Payment Integrity: Billing & Policy Trends
- Health plans strive for accurate claims payments, but implementing new payment policies requires a delicate balance.
- Cotiviti, leveraging a claims dataset encompassing billions of ambulatory claim lines and hundreds of billions of dollars in medical spending over several years, aims to empower payers.
- A Payment Integrity Pulse webinar is scheduled for Monday, June 23, at 2 p.m.ET.
Navigate teh complex landscape of health plan payment policies and their impact on providers with this timely update. This article unpacks the crucial balance health plans must strike between claim accuracy and provider relations, highlighting the latest industry trends.Discover how Emergency Department E/M claims and medical drug wastage influence payment integrity. Learn from Cotiviti’s extensive claims data, emphasizing tangible cost reduction strategies. A payment Integrity Pulse webinar is slated for June 23rd, offering deep dives into key areas like ED E/M claims and medical drug wastage. Stay ahead of the curve; News Directory 3 offers more insights. Discover what’s next in healthcare payment trends with this must-read analysis.
Health Plans Balance Claim Accuracy, Payment Policies, Provider Impact
Health plans strive for accurate claims payments, but implementing new payment policies requires a delicate balance. Weighing the impact on claim accuracy against the effort involved and potential friction with providers is crucial. Trends and benchmarks offer valuable insights, enabling plans to learn from peers who have implemented similar policies.
Cotiviti, leveraging a claims dataset encompassing billions of ambulatory claim lines and hundreds of billions of dollars in medical spending over several years, aims to empower payers. This data helps them make informed payment policy decisions consistently, improving the role of payment integrity.
A Payment Integrity Pulse webinar is scheduled for Monday, June 23, at 2 p.m.ET. Hosted by Cotiviti’s Jamie Calabrese, M.D., FAAP, vice president of medical affairs, the webinar will delve into key trends, including:
- Emergency Department (ED) E/M Claims: These claims, frequently enough billed at high levels of care due to coding complexities, considerably impact medical loss ratio (MLR) increases.
- Medical Drug Wastage: A deep dive into the increasing use of modifiers JW and JZ and thier implications for payment integrity.
The webinar will also highlight tangible medical cost reductions achieved by Cotiviti’s payment integrity clients through targeted payment policies aimed at improving claim accuracy. Attendees will learn how to enhance prepay accuracy and optimize resource allocation for appropriate member care, playing a key role in cost savings.
What’s next
Those unable to attend the live webinar are encouraged to register to receive the on-demand recording. Additional webinars in the series will cover recent payment integrity innovations (Sept.25) and an end-of-year update (Dec. 18). Topics are subject to change.