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Here's Part 3 of our series on Payment Integrity. Read on to learn more including how it's evolved. We can help navigate this increasingly complex landscape.

With an ever changing Healthcare Landscape, Payment Integrity has advanced into an essential (and to strategic) capability. This article highlights the evolution of Payment Integrity and opportunities to harness the value of regulatory and technology advancements. #paymentintegrity #healthcare #paymentaccuracy #healthplanstrategy #healthanalytics

Payment Integrity Evolution 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. A paradigm shift is underway, wherein many payers are recognizing that the status quo will not suffice in a volatile, disruptive market where, among other things, technology is advancing rapidly. Many are at the initial stages of fully understanding and implementing elements of a comprehensive future vision for payment integrity efforts, which in addition to dedicated analytic staff, comprise a team committed to ideation and innovation. Vital measures to track and drive performance of Payment Integrity (PI) initiatives, including the use of industry benchmarks and annual goal setting are gaining traction. #paymentintegrity #healthcare #healthcareclaims #metrics #processimprovement #claimsmanagement #claimsoperations

In today's economic climate, optimizing for financial efficiency is a must. And 𝐩𝐚𝐲𝐦𝐞𝐧𝐭 𝐢𝐧𝐭𝐞𝐠𝐫𝐢𝐭𝐲 is at the forefront of that strategy for healthcare payers. Advanced data analytics provides a leg up to understand and identify overpayments, anomalies and improper CPT coding. Get the scoop ▶️ https://hubs.li/Q02-1pSG0 #healthcarepayers #healthcareinsurance #paymentintegrity #healthcareanalytics #intelligencemadeactionable

The recent Change Healthcare cyberattack and other system outages expose a critical weakness in our healthcare system: over-reliance on traditional revenue streams. It's time we rethink how healthcare handles payments. Some key ideas on updating healthcare payments: 1. Diversify: Practices need multiple income sources to weather industry disruptions. 2. Meet patient preferences: 75% want online payments, but 71% of providers still use paper. This gap needs closing. 3. Boost cash flow: Offering easy, flexible payment options can significantly improve collection rates. 4. Communicate clearly: Open, kind discussions about costs build trust and improve patient-provider relationships. 5. Think long-term: A smart patient payment strategy leads to a healthier financial future for the entire healthcare ecosystem. As healthcare leaders, we must ask: How can we create payment systems that work for both providers and patients in today's digital world? The future of healthcare finance isn't just about new tech—it's about building a more resilient, patient-focused system. What steps is your organization taking to adapt? #HealthcareInnovation #PatientPayments #FinancialResilience https://lnkd.in/ds3PuU6V

Denial rates have steadily increased, with providers seeing rejection rates as high as 10% to 15%! This was from the new State of Claims 2024 report from Experian, which highlighted other issues healthcare providers face outside of rising claim denials such as increasing administrative burdens, operational bottlenecks, and financial strains. The increase in rejection rates complicates revenue collection, leads to administrative overhead and overuse of resources in resubmitting claims. Ever wondered why they keep happening?  ●      Outdated technology and inefficient workflows that fail to integrate with EHRs and payer platforms. ●      Lack of automation facilities leading to delays in claim submissions and verifications ●      The fee-for-service model hinders claims processing, creating a disconnect between healthcare delivery and reimbursement. So what can you do to tackle such problems? ●      Leveraging analytics: This can proactively address issues that could result in claim denials before they escalate. ●      Partnerships: Healthcare providers can partner with third-party vendors that specialize in revenue cycle management. ●      Investing in modern claims infrastructure: By adopting cloud-based solutions, providers can enhance operational efficiency within payer systems. ●      Staff training: Training staff on coding updates, payer policies are critical to avoiding claim denials. This isn’t just about managing claims - it’s about transforming processes to ensure better care for patients. At eClaimStatus, we offer you the tools you need to tackle claim denials and its associated costs. Contact us today and secure your revenue! #Healthcare #RevenueCycleManagement #eClaimStatus #ClaimDenials #HealthcareFinance

