Administrative complexity continues to drive the high level of waste in healthcare. Learn how to reduce improper payments with an optimized payment integrity approach that blends advanced analytics with human expertise.
Ever feel like you're living through "A Nightmare on Subro Street?" Healthcare subrogation can be terrifying! Health plans are “afraid...very afraid” of what high costs and low settlements do to their bottom line. Read our spooktacular blog post on turning your subro tricks into bottom-line treats.
It can be the small, unintentional errors that expose valuable health data to data thieves. Holding your building door open for a delivery person with their hands full. Clicking on an urgent email request from a senior executive.
The future of healthcare coordination of benefits might not be as exciting as humans living on Mars or Oprah for president, but there are some interesting things happening in COB that are changing the way health plans approach this age-old process.
When selecting a COB vendor, health plans are most interested in partnering with experts whose solutions deliver considerable incremental recovery opportunities with minimal disruption to their existing operations. Read our blog to see the most common integration points of alignment between supplemental COB and health plans' internal efforts.
Medicare Secondary Payer (MSP) is a multi-pronged issue for Medicare Advantage plans. If plans aren’t monitoring the effects of MSP on medical and pharmacy claims as well as premiums from CMS, they could be hurting their bottom line—to the tune of millions of dollars. MSP also introduces compliance responsibilities that plans must regard or else
Recent years have seen some health plans and subrogation vendors experiment with information technology and analytics to help improve the identification of claims with subrogation potential, reduce member abrasion across the subrogation process, and improve settlement rates.
What roles are necessary in your healthcare organization for successful application of your data analytics? Whatever the size, culture and maturity level of your company, I believe there are five key functions your organization needs to develop models that can help drive solutions to real-world problems.
A closer look at one of 2017’s top payment integrity trends. Health plans are making a concerted effort to focus more of their payment integrity resources on avoiding inaccurate claims payments up front, rather than recovering erroneous payments on the back end.
As cost reduction continues to take center stage, healthcare payment integrity is in the spotlight. Increasingly, health plan executives are recognizing the power of payment integrity functions to add significant value to a health plan’s bottom line by improving the plan’s ability to recover or avoid improper claims payments and improve accuracy of premium revenue.
Though MA plans are on the task – attempting to find and correct errors in member eligibility and CMS premium payments – most are still missing millions of dollars due to hidden challenges in the process.
Maintaining a high level of customer service and solution quality is challenging in any industry. And because our customers are in the highly-regulated market of healthcare and health insurance products, the services and outcomes we provide are under almost as much scrutiny as the plans we serve.
This topic has been evolving for more than 10 years as litigation and case law have disputed over the issue of whether the private cause of action for double damages under the Medicare Secondary Payer (“MSP”) Act provides Medicare Advantage (“MA”) Plans with the right to bring suit against primary payers.
For many health plans, payment integrity is able to influence the bottom line in powerful ways. For payment integrity organizations (sometimes called cost containment), the new year is the perfect time to evaluate what has been working well and what can be done better and more efficiently.
(Michele Stuart of JAG Investigations') presentation was alarming and fascinating as she showed us how vulnerable our social media activity makes us to criminal activity and walked us through steps we can take to protect ourselves.
As the healthcare industry continues to transform, it has become clear that the need for increased transparency is one of the critical drivers of change. Health plans are being asked to share more information with a broad range of stakeholders in an effort to control costs and drive improvements in efficiency.
CMS premiums have a direct impact on your bottom line and there’s a good chance that you’re not receiving the full premiums you’re owed. In fact, you may be getting shorted by millions of dollars in premiums due to MSP.
For many health plans, payment integrity is able to influence the bottom line in powerful ways. For payment integrity organizations (sometimes called cost containment), the new year is the perfect time to evaluate what has been working well and what can be done better and more efficiently. And often payment integrity technology is one of
With all of the demands on your team, your time, and your resources, eligibility data management may not be your first priority. In our experience with over 15 health plans, eligibility data issues are the root cause of between 20% and 30% of payment integrity costs.
Addressing eligibility data management can seem like an overwhelming or impossible task among all of your other competing priorities. However, fixing these data errors can eliminate downstream impacts to your payment integrity programs that are likely costing your plan millions of dollars.
Over the last two months, we’ve examined how organizational and technology structures can keep health plans from recognizing, understanding, and resolving their payment integrity challenges. This month, we want to spend a little time examining one thing that can be at the root cause of some of those challenges: eligibility. Eligibility issues impact a multitude
By Bill Whittemore, vice president of Ajilitee, Discovery Health Partners’ sister division In my last blog post, I discussed some of the challenges healthcare payers face related to their lack of transparency into recovery performance results at a program level. In this post, I’d like to dive deeper into the problems caused by lack of