To remain competitive in today’s rapidly changing healthcare market, health plans need a modern solution that can easily integrate across their enterprise to infuse more accurate and timely data into every corner of their organization. There is no better place to expose the implications of bad data than claims payment administration process. This article drills deep into the importance of having consistent, accurate, and transparent data.
The Current State of Data Among Health Plans
Health plan leaders must challenge the inefficient status quo that comes with legacy claims processing systems and invest in modern technology that enables data consistency, accuracy, and transparency, which will result in greater operational efficiencies and more informed business decisions.
Today, bad data is estimated to cost the healthcare industry $314B annually and negatively impact an organization’s revenue by 10-25%. The case for more accurate data has never been stronger, given the rapidly changing dynamics of the Medicaid system and the reality of the waste:
- 5.8% expected annual Medicaid enrollment growth
- 9.5% claims payment error rate
- $25B approximate annual MCO Medicaid spend on admissions functions
- $36B improper Medicaid payments in 2019
Good Data Means Good Business
The implications of having good data flowing into and out of your organization’s systems has implications across the entire business. In particular, the claims payment processing team depends on good data for its daily functions, such as claims edits, audits, pricers, analytics, and even contract terms and negotiations.
In addition to the efficiency gains, good data also drives more informed decisions, because data is the foundation on which business assumptions and decisions are made. Provider relationships improve due to the reduction in payment recovery activities. Plus, when it comes time to respond to a CMS audit, having good data means the difference between dedicating valuable resources for days on end vs. having a few resources respond quickly and confidently to address the requests.
When good data is driving the business, health plans are able to:
- Lower operating costs: Payers reduce FTE time dedicated to overpayment recovery and redirect the resources to more productive analysis.
- Decrease operating risks: Automating claims processing reduces the chance for human error that can occur when using spreadsheets or manually updating data when using disparate systems.
- Improve provider relationships: Increased transparency and fewer overpayment recoveries will help ease provider abrasion, and the partners will recognize clerical time reduction in deadline with payment issues.
A Fresh Approach to Good Data
To achieve long-term goals of consistent, accurate, and transparent payments, successful organizations have focused on:
- SaaS technologies
- Integrated ecosystems
- Centralized data
As a SaaS-based solution, Source is empowering healthcare payers who have Medicare, Medicaid, and commercial lines of business to leverage a single, unified platform that natively brings together up-to-date regulatory data, claims pricing and editing, and real-time analytics tools. These payers have a single source of truth and a single point of accountability.
More specifically, Source’s transformational approach to payment integrity allows payers to deliver accurate, defensible payments to providers in a single pass with precise audit trails and business intelligence tools that help payers model and forecast scenarios with total confidence.
But it doesn’t stop there. Source works seamlessly with a wide range of data and solution providers, including its sister solutions: HealthRules® Payer core administration system and GuidingCare® care management solution, to leverage the power of more accurate data.
The Business Case for Good Data
When evaluating the return on an investment of a recent Source-powered health plan, the results are undeniable:
- Decrease of 800,000 erroneous claims per year for an estimated savings of $4M/year
- Automated claims process saves approximately $6-12 per claim
- Reduced IT overhead, saving $350-500K annually
Customer Service Impact:
- Higher regulatory compliance and consistency
- CMS audit support
- Increased transparency on payment results
- Actionable data for improved business intelligence
Learn more about good data
Check out our latest white paper that discusses the complexities of healthcare data and how bad data can lead to inaccuracies and waste. Using technology solutions to address this issue, payers can harness data as a strategic asset and create positive change across their organization and for providers and members. Read now.
2 National Health Expenditure projections, 2017-26: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth; Centers for Medicare & Medicaid Services, Office of Actuary, National Health Statistics Group