Fraud & Security Reducing Health Care FWA Losses – Find Your Focus
A key component of stopping fraud, waste and abuse is to focus on your most productive targets: Who or what should be the focus of your payment integrity program?
Tag Archives: Insurance
Fraud & Security How Pre-Payment Prevention Can Lower Health Care Losses
The most effective approach to pre-payment prevention of losses is to risk score your claims, post-adjudication, prior to payment, in production-strength software which uses xAI and machine learning.
Fraud & Security How AI and Machine Learning Can Fight Health Care Fraud
AI and machine learning have become popular concepts in payment integrity. But how can they help reduce your losses to health care fraud, waste and abuse?
Analytics & Optimization Accelerating the Slow March Towards Digitization in the Insurance Industry: Part II
In our previous blog, we outlined five ways that insurers can adopt a decision-first approach to accelerate the digitization of your business. Below, we take a deeper dive into these areas. Adopt a decision-first approach: Rather than start with data, forward-looking insurers are defining their most critical business objectives and decision models before considering data and analytic requirements. Once the decision metrics have been identified – such as loss ratio, geographic distribution, growth, etc. – a carrier can assess data sources in order to gain customer insights and make decision at the exact right moment. The organization can then drive key decisions across all interactions and continuously improve so the next decisions are even more accurate. The leading decision management applications help businesses visually model their decisions before deploying them. Improve your agility by optimizing resources: Digitization is hindered when businesses can’t modify strategies quickly enough or respond to economic,... [Read More]
Analytics & Optimization Accelerating the Slow March Towards Digitization in the Insurance Industry
Let’s face it – while many see digital disruption as the future in insurance, in fact new entrants into the space have been hindered by the product complexity, distribution systems and legacy infrastructure that the insurance industry carries with it. The landscape is changing, however – consumers (and businesses) are moving quickly to go with insurers that offer targeted, more transparent, 7×24 services. Digitization is indeed alive in insurance, it’s just taking longer to infiltrate – but it is arriving, and insurers that move quickly to upgrade their technologies – particularly, decision management systems – will gain (and grow) a distinct advantage over those who wait. Is the software to blame? Like the industry itself, the insurance software that is used to help make decisions is also stuck between business as usual and the immense possibilities offered by digitization. While policy and claim management system vendors have evolved product functionality... [Read More]
Fraud & Security Cyber Risk Measurement: How to Measure a Moving Target
As I recently blogged, “Clearly, there’s a big disconnect between what companies perceive to be their strengths and the reality on the ground.” Now it’s time to move on to the reality of evolving cyber threats, and the important role of risk-scoring technology in cyber risk measurement. Again, I’ll draw on the session Cyber Risk, Cyber Ratings and Cyber Risk Transfer at the recent FICO World 2018 conference, and the conversation with my three panellists: Josh Ladeau, CISSP, Global Head of Cyber, Aspen Insurance Sasha Romanosky, Policy Researcher, RAND Corporation Mingyan Liu, Professor and Incoming Chair of Electrical Engineering & Computer Science, University of Michigan and founder of QuadMetrics. Cyber Risk Measurement: Cyber threats are multiplying Not surprisingly, the panellists’ perspectives on cyber risk growth were reflective of their professions. Josh said, “It’s about the interruption of business and systems being down; hackers aren’t the only source of cyber risk. Business outages... [Read More]
Fraud & Security Who Has Cyber Risk Insurance Around the World?
76% of Organizations Have Cyber Risk Insurance – But How Does That Change Across the Globe? Data breaches and cyber-attacks continue to dominate headlines, so we can be sure that try as they might, many organizations can’t protect themselves sufficiently. Should the worst happen, are companies able to use cyber risk insurance to help them recover? Our survey of 500 companies across 11 countries shows some interesting results and attitudes on the subject. More companies are investing in cyber risk insurance Last year we surveyed companies in six countries, when we compare year on year results we can see that in those countries the percentage of organizations that have cyber risk insurance has gone up from 62% to 75%. Looking at individual countries there are some standout figures. In the UK the percentage of insured companies has leapt by 29% with 90% now investing in cyber risk insurance. The UK... [Read More]
Fraud & Security Cybersecurity Insurance — But Not Full Coverage
The number of UK firms with cybersecurity insurance has risen in the past year — but less than half say their cyber insurance covers all risks. The second annual cybersecurity survey from research and consultancy firm Ovum, for Silicon Valley analytics firm FICO, found that the number of UK firms reporting they have no cybersecurity insurance dropped from 31 percent in 2017 to 10 percent in 2018. While this is substantially better than the 24 percent reported across all 11 countries surveyed, only 38 percent of UK respondents said their cybersecurity insurance covers all risks. Cybersecurity Insurance – Telcos still lack coverage Telecommunications firms were the most likely to have no cybersecurity insurance — 17 percent reported this, compared to just 5 percent of financial services firms. (This shows that not much has changed in the industry since last year as per the findings in our e-book “Cybersecurity for Telecoms –Views... [Read More]
Fraud & Security Who Should Be Responsible for Health Care Payment Integrity?
Given the negative impact of fraud, waste and abuse on health care, it’s in every payer’s interest to focus on these problems.
Fraud & Security Reducing Health Care Fraud, Waste & Abuse: How Much Is Enough?
So how does a health care payer measure success in payment integrity? How much is enough?