HOPS Reveal Healthcare

• Fraud Control
• Overpayment Identification
• Process Improvements
• Trend Management
• Compliance Monitoring

In an industry with estimated fraudulent losses of $51 billion to $170 billion per year, minimizing losses is vital to staying competitive in the healthcare market. Being able to meet regulatory obligations and fiscal management goals is essential to staying in business. Reducing fraud, waste and abuse is where HOPS Reveal Healthcare can help.

Estimates of fraud are from 3% to 10% and higher for healthcare claims. With Fee-For-Services (FFS) claims accounting for over $800 billion each year in the private commercial insurance industry alone, preventing even 1% of the fraudulent schemes would result in billions of dollars saved.

HOPS Reveal Healthcare helps you identify suspicious behavior quickly, enabling investigators to accurately detect, pursue and reduce the impact of a fraudulent scheme, thus reducing your losses. Change the landscape of fraud through quick and accurate actions, deterring future schemes and attracting honest providers so you can gain an advantage over your competition.

Private Insurers:

• Health plans providing fully insured products to employers and individuals
• Self-insured employers who take on the financial risk of health insurance
• Third Party Administrators (TPA) who provide claims processing services or health plans providing Administrative Services Only (ASO)

Government:

• Medicare
• Medicaid
• Self-insured State, Federal and Municipal employers

HOPS Reveal Healthcare provides you the tools to consolidate, compare and cross-reference your data to make strategic decisions about your organization. By consolidating Fee-For-Service (FFS) claims data from various areas of your organization along with market-wide claims information into one database, you can greatly improve accuracy, speed and effectiveness of your fraud detection and cost control efforts. HOPS can work with multiple terabytes of data and make accessing valuable information as easy as a few clicks of the mouse through our intuitive dashboards and drill-down capabilities.

Dashboard

At a glance, the dashboard allows you to keep your finger on the pulse of the industry and effectively manage your team with a customizable page featuring: user activity, news feeds, industry information overviews, a mini data explorer, reference searches to find codes and names for common procedures, announcements and contacts. From here, dive deeper into you data with:

Algorithms

Complex algorithms bring laser focus to aberrant behaviors. The most suspicious results are brought to the top so you know where to focus attention. Algorithms run on the HOPS Technology, providing actionable results with supporting details, on-the-fly.

Flexible Tools

Flexible data exploration and trending tools allow you to drill down into the information and compare it to industry averages so you can make intelligent business decisions on pursuing potential fraudulent behaviors. HOPS also gives you the ability to save and export data.

Data Visualization

Sometimes a picture is worth a thousand words, and sometimes seeing an outlier through data visualization is worth thousands of dollars. Utilize the charting and graphing functions to see trends in your data, supporting fact-based decision-making at your fingertips.

• Easy implementation with nothing to install on your PC
• Our subscription model allows you to utilize HOPS Reveal on a Software-as-a-Service (SaaS) platform, so we do all the heavy lifting for you with our HOPS Technology
• Web-based access, providing you reliability 24 hours a day, 7 days a week
• Ability to work with disparate data sets
• Security compliance and disaster recovery with 24-hour monitoring by HOPS so you can sleep at night
• Control which users can access specific information within your organization
• Professional services support from HOPS

Security is our number one priority. We maintain the highest levels of adherence to HIPAA requirements, as well as the stringent date protection and usage directives of the Center for Medicare and Medicaid Services (CMS).

Learn more about our security program and the multiple levels of security we place on your data in our Security section.

HOPS has strategic partnerships with companies who can help your organization to most effectively use the leads that HOPS Reveal brings to light. Please see our Partners page for more information on how you can investigate and recover your fraudulent losses.

Contact Us today to see how we can help your company.