Payment and Revenue Integrity Assessment
By conducting a payment and revenue integrity assessment, health plans can identify improvements that can lead to significant savings. Read this case study to learn how one payer engaged consultants to assess its claims payment, auditing, clinical care management, enrollment, and reconciliation processes.
The consultants discovered improper tracking and reporting of members with end stage renal disease (ESRD), leading to the retroactive recovery of additional payments from CMS. As a result of its assessment, the health plan also implemented changes to its overpayment recovery data management, interdepartmental operational flow, and audit policies and remediation.