Well Solutions Group’s Post

Here's Part Two of our discussion of Payment Integrity. This time, we present Guiding Principles to consider. One size does not fit all! And remember "Metrics That Matter"-- particularly when considering working with vendors to help with your efforts. If you'd like to learn more about how WSG can help, let us know!

Today’s technology innovations and workforce challenges (need to drive toward greater efficiency) are prompting payers to take a closer look at payment integrity with an eye toward a more strategic framework. More and more payers are recognizing that the status quo will not suffice in a volatile, disruptive market where change is happening with increasing speed. Over the past decade, the healthcare industry has seen payment integrity evolve from an under-resourced operational niche to a strategic asset that is central to the overall management of medical expense, in addition to efforts to improve quality of care and foster mutually satisfying provider relations. Let’s look at some guiding principles establishing Payment Integrity as a strategic asset. #paymentintegrity #processimprovement #healthcare #metrics #claimsmanagement

Whether building out or optimizing Payment Integrity, a key to maximize value is establishing your strategy. Organizational alignment, recovery approach and vendor management require guiding principles to provide consistent and reliable outcomes. A great primer to solidify your Payment Integrity Enterprise Solution. #paymentintegrity #healthcare #healthplanstrategy

5 Reasons Why Accurate Data is Important in Healthcare Claims Processing In the fast-paced world of healthcare, accurate data is not just a necessity; it’s a cornerstone for operational efficiency and financial stability. Inaccurate or incomplete data can lead to claim denials, delayed payments, and increased administrative burdens. Here's why precise data is paramount in healthcare claims processing: 1. Reduces Claim Denials:   Accurate data entry ensures that claims are correctly coded and submitted, reducing the likelihood of denials. Each denied claim represents a loss of revenue and requires additional time and resources to resolve. 2. Accelerates Payment Cycles:   With accurate data, claims are processed more swiftly, leading to faster reimbursements. Timely payments are crucial for maintaining the cash flow necessary to provide high-quality patient care. 3. Enhances Compliance:   Precision in data ensures compliance with the ever-evolving regulatory requirements. This helps avoid penalties and audits that can be both financially and reputationally damaging. 4. Improves Patient Satisfaction:   Correct data leads to fewer billing errors, minimizing disputes and enhancing the patient experience. When patients trust that their billing is handled accurately, their overall satisfaction with the healthcare provider increases. 5. Optimizes Resource Allocation:   By minimizing errors and streamlining the claims process, healthcare organizations can allocate their resources more efficiently. This allows staff to focus on patient care rather than administrative corrections. At Ariz, we understand the critical role of accurate data in healthcare claims processing. Our advanced solutions ensure that every claim is meticulously reviewed and accurately processed, helping healthcare providers achieve financial health and operational excellence. Join us in prioritizing accuracy and efficiency in healthcare claims. Together, we can drive better outcomes for healthcare providers and patients alike. #Healthcare #DataAccuracy #ClaimsProcessing #HealthTech #FinancialHealth

Time Moves Slow in the Healthcare Service Industry, but Lightning Fast in Healthcare Software Over four years ago, I departed from the payment integrity services sector at the onset of the pandemic, after decades of serving major health plans. Leading armies of auditors and experts to mitigate payment errors was rewarding, saving the industry billions. Yet, finding new efficiencies became increasingly challenging within that model. During my first year away, I took time to reflect and research emerging trends, consulting on industry shifts. A clear pattern emerged: health plans sought to consolidate vendors, negotiate lower fees, and transition from post to pre-payment integrity. "Insource First" became the mantra, driven by the need for transparency and control. Traditional vendors operated in opaque ways, focusing on high-return claims without addressing root causes. Technological limitations hindered widespread insourcing, requiring extensive manual intervention. Today, automation has transformed these processes, offering unprecedented efficiency. These trends prompted my return to the industry with Advanced Medical Strategies (AMS), where I could leverage expertise and industry evolution. AMS is at the forefront, disrupting healthcare software with solutions that: - Unleash Cost and Price Transparency - Provide Root Cause Analysis and Content Transparency - Manage Clinical Standards of Care and Find Outlier Claims - Identify Payment Integrity Issues and Combat Price Disparities - Prevent Overpayments and Reduce Fraud - Utilize Advanced Predictive Analytics for Risk Assessment - Offer Actionable Business Intelligence and Data Insights AMS doesn't just cut costs; it enhances accuracy and efficiency through advanced automation. Our solutions empower healthcare organizations to reduce administrative costs, adopt subscription-based models, and maintain operational excellence. Join 3,000+ users who have revolutionized their operations with AMS, addressing complex challenges while optimizing efficiency. Ready to streamline your healthcare risk and payment integrity management? Contact us today to discover how AMS can transform your approach. #HealthcareInnovation #DataInsights #WorkflowAutomation #AMS #BusinessIntelligence #HealthcareTransformation #PaymentIntegrity #RiskManagement #Underwriting #HealthcareTechnology

