Breaking Down Internal Silos

With so many moving – and vital – parts within the healthcare organization, how can we ensure total payment integrity? On paper, key departments that play a vital role (such as Claim Operations, Provider Audit, SIU and Payment Integrity) may appear to integrate harmoniously in overall cost containment.

The reality – as pointed out in this article – is that the division of tasks across multiple payment integrity departments swiftly leads to inefficiency, often in the form of data siloing. These internal silos are challenging to many operational aspects of healthcare, including payment integrity operations.

“Experts believe that healthcare organizations will need to invest in the appropriate tools and infrastructure to effectively manage data,” according to Stanford Medicine’s inaugural 2017 Health Trends Report. In an industry that faces ever-changing compliance, regulatory, and technological mandates, warehousing of data into inaccessible silos can be crippling.

Resolving Inefficiencies Created by Internal Silos

Inefficiencies caused by internal data silos can be swiftly resolved by a single, integrative technology platform. If every department involved in payment integrity has the ability to utilize a stream of aggregated data – data distilled from silos – interoperability is established.

Various departments can visualize data and leverage the distilled information in order to improve payment integrity. We know that minimizing revenue leakage is imperative – and complex- for our industry. It’s difficult to ascertain success and workflow if we cannot bridge the gap between various departmental efforts. Utilizing interoperability and navigating to a single information stream is the first step to successful payment integrity efforts.

Out of Many, One

Ideally, organizations will navigate to a platform that utilizes both internal and third-party data into a single information portal. Obtaining visibility into overall cost containment is an invaluable resource for payers, creating transparency between departments.

With good data practices in place, organizations are able to confidently manage payment recovery efforts. Once internal data silos have been distilled, organizations can effectively employ a comprehensive strategy for total payment integrity.

Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.