Are You Doing Enough to Avoid and Recover Payment Error Leakage?

Most health plans think they have it covered with a claim editing solution, internal payment integrity efforts, or a vendor or two. But what are the real results, and how does that compare to the industry?

There’s no doubt that the healthcare industry is in the midst of a technological revolution. With so many drivers creating a need for new technology, among the top being federal compliance, payers and providers have had to take a hard look at their bottom line.

Proactive health plans employ various measures to prevent payment error leakage, or the loss of revenue from improper payments. These measures include claim editing software integrations, cost-avoidance strategies, and leveraging extra technologies and services offered by third-party vendor.

However, on this new frontier of technology, no ‘best practice’ for efficient payment recovery and error leakage prevention has been established. So, how do you know if your efforts are on-par with the industry?

Third-Party Vendors Aren’t Enough

First, let’s address a major problem facing payment integrity. Various claims made by third-party vendors can leave healthcare payers beleaguered by promises that don’t deliver needed results. Most of these solutions function in a vacuum and do not provide health plans with integrated results leveraging and integrating information across all payment integrity operations.

To reach optimal performance, plans need solutions that can aggregate and present all data in one platform. Without a universally-accepted benchmark in place, health plans cannot turn to data to measure the success of their payment recovery program.

“Having information technology that helps to automate workflow and automate the transfer of information within and in-and-out of a health plan is critically important,” says Kimberly Branson, the ‎Vice President of Business Architecture & Strategy at Medica in an interview with HealthPayerIntelligence.com.

The Data Tells a Story

Within the hemisphere of value-based care, healthcare IT dollars are increasingly being re-directed towards consumer engagement, according to this recent survey. Identifying the gaps in payment recovery performance can have a big payoff, and alleviate some of the strain placed on IT departments, allowing them to focus on other issues.

In order for a plan to measure their success in preventing payment error leakage, they must evaluate if their metrics are accurate and complete. An approachable solution to achieving accurate metrics is utilizing technology that aggregates existing data into a singular portal, with accessibility to multiple departments, such as Pareo (offered by ClarisHealth).

With access to a complete data picture, health plans can build a firm foundation from which to measure the returns on their payment recovery investments. As industry innovators take charge of payment integrity, it is wise for health plans to accurately track their payment recovery efforts by first implementing good data practices.