A new vision for payment integrity

The PI paradigm is shifting. Will you be leading the change?

Video Component

[music throughout]

Female Speaker: Embracing the future, comprehensive payment integrity. Payers need to change business as usual and rise to the challenge of reducing medical and administrative costs. They need to adopt the comprehensive PI strategy so they can improve bottom-line savings, reduce provider operation and focus on member satisfaction.

Some payers may have insight into their claim over-payments, but most don't really know how many inappropriate claim payments and over-payments they are making or recapturing. The scope is compelling. Anywhere from 7% to 15% of claims are discovered to have been paid inaccurately, as a result of commonplace mistakes, fraud, and more causes.

Adopting comprehensive payment integrity could save $362,000,000,000 annually in medical costs. Payers, typically lose 20 to 30 cents for every dollar recovered, by trying to chase around erroneous payments after they have been made. Trying to recover disbursements made in error to providers can damage relationships. The problem is, that responsibility for payment integrity is currently siloed in several departments.

As a result, efforts can overlap and conflict when information isn't shared, creating a lack of real insight into actual performance. How can payers not just survive but move ahead of the competition and begin to thrive? Payer executives need to align internally on payment integrity to analyze and share data to yield greater better benefits and maximize savings opportunities.

In short, payers must elevate payment integrity into a core strategic function by creating a single payment integrity office that breaks down silos. The centralized payment integrity office must harness data, analytics, predictive modeling, and innovations, to target and establish actionable progress metrics. This will strengthen pre-adjudication and prepayment cost avoidance methods.

Today's dynamic and competitive marketplace makes comprehensive payment integrity essential. Choose trusted, proven payment integrity partners to keep moving forward. It's time to assess your payment integrity practices by visiting Optum at www.optum.com/piassessment.

[00:02:29] [END OF AUDIO]


Is your PI strategy on the cutting edge?

Why is a centralized payment integrity strategy so critical in these disruptive times? A video from Optum and Health Data Management reveals actions you must take to capitalize on strategic investments and innovation. Gain the competitive edge needed to thrive.

Video transcript: Comprehensive Payment Integrity


Video transcript:

Forward thinking payers are embracing a new vision for payment integrity, one where payment integrity is a centralized, strategic asset in these disruptive times.

These industry leaders are harnessing disruptive technologies, breaking down silos and creating centers of excellence to get a competitive edge. Their executives have realized that payment integrity must be a strategic focus.

Organizations that make this shift are reaping the rewards:
Sizeable administrative efficiencies, previously untapped medical cost savings, and freed-up resources so they can concentrate on their real mission of delivering quality care and coverage to their members.

Contrast that to the way their less innovative peers handle payments integrity:
Processes are fragmented across departments and vendors that may not share information, and whose efforts can overlap and unintentionally work against each other.
These payers may be losing up to 20 to 30 cents for every dollar recovered by trying to capture erroneous claims after payments have been made — and can cause provider abrasion in the process.

They could benefit from coordinating their PI end-to-end, identifying and addressing inappropriate claims at their root. Part of the answer is to centralize and streamline PI, eliminating duplicative and conflicting efforts. And more importantly: It’s time to take advantage of new technology such as: advanced claim editing software, to create customized auditing logic and automatically review claims for accuracy data analytics, to assess provider performance, and monitor cost and utilization trends and predictive scoring models, which can identify, flag and score billing data for potential errors based on the agreement of billing codes and patient data.

The potential savings are enormous. Under current practices, half of health plan professionals say they capture only 7% or less of inappropriate payments and overpayments.

With comprehensive PI, Optum clients routinely experience a 1% to 2% increase in medical expense savings. One large health plan in the Midwest saved $158 million by shifting to a pre-payment cost avoidance strategy.

In today’s competitive and dynamic marketplace, the savings and efficiencies comprehensive PI can generate are necessary for health plans to survive and thrive.

To find out more about comprehensive payment integrity and where your organization is on the road to developing a strategic, centralized model, get in touch with our PI experts by visiting [INSERT VANITY URL]. Our experts will work with to assess where you’re at on your journey and give guidance on how to move forward.

[SOURCE SLIDE] Source: Optum Healthcare Payment Integrity Custom Research Study, SourceMedia Research/Health Data Management, October 2017