Check out the latest post from AMS (Advanced Medical Strategies)' Chief Strategy Officer David Cardelle RPh on the rapid advancements in healthcare software and how AMS is leading the charge. Any questions, feel free to reach out to [email protected]

𝐓𝐫𝐚𝐧𝐬𝐟𝐨𝐫𝐦 𝐘𝐨𝐮𝐫 𝐋𝐨𝐧𝐠-𝐓𝐞𝐫𝐦 𝐂𝐚𝐫𝐞 𝐎𝐩𝐞𝐫𝐚𝐭𝐢𝐨𝐧𝐬 𝐰𝐢𝐭𝐡 𝐎𝐮𝐭𝐬𝐨𝐮𝐫𝐜𝐞𝐝 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐲 𝐁𝐢𝐥𝐥𝐢𝐧𝐠 In the fast-paced world of long-term care (LTC), managing pharmacy billing is a complex but critical task. It’s not just about sending invoices; it’s about ensuring timely reimbursements, reducing denials, and maintaining compliance with intricate regulations. Key Takeaways Improved Cash Flow: Timely reimbursements and fewer denials lead to healthier revenue cycles. Cost Savings: Reduce overhead costs associated with in-house billing teams and technology maintenance. Enhanced Compliance: Outsourcing providers ensure compliance with complex LTC billing regulations, minimizing audit risks. Focus on Core Care: Free up internal resources to improve resident care and operational strategy. 𝐅𝐨𝐫 𝐦𝐨𝐫𝐞 𝐢𝐧𝐟𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧: https://lnkd.in/gZe25MU3 𝐂𝐚𝐥𝐥 𝐓𝐨 𝐀𝐜𝐭𝐢𝐨𝐧 : If you need Outsourcing Services for Healthcare, visit us🌐 https://www.staffingly.com 📧 [email protected] 📞 Call Toll Free: (800) 489-5877 📅 Book a Meeting: https://hie.li/meetdan

According to McKinsey & Company, Complex Clinical Audits and COB are key areas of the payment-integrity value chain that are ripe for improvement with the right technology. Why does this matter? "Early adopters may have an opportunity to create a strategic distance between themselves and competitors, and meaningfully improve PI programs’ ROI..." This is exactly why we built AuditShark, a comprehensive audit and recovery platform designed to relieve payer Audit and COB teams of the legacy technology and manual process holding them back from experiencing maximum efficiency, and maximum savings. Schedule a free consultation with our team today! 🦈 ➡ https://lnkd.in/g7HTB3Kg ⬅  #PaymentIntegrity #ClaimShark #CoordinationOfBenefits #DRG #ItemizedBillReview

🔍 Optimizing Revenue Cycle Management for Small Practices Efficient revenue cycle management (RCM) is crucial for the financial health of small healthcare practices. Here’s how to ensure success: -Patient Registration: Collect accurate information and verify insurance coverage upfront. -Charge Capture: Record all services provided using precise medical codes. -Claim Submission: Submit clean claims promptly to avoid delays and denials. -Payment Posting: Accurately record payments, make necessary adjustments, and handle discrepancies. -Follow-up: Manage denied claims promptly and maintain clear communication with patients about their balances. -Monitoring and Reporting: Track KPIs and generate regular financial reports to identify and address issues. -Technology Integration: Use advanced billing software and patient portals to streamline processes and enhance transparency. By focusing on these key areas, small practices can optimize their billing operations, maintain steady cash flow, and improve patient satisfaction. 💼💡 Learn More: https://loom.ly/mSWL8u0 #Healthcare #RevenueCycleManagement #MedicalBilling #SmallPractice #HealthTech #PatientExperience

Why Accurate Coding Matters? 1. Reduces Claim Denials Proper coding ensures that claims are processed correctly the first time, minimizing denials and delays in payments. 2. Ensures Compliance Accurate coding helps your practice stay compliant with healthcare regulations, avoiding costly fines and audits. 3. Optimizes Reimbursement By coding accurately, you ensure that services are billed at the correct rate, maximizing your reimbursement potential. 4. Enhances Patient Satisfaction When billing issues are minimized, patients experience fewer surprises with their bills, leading to higher satisfaction. 5. Streamlines Workflow Accurate coding reduces the need for rework and corrections, making your billing process more efficient. 6. Supports Quality Reporting Accurate coding contributes to the collection of quality data, which is critical for reporting and improving patient care. 7. Improves Financial Health Fewer errors and denials mean a smoother revenue cycle and a healthier financial state for your practice. 8. Builds Trust with Insurers Consistent accuracy in coding builds a strong relationship with insurers, leading to quicker and more reliable payments. Don't let coding errors stand in the way of your practice's success. Secure accurate reimbursements, enhance compliance, and streamline your workflow today. Partner with us to safeguard your financial health and improve patient satisfaction. Contact us now to optimize your coding accuracy and watch your practice thrive! 📧 [email protected] . . . . . #Primeplusmedicalbilling #MedicalBilling #AccurateCoding #RevenueCycleManagement #HealthcareCompliance #ClaimSuccess