O assisted repayment is an increasingly common practice in the supplementary health sector, offering support to beneficiaries in requesting reimbursements for services performed outside the accredited network. Although this approach aims to make the process easier for patients, it can also open up loopholes for fraud and abuse that negatively impact healthcare operators. In this scenario, SAUDI stands out as an effective solution for automating the auditing of medical bills and mitigating the risks associated with assisted reimbursement.
What is Assisted Reimbursement?
Assisted reimbursement refers to the process in which clinics, practices or third parties help beneficiaries to obtain reimbursement from health insurance companies. This assistance can range from filling in forms to sending the necessary documents for the request. Although it may seem beneficial, this practice can be exploited improperly, resulting in fraudulent claims and financial losses for operators.
Associated Risks and Frauds
The National Federation of Supplementary Health (FenaSaúde) warns of the risks of assisted repayment, highlighting fraudulent practices such as:
- Fake documentation: Presenting forged receipts or medical reports to justify procedures not carried out.
- Services Not Provided: Request for reimbursement for services that never took place.
- Erroneous Coding: Changing procedure codes to inflate reimbursable amounts.
- Identity Misuse: Use of third party data to request undue reimbursements.
These practices not only harm operators financially, but also jeopardize the sustainability of the supplementary health system as a whole.
How SAUDI Works to Prevent Fraud
SAUDI is an advanced platform that automates the auditing of medical bills, offering various functionalities to identify and prevent fraud associated with medical bills. assisted repayment:
1. Real-time data analysis
Using artificial intelligence, SAUDI analyzes large volumes of clinical and financial data in real time, identifying suspicious patterns and flagging possible irregularities.
2. Process automation
The platform automates administrative tasks such as compliance checks and document validation, reducing the possibility of human error and speeding up the audit process.
3. Continuous monitoring
SAUDI constantly monitors changes in regulations and internal policies, ensuring that all reimbursement requests comply with current regulations.
4. Detailed reports
The generation of analytical reports provides a comprehensive view of financial and operational performance, facilitating strategic decision-making and the identification of areas in need of improvement.
Benefits for Healthcare Providers
The implementation of SAUDI brings several benefits to healthcare operators:
- Cost reduction: Significant reduction in expenses associated with fraud and manual processes.
- Increased Efficiency: More agile and precise processes, resulting in greater productivity.
- Improved Compliance: Ensuring that all operations are in line with sector regulations.
- Transparency and Trust: Strengthening the relationship between operators, service providers and beneficiaries through clear and auditable processes.
Adopt the solution used by dozens of healthcare operators throughout Brazil!
Assisted reimbursement, while intended to make it easier for beneficiaries to access health services, can be a gateway to fraud that compromises the integrity and sustainability of operators. In this context, SAUDI is the best solution for automating the auditing of medical bills and has been adopted by dozens of healthcare operators throughout Brazil. With state-of-the-art technology and robust functionalities, SAUDI offers an effective approach to preventing fraud, optimizing processes and ensuring compliance with industry regulations.
Contact and request a demo now!
