Balancing Efficiency and Provider Relationships When Optimizing Payment Integrity

Payment integrity is an essential function in the healthcare space. It ensures all claims are coded and billed properly, resulting in efficient and accurate payment. However, achieving payment integrity is no simple task and is often a source of abrasion.

Healthcare regulations are constantly changing. Approximately 150,000 diagnosis and procedure codes are subject to update. Clinical definitions and the way care is delivered evolve. Payers are focused on managing benefits, and providers are focused on patient care. Handling their core competencies while trying to keep up with the complex demands of payment integrity is a significant challenge. Finding a partner in payment integrity can make that process more efficient. The right partner allows payers and providers to focus on what they do best, leading to stronger relationships between these stakeholders.

What are today’s payment integrity challenges, and how can the right partner resolve them?