Navigating Skepticism:

Building Momentum for Payment Integrity in Healthcare Operations

Embarking on the journey to establish a robust Payment Integrity (PI) program within healthcare operations often entails addressing initial skepticism and misconceptions. In my two decades in healthcare, I’ve encountered a spectrum of comments reflecting initial skepticism when introducing PI initiatives:
PI Mirco 2 think
  • “What is PI, and why do we need it?”
  • “We already have a quality department.”
  • “Providers are going to be frustrated because we’ve always paid it this way.”
  • “Why do we need another claims organization to monitor claims?”
  • “We can do PI with existing staff.”

These comments underscore the need for comprehensive education and advocacy surrounding the significance of Payment Integrity. Given these common concerns, I’ve championed initiatives to address these concerns, emphasizing the transformative potential of PI in a variety of health plans.

Navigating the path to Payment Integrity requires a multi-faceted approach. Identifying quick win opportunities and showcasing incremental savings are pivotal in gaining organizational buy-in. Additionally, by reviewing savings examples cross-functionally, stakeholders gain insights into actionable strategies for reducing medical expenses and enhancing financial outcomes.

Over the course of my career, I’ve observed that after approximately six months of implementation, a notable shift occurs within the organization. Skepticism gives way to curiosity, and eventually, to enthusiasm as stakeholders begin to recognize the tangible benefits of PI. This transformation marks the onset of momentum—a momentum driven by results and a deeper understanding of the value PI brings to the table.

It’s crucial to acknowledge that providers are accustomed to payment integrity audits from various payers, albeit possibly not from your specific plan. Transparent communication about the objectives and benefits of Payment Integrity fosters collaboration and trust-building with providers, ultimately enhancing the program’s effectiveness.

Explore our Payment Integrity Program Implementation Solutions

In conclusion, my journey as an industry expert has taught me that overcoming skepticism and misconceptions surrounding Payment Integrity is an essential precursor to driving innovation and excellence in healthcare. By leveraging education, advocacy, and strategic initiatives, we can pave the way for sustained financial health and quality care delivery. As momentum builds, the focus shifts from questioning the need for Payment Integrity to maximizing its impact.

Elevate your organization’s Payment Integrity efforts with our guidance and support. Reach out today to discuss how we can collaborate to drive innovation and excellence in healthcare operations.

VP of Healthcare Consulting at Curate Partners

Meet the Author

Chad Roswick, VP of Healthcare Consulting

Link to bio

The material and information contained in this resource is for general interest purposes only and is based on our experience; it does not constitute financial, legal, or investment advice.

Download Part 2:
Initiation, Strategic Vision & CX - HCD