– Lisa R. Cavitt, IT Compliance Auditor, Corporate Compliance, Southern Illinois Healthcare
Given the constant changes in the healthcare environment and growing complexity of regulations relating to electronic health transactions and information exchange, the need for effective compliance programs is more critical than ever. While the introduction of regulatory requirements such as the U.S. Health Insurance Portability and Accountability Act (HIPAA) and Sarbanes-Oxley legislation have brought to the forefront the need for better controls systems and processes, healthcare organizations also face ongoing challenges in containing rising costs and improving operational efficiencies.
ACL’s powerful solutions allow healthcare organizations to quickly and easily access, compare, and independently check transactions from multiple application systems against control parameters, business rules, and historical data trends to identify errors, fraud and inefficiencies.
Contact us today to learn more about how ACL technology solutions can be used to:
- Analyze provider claims history relative to peer groups
- Identify indicators of over-utilization, unbundling, and upcoding
- Identify invalid or high-dollar charges and incompatible coding
- Match laboratory procedure codes to appropriate billed charges
- Test for duplicate patient billings and claim payments
- Review single-day stays and same-day readmissions
- Application Sheet: Applications for Healthcare
- Industry Portal: Healthcare
- Discussion Paper: Fraud Detection Using Data Analytics in the Healthcare Industry
- Contact ACL today to learn more about how ACL software can help you!