you the tools to move forward with confidence in a career field that you will LOVE. Our experts evaluate your experience and resume, customize a mentorship plan to get you trained, and work with you on the skills you need to develop to be a #rockstar at your organization!