Webinar: Healthcare Payment Integrity Trends - New Research Reveals a Paradigm Shift is Underway

Healthcare Payment Integrity Trends

The recent webinar on Healthcare Payment Integrity Trends unveiled a paradigm shift within the industry, highlighting critical insights and challenges faced by healthcare payers. This executive summary will provide an overview of the key findings, focusing on top issues and emerging trends.

Key Findings

Top Challenges in Payment Integrity

Workforce Shortages:

• 64% of respondents cited limited resources as a significant barrier, affecting their ability to keep up with changing fee schedules and policy updates.
• 58% reported difficulties in hiring and retaining qualified personnel for complex payment integrity tasks.

Limited Visibility

• Visibility into third-party vendors and root cause issues was another major challenge, impacting the efficiency of payment integrity processes.

Technology Limitations

• 56% of respondents indicated the need for modern, flexible technology to handle rising complexities in payment integrity.

Manual Rework and Costs

• Over 50% of payers stated that more than 20% of claims require manual rework due to inaccurate first-pass adjudication.
• The cost of rework ranges from $25 to $181 per claim, emphasizing the financial burden on healthcare organizations.

Resource Allocation

• The survey revealed that 56% of respondents believe the number of full-time employees (FTEs) dedicated to payment integrity will grow in the next one to two years. This expectation arises despite the challenges in acquiring skilled resources.

Watch the video to gain insights into how health plans can tackle workforce shortages, improve claims processing, and enhance visibility. Learn how advanced solutions can support these initiatives, helping organizations reduce costs, improve operations, and provide better care for members.