Anyone who deals with insurance claims eventually learns of medical canvassing, the process of discretely investigating whether a claimant has received medical treatment or filled prescriptions at any medical facility or pharmacy within a specific geographic radius of his or her home or office. The information obtained through medical canvassing is a piece of the greater puzzle to provide validity (or lack thereof) of a claim. It should not be surprising that many fraudulent claims are, in fact, cases of double-dipping or the claimant claiming a previous injury in a current claim to obtain a second or even third payment. It also should not be surprising that many claimants allege treatments and prescriptions that were never received and continuously delay providing paperwork in hopes the claim settles before the documentation absolutely must be provided. However, as valuable as medical canvassing can be, there is a fine line between a skilled and experienced professional and an amateur conducting the medical canvassing and the results achieved.
Professional vs. Amateur
A professional is confident in his inquiry, speaking clearly to the individual on the other end of the phone, utilizing the appropriate vocabulary while articulating exactly what is needed. A professional knows what he can ask for and what he cannot. A professional also knows not to waste pertinent time and client resources arguing with medical personnel who choose to err on the side of caution when releasing information. Nothing good can ever come from that.
An amateur, on the other hand, is the antithesis of a professional. An amateur impersonates the claimant, a medical professional, or law enforcement, asks for HIPAA protected information, and argues with medical personnel when challenged or refused. An amateur places the entire investigation and the claim in jeopardy, potentially costing the client thousands if not millions of dollars in fines, legal fees, and settlement costs.
When a medical canvass is conducted, it is paramount that the individual conducting the canvass be a skilled professional such as Prefered Intelligence. Further, it is equally essential to have the medical canvass result available to the client in a timely manner, using an appropriate case management system. The CMS, such as the one utilized by Preferred Intelligence, places the Medical Canvass results directly at the client’s fingertips digitally while also allowing for a separately generated Medical Canvass Report to be provided to the client for reproduction as needed.
When you need a Medical Canvass conducted professionally, be sure to call Preferred Intelligence at 214-785-4504 or email us at info@preferredintelligence.com.