4C Health Solutions (4C), a health care data analytics company, today announced an evolution to their advanced analytics capabilities – a new COVID-19 analytics module. This enhancement to their proprietary algorithms targets pandemic-driven changes in modes and methods of healthcare such as the increased use of ‘Telehealth’ and billing for COVID-19 testing and treatment, to identify improper payments. In addition, the COVID-19 module covers changes introduced by the Cares Act to ensure employers with self-insured health plans and their employees do not overpay due to improper billing.
‘This new set of COVID-19 algorithms will continue to evolve as the healthcare ecosystem adapts to new rules and procedures’, said Ron Templeton, CEO of 4C. ‘While improper payments and fraud are always present, pandemic-driven changes create a host of new healthcare overpayment risks for self-insured employers. This platform enhancement ensures our clients continue to enjoy total cost transparency over their self-insured health plans.’
Specific features of the new COVID-19 module include a COVID-19 payment integrity review that looks for common improper payments such as:
Excessive units
Incorrect code combinations
Invalid DRG Add-on payments
Invalid cost sharing
Total spend for members with COVID-19 diagnoses are analyzed to identify outliers and provide insights on related underlying health conditions.
The new COVID-19 module was launched in April for current 4C clients. For more information on how 4C can help your company recover improper health plan payments, visit 4chealthsolutions.com.
About 4C Health Solutions: 4C was formed by leading health experts to focus on addressing an ineffective healthcare payment ecosystem and to provide actionable solutions for the key cost drivers of care. 4C provides independent oversight of healthcare vendors using powerful analytic tools that self-insured employers need to retrospectively recoup millions of dollars in improper payments and proactively gain control of healthcare costs and spending. 4C consistently delivers to clients industry-defining technology and world-class service.