Physician Behavior Pattern Detection for Fraud, Abuse, and Waste in Healthcare

September 22, 2015

A Predictive Intelligence Approach to Lowering Healthcare Costs In 2011, The National Healthcare Anti-Fraud Association (NHCAA) estimated an average of 3 percent to 10 percent of healthcare spending is lost because of fraud – which includes non-rendered services, upcoding, unbundling, mischaracterization, unnecessary medical services and kickbacks.1 That’s up to $230...

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A Cost-Saving, Physician-Friendly Alternative for Prior Authorization

September 15, 2015

Improving Outcomes and Reducing Costs with a Non-Denial Model Requiring prior authorization for medical diagnostic testing and procedures provides one of the only captive periods when a physician can be engaged with the payer and its utilization management services to determine the most appropriate, evidence-based care that their patients...

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Imaging Abuse: Diagnosis and Treatment

May 8, 2015

Through involvement in the last step of HealthHelp’s three-tier radiology benefit management (RBM) process over the past four years, Jeffrey D. Robinson, M.D, radiologist, has unique insight into imaging abuse. After conducting more than 30,000 peer-to-peer telephone consultations, he concludes that providers’ inappropriate requests for imaging studies are often...

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HealthHelp Programs Qualify Under the Medical Loss Ratio (MLR) Requirements

April 13, 2015

By: Cherrill Farnsworth, President and CEO, HealthHelp Updated April 2015 Purpose Educate the health-insurance industry on the Medical Loss Ratio regulations and its overall impact. Reduce confusion in the health-insurance market by clearly outlining criteria and requirements of the Medical Loss Ratio regulations. Identify how HealthHelp’s programs fall into the...

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The Impact of a Radiology Benefit Management (RBM) Program: Does the Specialty of the Referring Provider Matter?

February 4, 2015

By: David P. Friedman, M.D.; Nancy Smith, B.S.; and Kiran Talekar, M.D. Purpose HealthHelp, a specialty benefits management company focused on collaborative care management, provides radiology benefits management (RBM) to help referring physicians order the best-suited diagnostic imaging examinations for patients enrolled in national and local health plans. HealthHelp’s...

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