SYS-CON MEDIA Authors: Adrian Bridgwater, Yeshim Deniz, Elizabeth White, Sean Houghton, Glenn Rossman

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McKesson Tackles Healthcare Waste, Abuse and Fraud with Proactive Payment Integrity Solutions

The National Healthcare Anti-Fraud Association estimates the waste, abuse and fraud problem in the U.S. healthcare industry at 3% of total costs. As payers seek new ways to address the issue, McKesson has seen increased interest in its proactive technology solutions that emphasize pre-pay prevention rather than inefficient “pay and chase” processes. In 2012, the company signed two new clients for InvestiClaim®, its enterprise waste, abuse and fraud management system, and five new clients for its ClaimsXten® Waste and Abuse KnowledgePack claims editing rules. Several additional clients went live with the KnowledgePack in 2012, including Health Alliance Plan of Michigan.

“In navigating new, more complex payment models, payers face even greater challenges in ensuring that dollars are spent appropriately. Flexible, advanced reimbursement solutions are essential to maintain payment integrity while enabling innovation and containing administrative costs,” said James Evans, vice president of financial and network management at McKesson Health Solutions. “Our clinical editing content and advanced technology paired with neural analytics represent a more intelligent approach to waste, abuse and fraud prevention that helps payers stay on top of emerging payment risks.”

McKesson’s comprehensive payment integrity solutions help payers address all known issues of waste and abuse up front with pre-pay claims editing rules, while pre- and post-pay neural analytics provide another layer of detection for unknown or emerging issues. Importantly, because both payment integrity solutions are integrated on the McKesson Total Payment™ platform, they form a continuous improvement loop in which reasons for unknown waste or abuse found in the neural analytics can be quickly addressed with new policies or editing rules.

For more information on McKesson Health Solutions, please visit our Web site. You can also hear from our experts at MHSDialogue and follow us on Twitter at @McKesson_MHS.

Related McKesson Health Solutions News

Amerigroup Selects McKesson’s Clear Coverage to Improve Care Quality, Cost Efficiency and Provider Communication
McKesson and HC13 Form Partnership to Support Large-Scale Bundled Payment Programs
McKesson VITAL Care Management Software to Help Deliver Better Care to Thousands of Western Growers Assurance Trust Participants

About McKesson Corporation

McKesson Corporation, currently ranked 14th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit us at www.mckesson.com.

Tags: McKesson, McKesson Health Solutions, waste, abuse, fraud, healthcare fraud, wasteful healthcare spending, neural analytics, payment integrity, advanced reimbursement solutions, claims editing, neural analytics

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