Transparency Builders

Greg Dorn, President & Mark Johnson, SVP Product Management

October 10, 2023


Deeper Dive into The Pulse of Payment Integrity 


In an era where transparency is paramount, acknowledging hurdles within payment integrity cannot be overstated. Innovative Strategies may be necessary to overcome these hurdles In payers’ pursuit of clarity and openness, five pivotal challenges need to be addressed to optimize payment integrity. This article delves into the heart of these challenges and focuses on strategic vantage points. By dissecting issues, we aim to empower stakeholders in the healthcare sector with the insights they need to forge a path towards greater transparency, efficiency, and, ultimately, enhanced payment integrity.

Transparency Builders key excerpt from The Pulse on Payment Integrity:
With transparency top of mind across the industry, it is important to recognize the challenges in payment integrity that hinder transparency and techniques to overcome those challenges.

5 key challenges can hinder transparency in payment integrity, including:

  1. A fragmented and siloed organizational structure limits collaboration and coordination among different departments and stakeholders making it difficult to achieve a holistic view of payment accuracy and integrity.
  2. The lack of standardization and interoperability in healthcare data makes it difficult to track payment information, identify trends and patterns, and detect errors and waste.
  3. The complex and ever-changing regulatory environment can make it difficult for healthcare organizations to stay current with payment requirements, which can lead to confusion in the
    payment integrity process.
  4. A lack of technology and analytic tools can limit an organization’s ability to effectively monitor accuracy and make it difficult to identify areas for improvement.
  5. Resistance to change and a lack of stakeholder support can make it difficult to implement new processes and technologies that effectively promote transparency and accountability.

By addressing these challenges, payers can promote greater transparency in their payment integrity efforts, contributing to lower total cost of care and improved outcomes. Transparency-building techniques should be a part of continuous improvement in every payer’s payment integrity playbook

This deeper dive article looks further into transparency-building techniques initially outlined in our Pulse on Payment Integrity white paper We hope our in-depth analyses continue to provide tools to help you enhance payment integrity success.

Let's partner to a clear path to greater accuracy and cost savings.

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