The million-dollar question that sets every self-insured company in a quandary is: How do we know if what we pay for healthcare is correct? The federal government estimates an error rate of 12.1 percent on healthcare claims wherein enterprises end up paying more for healthcare due to errors made in the billing process, and for charges far in excess of market value. One Charleston-based company, finHealth, strives to help self-insured organizations reduce costs and improve profitability by simplifying and controlling healthcare spend.
Through the use of powerful algorithms, finHealth’s web-based platform identifies errors in the billing of healthcare claims. Types of errors identified include claims paid without coverage (eligibility), duplicate billings, nonconformance with coding standards, and medically unlikely costs due to age/gender conflicts and incorrect units billed. Also, finHealth identifies and recovers billings far in excess of market value, up coding on claims, and potential fraudulent charges. finHealth’s application brings transparency to the transactions and enables finHealth to deliver powerful data analytics that reduce healthcare costs and promote healthy outcomes for employees.
finHealth’s best-in-class audit methodologies coupled with their analytic engine can resolve discrepancies regarding historical payments already made. The company retrieves a client’s historical data, processes the data through its application, and notifies the client’s third party administrator (TPA) of the errors made. “We work together with our customers and their TPAs to ensure that our clients get back the credits in cases of excessive or wrong payments,” states Jim Arnold, Founder and CEO of the firm.
Today, finHealth has established itself as the go-to place for healthcare analytics and recovery of payment and billing issues
Once the historical look back is complete, the platform analyzes data in real-time and can efficiently reveal the eligibility status of an employee, their spouse and dependents, and whether the healthcare claims are accurate/bona-fide before any payment is made. The platform’s unique capabilities provides complete visibility into a company’s historical and ongoing healthcare spend.
It is a common occurrence for organizations depending on their TPAs to fail to identify hospitals or healthcare providers offering the best affordable treatment. This is yet another space where finHealth helps enterprises select hospitals or providers with the lowest rate with no compromises made on the quality of care rendered. “There are huge cost variations, up to 10 times, between hospitals for same medical procedures even within the same city with no correlation to the quality of care,” adds Arnold.
finHealth also can store and analyze the latest health assessment data and fitness tracker data. This gives a company a view of the historical health of its population through claims already processed, a view of their current health via the health assessments and helps predict the future health conditions of covered members based on fitness tracker performance. This look of past, present, and future health data can spot potential health risks and help the concerned individuals maintain good health.
The firm boasts a bag full of customer appreciation and has received numerous accolades for its expertise. Citing one of the case studies, Arnold recalls one large retailer with high turn-over faced eligibility issues leading to payment of healthcare claims for non-employees. The retailer gave credit to finHealth for resolving its entire payment discrepancies with insightful data collection, in real-time, with instant notifications of ineligible claims. “Our platform proved as a one-stop solution for all their business roadblocks,” notes Arnold.
With an impressive track record blended with unwavering commitment to drive employee health and in-turn business profits, today, finHealth has established itself as the go-to place for healthcare analytics and recovery of payment and billing issues. “We equip enterprises with the data to keep their employees healthy while reducing the cost of healthcare,” concludes Arnold.