Fraud Detection
Fabian & Byrn offers integration solutions to maximize service results using coordinated high quality technology to analyze data. Clients gain greater transparency using improved coordinated cost effective management solutions.
Editing
F&B provides software that provides a review system. It uses customized rules to audit, detect duplication of procedures, and correct coding on medical billing. Medical history is cross- referenced with patient history to help determine medical appropriateness. We us pre-payment editing and post payment audits to perform a comprehensive review of medical claims to target billing mistakes, code errors and fraudulent health care claims.
Clinical Review and Auditing
Our professional staff audits the claims from both a clinical and financial position for in-network and out-of-network claims. The audit reviews for accuracy and flags for impending claims. The system also checks for duplicate procedures or tests that conflict with the patient's diagnosis.
Trend Analysis and Reporting
F&B works to provide software that improves data integrity and can isolate care-management issues through low cost analysis. Using advanced reporting methods, we can show comprehensive history, provide comparisons and anticipate future trends. This allows us to identify and address the specific needs of each client. Customized reports are available to assist clients develop the strategies needed to control cost and utilize assets.
Network Repricing and Out of Network Negotiating
Combining state-of -the -art technology with highly trained personnel, we provide cost effective timely repricing. Our specialists negotiate discounts with each provider and secure a choice network contract for all future claims. Future claims submitted with that providers tax ID are processed based on the contracted discount.
Fraud and Abuse Detection
Using software with high-impact fraud rules and statistical analysis, F&B provides complete protection. Suspect providers are identified and tracked, by specialty, flagged with amount paid or rule infraction, showing duplicate claims along with potential upcoding patterns. When appropriate, we also provide investigation of suspect claims.