Paul Vosters, president and COO of LaunchPoint, was recently featured in Healthcare Payer News. His article discussed the importance of payment integrity for healthcare payers in the post-reform era.
Many payers face profitability declines while also taking in a huge influx of newly insured members whose risk profiles are unknown. Payers continue to see billions of dollars in error rates on claims each year, and fraud and other abuse further erode the bottom line.
So what can payers do to shrink the risk and increase revenue? By elevating attention to siloed operations (such as subrogation, COB, eligibility, claims analytics, and others) and taking a strategic and holistic approach to the payment integrity challenges that all payers face, millions of dollars can be translated into funding to support the initial cost of entry into new markets and to mitigate the risk of new ventures. Payers should be paying a claim the right way the first time, and avoiding errors in the first place.