Surveillance Utilization Review Systems
Industry Challenge
National healthcare spending continues to escalate exponentially each year. Unfortunately, the growth in spending includes reimbursements paid to individuals who unlawfully game the healthcare system through acts of fraud and abuse. Uncontrolled, unidentified fraud and abuse―whether large or small scale―can result in significant monetary losses for the healthcare program and increase the overall healthcare costs for law-abiding members. Healthcare officials need a means to prospectively and retrospectively identify the providers and beneficiaries who attempt to abuse or defraud their systems.
Solution
| For insight and recommendations for a contemporary and comprehensive approach to fraud control using data analytics, read the HID white paper, Using Data Analytics to Fight Fraud and Abuse: A Call to Action. |
HID’s SURVEIL™ Surveillance Utilization Review System (SURS) provides the solution to unravel complex and sophisticated fraud and abuse strategies in the healthcare system. SURVEIL is a comprehensive exception processing system designed to identify patterns and trends that may lead to potential fraud and abuse. Conceived by a team of business and technical experts, including a nationally-recognized fraud and abuse expert, SURVEIL optimizes the identification of potential fraud and abuse through the prospective identification of emerging fraudulent patterns and retrospective evaluation of paid and rejected claims data.
SURVEIL is used to identify providers and beneficiaries who commit fraud against the healthcare community in both the private and public sectors.
Features
- Web-based, fully integrated exception processing and case management
- "Single sign-on" access to a suite of applications, which provide exception processing, case management, and ad hoc reporting through Cognos®, as well as a user forum, assistance from SURS experts, and administrative functions
- Role-based security, which allows the client to seamlessly and invisibly control user access to functions and data by assigning access rights to the user’s logon credentials
- Flexibility to design exception processes or ad-hoc queries and subsequently explore their results by drilling down to the claim detail level to examine identified anomalies
- Ability to perform statistically valid random sampling on any result set
- Real-time, efficient access to data
- Real-time, efficient access to ad-hoc reports development and execution
- Ability to graph report results or export to other applications, including Microsoft® Excel
- User Forum, which allows users to communicate and share information with other users as well as interact with the HID team of technical, medical and data content experts
Benefits
Decreased healthcare costs, through:
- Prospective identification of healthcare system abusers
- Recovery of funds from offenders
- Support of program reform measures
- Ability to monitor results of program reform measures
- Support of fraud prosecution
For more information on how SURVEIL can help your organization, contact us. For an overview of SURVEIL, click here. For an in-depth look at SURVEIL's features, click here. Follow SURVEIL on Twitter.