Following trends in health plan claim payment is key for hospitals navigating vendor options and postpayment recovery.
This is an excerpt from an article originally published on Revenue Cycle Advisor on July 19.
For hospitals to understand how claims are audited, they must be aware of how health plans are tackling payment integrity.
Ensuring that a health claim gets correctly paid is the crux of payment integrity. Contractual compliance, claims audit, and coordination of benefits are all part of payment integrity. Discovery Health Partners released a white paper last month highlighting eight payment integrity trends to watch in 2017, including the following:
- Prepayment cost avoidance is increasing in popularity
- Postpayment recovery is becoming a necessity
- Payment integrity is becoming a higher priority in the health plan
- Internal and vendor teams are uncertain about payment integrity performance
- Fewer vendor options are available due to market consolidation
- Business process outsourcing is being prioritized over software solutions
- Potential to outsource all of the payment integrity function
- Cloud-based solutions are becoming more widely accepted
For hospitals that want to implement postpayment recovery, having strong decision-makers on staff is key, according to Discovery Health Partners. They advise taking time with training to ensure staff has eligibility management skills and can handle data integration. One specific avenue to venture into is implementing data mining to identify member eligibility issues.
When it comes to navigating rising medical costs and the connected risks, employ a strong leadership team, the company writes. Share the workload by dividing functions across teams; allow operations, legal, and finance to each have a part in overseeing the payment.
While exploring vendor options, make sure hospitals should choose the right company for their team, advises Discovery Health Partners. They should take the time to research their vendor, understand its workload, and assess the fit. If the vendor has recently undergone a merger, hospitals should make sure the vendor is equipped to handle the additional workload of maintaining recovery services. Although it is an option to outsource 100% of the payment integrity function to one vendor, it’s still up for debate whether this is the best option, according to the white paper.
For cloud-based software, the benefits are timeliness in accessing information and keeping a low cost, according to Discovery Health Partners. However, hospitals need to take security measures and conduct security assessments to make sure their information is safe and protected.
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