Successful Health Plans must constantly monitor their claims cost in order to understand and contain cost growth in the various provider types, service categories and beneficiary populations. Additionally, they have to focus on fraud, waste, abuse, pricing accuracy and prevention.
LD works with Medicare Advantage and Medicaid Health Plans as well as other CMMI demonstration programs to provide sophisticated trend reporting and analysis at all of these levels and makes recommendations to reduce claims cost.
LD has robust knowledge of CMS pricing methodologies for Acute IPPS, Post-Acute SNF/Home Health, Ambulatory and Professional services. Payment of medical claims can be complicated and LD has experience in auditing the accuracy of the claims payments made by Health Plans as well as the automation of the process for over-payments to be recovered. We follow the Recovery Audit Contractors (RAC) for CMS who publish all the over-payment issues for Medicare FFS which usually translates to the same issues with MA and other Health Plans. LD has a history of high return on investment in this area for existing client Health Plans.
Compliance and operational demands on Health Plans continue to increase over time and contribute to high administrative costs. LD has a proven track record of auditing tasks to remove the need for costly third-party vendors or large departments of employees. We have built highly automated processes around the payment of broker commissions, provider incentive payments, electronic data exchanges, provider communications, member communications, EDI, etc. We build these solutions without the need for costly software procurements but rather through the use of often existing Microsoft Office products, SQL/SAS/Visual Studio and Visual Basic programming.
LD Consulting 