3 Reasons why Payers must now reinforce Payment Integrity

Mar 10, 2023
4 min read
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Payers are backing Payment Integrity practices more than ever, but unfortunately are still struggling to plug in all the leakages. Payers pay a high price for administrative and pricing inaccuracies which escalate member healthcare premiums and weaken provider loyalty.

Numerous divisions within the payers may employ different strategies and invest in redundant solutions which may solve one or two problems, but the source of inaccuracies still remains unsolved.

Lack of transparency from multiple vendors is still a cause of concern for many organizations. As we strive to be more efficient and cost-effective, the need for a clear understanding of what we are spending our money on is more important than ever. It would be beneficial to have a clear understanding of what we are paying for and what services we are actually receiving. 

  1. Reduction of administrative waste

Healthcare expenditure is growing at a massive pace, and according to a study, is expected to grow over 7.1% over the next 5 years. Over a quarter of this amount is spent on fraud, waste, and abuse, and therefore, it is the need of the hour to take bold steps to address this. There is a dire need to thus optimize and bring forward a centralized/comprehensive, one-stop payment integrity solution in order to streamline the entire claims management process, and ultimately reduce administrative costs. 

  1. To stay in line with the constantly evolving compliance and regulatory policies - 

The world of healthcare is filled with complex rules, policies and regulations. With heavy regulations, we also tend to see cumbersome compliance policies which impact care on an overall scale. Maintenance of these is a challenge as code-sets & policies are periodically updated with the latest changes. It is mandatory for the code sets and policies to be updated before the effective date of the rule. Maintenance requires both the rules and technology to accommodate the changes. If not updated then this would lead to compliance issues, revenue loss, re-work, and provider dissatisfaction. 

Strengthening one’s PI Program will allow every payer to stay in line with new policies and regulations and therefore justify their recompense decisions. 

  1. Reduces workflow complexities

Claims management involves a lot of rules in order to get the right party to pay properly for the services rendered. Further, there’s always a chance of conflict between two stakeholders because of the existence of a multitude of rules and requirements. With platforms like CoverSelf which provide a pre-existing and perpetually up-to-date integrated rules library, the process of claims management becomes streamlined, thus reducing workflow complexities and payment inaccuracies, all at once.

Along with this, the introduction of payment integrity as a tool ensures that not only

are administrative costs reduced, but there is a scope to explore new savings opportunities in order to focus on multiple growth avenues. 

Looking to start your Payment Integrity journey today? Click here to know more about CoverSelf!