Increase NEMT Program Integrity to Reduce Fraud

Increase NEMT Program Integrity to Reduce Fraud, Waste, and Abuse with VectorCare Hub

With MORE THAN 3 MILLION AMERICANS FORGOING MEDICAL CARE EVERY YEAR DUE TO TRANSPORTATION ISSUES, having reliable non-emergency medical transportation (NEMT) services available is vital to a functioning, healthy society.

The need for these critical services has not gone unnoticed—NEMT SERVICES ARE, ACCORDING TO FEDERAL LAW, REQUIRED BY STATE MEDICAID PROGRAMS.

However, the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) reports that NEMT SERVICES ARE ESPECIALLY VULNERABLE TO FRAUD, WASTE, AND ABUSE (FWA), which results in a significant amount of money lost every year. With this in mind, it’s of the utmost importance that payers prioritize the integrity of their NEMT services.

As a Medicare Advantage plan, establishing, growing, and ensuring the integrity of a large group of in-network NEMT providers is in your best interest as it helps improve transportation services for your members, as well as reduce FWA.

Improved integrity of NEMT services and reduced cases of FWA can be accomplished by utilizing credentialed transportation providers, taking advantage of ride-sharing platforms, and most importantly, implementing comprehensive technology.

Credentialed Transportation Providers

Ensuring NEMT providers are qualified based upon various credentials is crucial to improving program integrity.

These qualifications and/or requirements may include:

• Background checks
• Adequate training
• Inspection of vehicle safety and usability
• Valid liability insurance

It’s essential to not only validate these credentials once but to do so regularly. VECTORCARE TRUST allows plans to keep all information relating to NEMT providers’ credentials within one comprehensive platform to ensure their continued eligibility.

Ride-Sharing Platforms

Transportation Network Companies (TNCs), also known as ride-sharing platforms, are another option for plans to increase program integrity and improve services to members.

The popularity of ride-sharing has shaped and altered consumers’ expectations regarding pick-up times and provider responsiveness. Ride-sharing services are a reliable option for a member who needs a last-minute service.

VECTORCARE HUB’S PLATFORM INTEGRATES WITH SEDAN CAR SERVICES such as Uber and Lyft to ensure seamless communication across every facet of the patient journey. These services improve patient health and satisfaction, reduce appointment no-shows, and decrease wait times.

Utilizing Comprehensive Technology

A comprehensive technology solution, like VectorCare Hub, increases the integrity of NEMT services through END-TO-END VISIBILITY across the entire patient care journey.

VectorCareHub allows Medicare Advantage plans to:

• Confirm a member’s eligibility with ease before any requested NEMT service is provided, which helps to reduce cases of denied claims or unnecessary trips.
• Adopt a comprehensive, HIPAA-secure cloud-based system to eliminate outdated methods of communication, such as paper forms that jeopardize patients’ personal information.
• Remove friction during the requesting, receiving, bidding, scheduling, confirming, and delivering of NEMT services on both the payer and NEMT provider’s end.
• Access insights into troubling occurrences such as missed rides (i.e. whether due to the  NEMT provider or member).
• Identify fraudulent activity such as excessive mileage claims, multiple charges for the same ride, or charges for a ride that never occurred.

You may also want to learn about these 5 MUST-HAVE PRODUCT FEATURES THAT HELP MEDICARE ADVANTAGE PLANS MITIGATE NEMT FWA.

Ensure the Integrity of Your NEMT Services

Medicare Advantage plans can create, grow, and ensure the integrity of a large group of in-network NEMT providers through proper credentialing, augmenting their services with ride-sharing, and utilizing the right technology.

Tap into the power of VectorCare Hub to make providing reliable, high-quality NEMT services for your members﹣and fighting fraud, waste, and abuse﹣easy.