FORT WORTH, Texas, April 11, 2023 — CERIS, a CorVel company, has released “The Pulse of Payment Integrity,” a white paper encouraging healthcare payers to focus on reviewing claims before they are paid, as opposed to months or years afterward in a post pay environment.
The whitepaper notes that taking such an approach to payment integrity reduces errors and improves the relationship between payers and providers by eliminating the need to collect excess payments after they have been made.
New pressures on the existing healthcare payment process are also encouraging a move toward greater payment integrity. The white paper discusses issues created by the COVID-19 pandemic, which include the rapid introduction of telehealth services and increased difficulties in forecasting care utilization. It also touches on the demands created by new value-based care initiatives.
“The culture of payment integrity needs to be focused not only on reducing the total cost of care but also on better patient outcomes and satisfaction,” said CERIS President, Greg Dorn. “This needed shift includes better alignment between incentives and quality of care and better communication between payers, providers, and patients.”
CERIS has been introducing clients to improved payment integrity for decades and its services helps save health plans billions of dollars a year.
CERIS, a leader in both prospective and retrospective claims review and repricing, combines clinical expertise and cost containment solutions to ensure the accuracy and transparency in healthcare payments. Accuracy and validation services include itemization review, DRG validation, facility repricing, contract and policy applications, review of implants and devices, and primary payer cost avoidance. Its universal chargemaster contains billions of charge items from more than 97% of the nation’s hospitals, helping to ensure the accuracy and objectivity of each claim review.