As the audit industry grew, APEX was highly successful in delivering millions of hard dollar savings back to their clients. However, clients were searching for a better solution than reclaiming lost money 12-18 months after it occurred.
This led to installing proprietary algorithms on the front end of the payment process to capture overpayments before they occurred. That event in 1995 led to the innovative concept of arming Fortune 100 organizations with deep data analytics to support their shared services, and prevent overpayments in real-time.
In addition to equipping customers with powerful tools that worked across any number of payment platforms (SAP, Oracle, PeopleSoft, homegrown and more), APEX Analytix developed granular benchmarking data that helped large organizations promote & adopt best practices learned from their peers.
APEX was able to offer substantial cost savings from duplicate payments to cash discounts to sales tax errors to VAT reclaims to returned merchandise and many types of pricing errors. To this day, the company remains the most powerful force in the marketplace to ensure payment integrity within large-scale organizations.
Fast forward to today, as finHealth seeks to perform that same radical reshaping of the healthcare payment landscape. To that end, finHealth is arming folks with powerful data analytics and algorithms to minimize the well-known excesses of healthcare fraud, waste and abuse.
Unfortunately for those involved in healthcare, the prevailing error rates dwarf those in private industry, with CMS reporting an improper payment rate of 12.7% in the 2014 Comprehensive Error Rate Testing (CERT).
This detailed review of 50,000-100,000 claims annually to measure error rates is the most comprehensive audit of paid healthcare claims of its kind. Imagine the level of error that may exist in self-insured corporate health plans that have never been subjected to stringent audits.