Blue Cross and Blue Shield of Texas selects VIPS' STARS System to combat Medicare fraud and abuse.TOWSON, Md.--(BUSINESS WIRE)--Nov. 12, 1996-- STARS now being used to analyze over one third of nation's Medicare claims VIPS VIPS Volunteers in Police Service VIPS VAT (value added tax) Information Management System VIPS Veteran Intelligence Professionals for Sanity VIPS Volunteers in Public Schools VIPS VIsion-based Page Segmentation Inc., a health care software development company based here, announced Tuesday that Blue Cross and Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. of Texas recently purchased STARS(TM) (Services Tracking, Analysis & Reporting System) to detect fraud and abuse within the millions of Medicare claims processed annually by this Richardson, Texas-based contractor. With the Texas sale, VIPS has increased its share of the Medicare fraud Medicare fraud Medifraud Medical practice Any unlawful act which results in the inappropriate billing of Medicare for services by a health care provider–eg, physicians, hospitals and affiliated providers. See Medicare. and abuse/decision support market to 11 client installations, three of which are for Operation Restore Trust (ORT) contractors. ORT was enacted last year by the Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS at the behest of the Clinton administration Noun 1. Clinton administration - the executive under President Clinton executive - persons who administer the law to take a bite out Verb 1. bite out - utter; "She bit out a curse" let loose, let out, utter, emit - express audibly; utter sounds (not necessarily words); "She let out a big heavy sigh"; "He uttered strange sounds that nobody could understand" of Medicare and Medicaid Medicare and Medicaid U.S. government programs in effect since 1966. Medicare covers most people 65 or older and those with long-term disabilities. Part A, a hospital insurance plan, also pays for home health visits and hospice care. fraud. VIPS' clients are accountable for processing over 270 million Medicare claims more than one third of the nation's total. Blue Cross and Blue Shield of Texas, which is contracted to process claims from providers billing in Texas, Maryland, Colorado and New Mexico, is one of the largest HCFA HCFA abbr. Health Care Financing Administration HCFA, n.pr See Health Care Financing Administration. (Health Care Financing Administration Health Care Financing Administration, n.pr department in the U.S. agency of Health and Human Services responsible for the oversight of the Medicaid and Medicare benefit programs, including guidelines, payment, and coverage policies. ) Medicare contractors in the nation, with an annual volume of 56 million claims. "As an Operation Restore Trust pilot contractor with millions of beneficiaries and operations in multiple states, we selected STARS to enhance our fraud detection activities, because it gives our inspectors the power and flexibility to conduct detailed inquiries from the desktop, free from the bottlenecks created by systems requiring support from programming staff," said Leah Ann Embry, director of program compliance for Medicare Part A and Part B, Blue Cross and Blue Shield of Texas. "With claims data freed from the constraints of our mainframe, inspectors here can follow a lead throughout our database. STARS enables us to conduct thorough, statistically relevant analyses, and it electronically tracks every step we've taken, automatically building a detailed audit trail," she added. "VIPS' software is engineered to put significant analytical power into the hands of decision makers, rather than programmers. STARS offers a range of features such as pattern recognition, utilization analysis, cost analysis, focused medical review, and provider profiling. "Most important, it effectively brings large volumes of claims together across multiple provider settings and different insurer lines of business broadening the payer's view of standard' billing patterns versus aberrancies," said Karen Kaldal, director of marketing, VIPS Inc. STARS combines a comprehensive data warehouse with powerful analytical tools, providing users with highly sophisticated techniques to support the analysis and investigation of fraud and abuse cases. STARS uncovers aberrancies in large claims databases and then equips the analyst/investigator to isolate causes, explore different paths of analysis, document case progression and package the results for possible prosecution or provider education. Founded in 1979, VIPS Inc. develops powerful software tools for managing health care information. In addition to STARS, VIPS markets SuperOp(TM), a pre-payment decision support system that empowers health care insurers to proactively screen claims for possible fraud, miscoding or conflict with medical policy before claims are paid, and recently introduced MCSource(TM), a second-generation managed care decision support system. VIPS is a First Data company (NYSE NYSE See: New York Stock Exchange :FDC FDC - Floppy Disk Controller ). First Data, which reported more than $4.1 billion in revenues in 1995, provides information processing services to financial institutions, merchants, insurance companies, health care providers, government agencies, public utilities, and consumers throughout the United States, the United Kingdom, Australia, and through its agent network to more than 120 countries around the world. CONTACT: VIPS Inc. Karen Kaldal, 410/832-8300 or Cornerstone David Schreiber, 410/727-2131 |
|
Printer friendly
Cite/link
Email
Feedback
Reader Opinion