Three-quarters of consumers are ready to pay their medical bills online, according to a recent survey by JPMorgan Chase. The bank's 14th Trends in Healthcare Payments report also found that two-thirds of healthcare providers are focusing on online, automated, and self-service payments for patients. As the world continues to move towards digitalization, it is important for healthcare providers to adapt to the changing payment landscape and offer patients the payment options they prefer. This not only improves patient satisfaction but also streamlines payment processes for providers. #healthcarepayments #digitalpayments #patientexperience

Tackling Underpaid or Short Paid Claims: Navigating the Challenges with the No Surprises Act 🚫💸 One of the persistent challenges faced by healthcare providers is dealing with underpaid or short paid claims from payers. These issues strain financial resources and impact care quality. Let’s explore these challenges and how the No Surprises Act can help mitigate them. Challenges of Underpaid or Short Paid Claims 🏥💔 1. Administrative Burden 📑   - Processing underpaid claims requires significant effort. Staff must investigate discrepancies, communicate with payers, and resubmit claims, leading to increased costs. 2. Cash Flow Disruption 💰🔄   - Underpaid claims disrupt cash flow, making it difficult to manage finances effectively, delaying payments to staff, and reducing care quality. 3. Patient Satisfaction 😕📉   - Patients may receive unexpected bills due to short payments from insurers, impacting their financial well-being and trust in providers. Applying the No Surprises Act 🛡️🔍 The No Surprises Act, effective January 1, 2022, aims to protect patients from unexpected medical bills and provides a framework for payment disputes between providers and insurers. Here’s how to leverage this act: 1. Understand the Protections 🚫🔍   - The act prohibits balance billing for emergency and certain non-emergency services. Ensure billing practices comply with regulations to avoid penalties. 2. Utilize the Independent Dispute Resolution (IDR) Process ⚖️🔗   - For underpaid claims, providers can initiate the IDR process to resolve payment disputes, with an arbitrator determining the appropriate payment. 3. Educate Staff and Patients 📚🗣️   - Train billing staff on the act’s provisions and educate patients about their rights to enhance transparency and trust. 4. Monitor and Document Claims 📊🗂️   - Keep detailed records of claims, payments, and disputes. Monitoring claims helps identify patterns and behaviors for IDR or negotiations. 5. Engage with Payers 🗨️🤝   - Establish communication with payers to resolve discrepancies amicably, leading to quicker resolutions and better relationships. By understanding the challenges of underpaid or short paid claims and using the No Surprises Act, healthcare providers can protect their financial health and maintain high standards of patient care. Let’s ensure fair and transparent billing practices in healthcare. 🏥💪 --- #Healthcare #RevenueCycle #NoSurprisesAct #PatientCare #MedicalBilling #HealthcareFinance #InsuranceClaims #HealthcareAdministration

The February 21st cyberattack against Change Healthcare continues to impact healthcare providers across the country. As a result of the attack, thousands of healthcare providers have been unable to receive electronic remittance advice (ERAs) from Change Healthcare or its affiliates, which has disrupted payment processing for healthcare organizations nationwide. MediStreams has developed an emergency solution to assist affected providers. Leveraging decades of expertise in remittance processing, we now offer a specialized service enabling providers to convert Explanation of Benefits (EOBs) received as PDFs from healthcare payer portals into 835/ERA files for immediate posting. In light of the urgency, we have built a streamlined implementation process that can be completed within a few days. For more information, contact us any time at [email protected] https://lnkd.in/eJeGtTAS #healthcare #rcm #revenuecycle #revenuecyclemanagement #cyberattacks #changehealthcare #eob #pdf #era #solution #healthcareprovider

What are you missing? As we partner with clients to optimize payment integrity, many have remarked their (lack of) understanding of scope limited their savings. Learn more here. #paymentintegrity #healthcare #medicalcosts #healthcareaffordability https://lnkd.in/gy2NXT3i