Unlocking Payment Integrity Success:

Why Claims Leaders Need Dedicated Support

In my experience navigating the intricate world of healthcare operations and finance, I’ve come to recognize a crucial aspect that can make or break Payment Integrity (PI) initiatives: the need for dedicated support. Let me share why expecting claims leaders to manage PI efforts alongside their existing responsibilities can hinder progress rather than propel it forward.

As someone entrenched in healthcare operations, I understand the conflicting incentives claims leaders face when it comes to PI. Their objectives often revolve around reducing provider abrasion, improving auto-adjudication rates, and minimizing provider disputes. However, the implementation and management of incremental PI solutions demand a significant amount of time and resources, which claims leaders may not always have at their disposal. From my vantage point, it’s clear expecting claims leaders to juggle these competing priorities can lead to fragmented efforts and suboptimal outcomes. That’s why I firmly believe in the necessity of establishing a separate PI organization with a distinct focus and clear accountability.
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By carving out a dedicated team for PI initiatives, organizations can ensure these critical efforts receive the attention and resources they deserve. This approach allows for concentrated efforts on identifying and addressing payment inaccuracies, ultimately leading to improved financial outcomes and stronger relationships with providers.

Moreover, a dedicated PI organization fosters collaboration across departments, harnessing expertise from various stakeholders to drive meaningful results. With clearly defined goals and accountability structures in place, organizations can streamline processes, implement targeted interventions, and measure outcomes more effectively.

In conclusion, my journey in healthcare has taught me the importance of providing dedicated support for Payment Integrity initiatives. By establishing a separate PI team, organizations can accelerate their PI program, optimize financial health, and ensure quality care.

Let’s make Payment Integrity a strategic focus and commit the necessary resources and support to achieve success.

VP of Healthcare Consulting at Curate Partners

Meet the Author

Chad Roswick, VP of Healthcare Consulting

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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.

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Initiation, Strategic Vision & CX - HCD