Transform The Payment Process for Accuracy & Savings
Whitepaper | Amy Larsson, RN, BSN, MBA
Vice President, Payment Accuracy and Value Based Payment Consulting Services, Change Healthcare
As a leader in healthcare information technology specializing in payment innovation, Ms. Larsson brings clinical and business experience to her role designing solutions for top health plans. Amy has led the Clinical Claims Management business, including the leading claims-editing and payment-policy management solution used by health plans nationwide.
Amy has held a variety of roles, including product management, customer experience, clinical development, and software development, as well as development and design for episode of care solutions. She has a clinical background in pediatric nursing and transplantation services.
U.S. healthcare spending continues to climb and now totals $3.8 trillion annually, or almost triple the amount spent in 2000.2 On a per capita basis, expenditures reached $11,500 in 2019, up from $4,843 in 2000.3
Fully one-quarter of spending is due to waste and inefficiency, and administrative complexity represents the largest single category of waste at about one quarter of a trillion dollars annually. Much of that misallocation occurs during the payment process, which is riddled with complexities, inefficiencies, and conflicting rules and regulations.
The consequences of this costly, fragmented payment system are far-reaching: Payers experience higher administrative costs, which contribute to higher premium costs; providers become dissatisfied with the administrative burden and suffer financially when payments are delayed or inaccurate; and patients can face unexpected or confusing bills and higher out-of-pocket costs.
Excessive payment costs also contribute to major societal consequences, from making care more unaffordable and threatening employer-sponsored coverage to impairing government budgets and diverting dollars from other critical needs.
Payment innovation is the key to modernizing the payment process to support better care at lower costs, and it culminates in streamlined, timely, and secure provider payments. Clean claims power effective analytics, which can generate the actionable insights required to drive cost reductions and process improvements. And accurate claims paid in a timely manner help support essential provider relationships.
By improving interaction between payers and providers and deploying automated tools at each step of the payment continuum, potential claim errors can be flagged earlier, at a point when they can still be avoided or are still relatively easy to fix. That means faster, more accurate payment and a substantially reduced administrative burden for both you and your network partners.
The triggers for payment problems are many and varied, but some of the most common issues that lead to denials, under/over payments, slow-pay, or no-pay include:
The list could go on, but generally speaking, the root cause of many payment issues is a lack of provider understanding about payer-specific rules. And it’s no wonder: Rules can vary significantly across payers, lines of business, employers, and provider contracts, and that fragmentation is only increasing as alternative payment methods (APMs) keep expanding.
Helping providers quickly access and understand payment information at the point where they need it—while ensuring member data is easily available to help them accurately complete a claim— requires real-time or near real-time payer-provider interaction and automated solutions integrated into both entities’ workflows.
In the simplest terms, payment innovation is about optimizing data and automation to improve collaboration and help push payment accuracy closer to the point of care. Safeguards are established at each successive step along the payment continuum. Here’s how it works:
Creating a strategic approach to streamlining the payment process is critical to reducing unnecessary expenses and improving both the patient’s and the provider’s experience. By working collaboratively with your network providers, you can deploy advanced technologies to reduce costs, cut administrative burden, and help providers get paid accurately and efficiently.
Change Healthcare helps health leaders nationwide achieve their strategic objectives. We serve 6,000 hospitals and more than 1 million physicians, and we have more than 2,00 payer connections. More than 90% of top U.S. health plans use Change Healthcare to support 190 million covered lives, and one-in-three patient records are touched by our clinical-connectivity solutions. Through our interconnected position at the center of healthcare, we help provide a visible measure of quality and value for all major stakeholders.
1) How Has U.S. Spending on Healthcare Changed Over Time?, Peterson-KFF Health System Tracker, Dec. 23, 2020
2) How Has U.S. Spending on Healthcare Changed Over Time?, Peterson-KFF Health System Tracker, Dec. 23, 2020
4) Wasteful Spending in U.S. Healthcare Estimated at $760 Billion to $935 Billion, HealthLeaders, Oct. 7, 2019