Fallcatcher believes that the patient and the doctor should have accountability. In the ongoing fight agaiust fraud there are multiple scenarios that perpetrators of fraud are involved in. The first scenario is the Care Provider Fraud. In CPF (Care Provider Fraud), the business that is providing the service will have different options that they will exercise. The first and most subtle form of fraud is through erroneous billing. In the erroneous billing case, the business will have the patient in their care. The patient will be on census and the billing agency will have ala carte billing capabilities. This simply means that the business will bill for more services than they provide.
The business may provide a the mains service and feel as though billing for ancillary services that they did not provide is really, “no problem” because nobody will know or find out unless they speak to the patient. Insurance Companies, do not normally call up the patient and ask them if they received a “one-on-one” counseling session. Insurance companies have one fatal flaw in their process which stokes the fires of fraud; they send out the billing summary 30 to 60 days after the bill has been paid. Now, in the minds of the patient, nobody really pays attention to each specific line unless there is an outrageously high amount that was paid for a service. This is where Fallcatcher shines.
With our bi-directional interface, Fallcatcher asks the patient specific questions in real time. In the Addiction Recovery space, we can ask any menu of questions. Currently, we ask if the patient has had a Group Session, One on One Session and Toxicology. The value to our system is that we ask the patient directly and not the Care Provider. This adds an entirely new dimension to care because now the patient can respond in real-time to the Insurance Provider. With our dashboard the patient can interface with the system and provide information that will not only save the Insurance providers against egregious billing, over billing and erroneous billing but now Fallcatcher helps that parties involved get to the root cause of any patients care issues.
This is why the physicians themselves have set parameters that the insurance companies can put in place. If the Insurance companies want the patients to be seen a certain amount of times by the Physicians, they can tell us and with our biometric system we can program these parameters in place and require the doctor to submit, fingerprint or retinal scans showing that they were there when the patient was there. Our system is smart enough to “throw alerts” if billing was submitted for doctor related services and the patient or doctor failed to execute an attendance scan on that specific day and time frame. This will save the Insurance companies billions in fraudulently placed claims and even more importantly, this feature will save lives.
This is what true patient accountability is.
The next form of Fraud committed by a CPF is absentee billing. This is when the CPF has the patients billing information and submits bills for services provided and the patient was never even there. This is rampant in the lab business. The Laboratories receive urines and blood samples all the time, but who is to say that the urine actually came from that patient? The laboratories have the patient sign each sample but who says that the patient actually actually signed the cups. Fallcatcher, will have the patient request a new confirmation number to be issued directly from the Touchpad itself after their retina has been scanned. After the retina has been scanned the screen will issue a new tracking number that the labs and the insurance companies will both have access to. Can you say “bye-bye” to laboratory fraud? If the patient does not have the confirmation number issued from the pad, the Insurance companies do not have to honor the claim and if the DCF of the States wants access to the toxicology alerts for inconsistent billing all they have to do is “log in” and view the alerts on any one patient, any ony one Treatment Provider or any one lab.
Treatment Centers and Providers aren’t the only culprits in the fraud. We have an over abundant amount of patients that manipulate the system and will knowingly go into a facility for treatment without disclosing where they have been. It is not uncommon for a patient to go into a facility for detox and not disclose that they were in detox 3 or 4 days earlier. The insurance companies often-times do not know because they will not have receive the bill from the first detox. So the patient will go to 2 or 3 detoxes in a month and often times attend 10- 20 detoxes in a year. With Fallcatcher, our system will throw a “Red Flag alert” if the patient has been to multiple locations in a pre-determined time frame. And unless the patient has the ability to get a new pair of eyeballs from somewhere, shuffling from center to center for treatment becomes impossible.
HIPPA Compliance is not an issue because we are not transmitting patient treatment data. We are transmitting patient attendance data internally and the result that the center sees when they enroll a patient is that the patient has attended more detox, PHP or IOP sessions than the allowable coverage will allow. The Treatment Provider can opt to still see the patient but the option to treat the patient will be from a position of information and not deception.
Delayed Billing is another form of Fraud that Fallcatcher demolishes. If a Center chooses to admit a patient, the patient can go through the service regiment and the center may not submit billing for a month, 2 months or longer. You may ask, why would a Treatment Center do that? Well the reason is simple. Some policies have a high deductible and the Treatment Provide has to mean the minimum deduction amount if it has not been met. So if a person goes to a Detox and needs to be seen, the Detox will often call and get a Verification of Benefits ( VOB) and then an authorization Code. This is a flawed process because the insurance companies will continue to issue VOBS and Authorizations aimlessly to Treatment Providers especially when there could be 2 0r 3 other centers that have seen the same patient but they are “sitting” on their claims because they want another center to submit billing and take the “deductible hit.”
Centers are notorious for seeing a patient, after they know that the patient has a 10,000 dollar deductible and instead of them seeing the patient and submitting their bill in real time, they will hold that billing claim for months and then hit the insurance companies with their bill for services rendered four months early. This is a brutal game that the Treatment Centers play. There are instances where insurance companies receive bills on the same patient at the same time and then must negotiate with the Treatment Centers on acceptable compensation.
Fallcatcher Stops all of that.