Fraud Fighting NEMT Software Technology
Patient Logistics

Fraud Fighting NEMT Software Technology | VectorCare

September 21, 2021
David Emanuel

5 Must-Have Product Features That Help Medicare Advantage Plans Mitigate NEMT FWA

Comprehensive and intelligent technology gives Medicare Advantage plans a competitive edge against fraud, waste, and abuse (FWA).

FWA is a significant issue—WHICH CAUSED AN ESTIMATED $16B IN IMPROPER PAYMENTS TO MEDICARE ADVANTAGE PLANS—that calls for a solution that takes every aspect of the patient care journey into consideration.

An area of the patient care journey that’s particularly at risk for fraud is during the use of non-emergency medical transportation (NEMT). NEMT FWA occurs through instances such as claims of transportation that never happened, excessive mileage, and duplicate charges.

Medicare Advantage plans who utilize tech-enabled PATIENT CARE LOGISTICS SOLUTIONS can conquer the challenge of reducing fraudulent NEMT claims.

While considering which technology solution to employ, here are the five must-have product features that help curb and eliminate NEMT FWA:

1. Comprehensiveness

Employing comprehensive software that provides END-TO-END VISIBILITY around all players can help Medicare Advantage plans mitigate NEMT FWA.

Working within a single, user-friendly interface allows Medicare Advantage plans to stop using archaic methods that are difficult to track, such as faxing paperwork, phone calls, and manually matching records across systems. Using these outdated methods fosters an environment where undetected cases of FWA can thrive.

Auditing NEMT brokers and transportation providers, which helps root out FWA, is much more manageable when working on one single system.

2. Data-Driven Insights

Having access to data that offers real-time visibility and insights into the patient care journey is vital in fighting NEMT FWA.

Analyzing operations through reporting and dashboard tools can help spot any troubling outliers and anomalies within your system.

3. Customized Reporting

Technology that allows Medicare Advantage plans to create customized reporting aids in quick detection of NEMT FWA.

For example, VectorCare Hub allows payers to create and maintain customized reports that identify and flag potential cases of FWA. Real-time data pulled through these custom reports gives your plan insight into average costs, mileage, volumes, and associated pricing for which your vendors seek reimbursement.

These reports can also:

  • Flag potential duplicate charges.
  • Show trends in pricing to detect any outliers.
  • Compare miles submitted for the same transportation service from different companies.

4. Real-Time Communication Between All Players

Cases of NEMT FWA can occur when there’s poor communication between Medicare Advantage plans and their NEMT providers. Having technology in place that facilitates real-time communication between providers and payers helps to ensure no fraudulent activity takes place.

This real-time communication between Medicare Advantage plans and their NEMT providers looks like:

  1. A transportation service is requested and bid on by NEMT providers in real-time.
  2. Once a provider accepts the service, plans can see exactly when a patient was picked up and dropped off.
  3. Plans can then confirm that the service did occur, how long it took, and how many miles were driven.

This helps Medicare Advantage plans uncover and fight fraudulent claims of transportation that never actually happened, padding of mileage, and duplicate charges for the same service.

5. Integration Capabilities

Software that integrates with your plan’s existing systems and billing records not only increases operational efficiencies, but helps fight NEMT FWA. Integration enables your plan to automate auditing functions and avoid depending on manual processes where fraud can be easily missed.

VectorCare Hub has EHR and CAD integration capabilities, ensuring seamless communication to mitigate cases of FWA across the entire patient care journey.  

Comprehensive Technology Is Vital for Fighting NEMT FWA

A comprehensive software solution that puts data at your fingertips allows for customized reporting, facilitates real-time communication, and has integration capabilities that can help Medicare Advantage plans fight fraudulent activity within their NEMT services.

Learn how VECTORCARE HUB’s intelligent technology can help uncover and circumvent NEMT fraud, waste, and abuse.  

CONTACT US today to schedule a demo.