A Strategic ImperativeWhy are payment integrity departments centralizing their efforts? Most likely because it aligns with other necessary changes in healthcare, including the elimination of data silos and designating a single point of accountability. It may be an answer to the organizational challenges that put payment integrity in peril at organizations. “Our nation’s claims payment system is highly complicated…over time, this has resulted in the growth of numerous groups to address such issues,” writes Healthcare Finance. These groups include subrogation, coordination of benefits, overpayments, SIU/FWA, and more. In the past, the issue hasn’t been that a health plan doesn’t understand the business case for payment integrity, notes Healthcare Finance. It’s simply just been too complicated to coordinate. It’s estimated that by centralizing PI efforts however, returns on claim spend can increase 10x. Centralizing your PI department is a strategic imperative as health plans are being asked to engage at a higher level with their data and to essentially do more with less. But, how? How can a health plan keep specialty departments in play while carefully gleaning PI-specific tasks out into one central department? It’s an incredibly complex issue, so how are health plans making centralization work? The answer it seems is technology.
Change Management TechniquesAs you likely know, just because centralizing payment integrity efforts sounds good on paper doesn’t mean it is easy. Moving responsibilities away from singular departments may be hard for organizations used to interdepartmental autonomy. How can you motivate acceptance of change? “Based on interviews with officials from agencies, we found that visibility and accountability are motivating,” writes the authors of this MITRE report titled “Payment Integrity: What Motivates Entities Making Payments and Claimants to Optimize Ongoing Payment Integrity Efforts?” The report makes 11 recommendations for system transformation. Those recommendations are summarized below:
- Set clear organizational goals with accountability
- Establish a culture of Payment Integrity
- Balance closely priorities of “mission” and “management”
- Emphasize coordination to address challenges
- Address statutory barriers
- Explore funding options to strengthen PI
- Consider PI when modernizing technology and shared service systems
- Give claimants easy ways to interact with agencies
- Be proactive and timely when communicating with claimants
- Broaden use of data-mining and other “compliance-oriented motivators”
- Expand compliance motivators as needed
Centralizing Payment Integrity in the Real World with Pareo®
Outsourcing SolutionsHealth plans may not realize that totally outsourcing the function of their payment integrity department is an option. Pareo® can step in where others leave off, allowing your health plan to have complete operational transparency without a heavy lift. Gain traction, quickly, and rely on the processes that Pareo® helps you build alongside your Payment Integrity department so you can one day insource the work completely.
Talk to ClarisHealth about how Pareo® can transform your health plan’s payment integrity operations.
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