In the fast-paced world of health care, effective payment integrity (PI) solutions are an absolute necessity. However, the tools you started with might not be serving you as well as they once did. As technology continues to evolve and advance, so should your PI tools. If you’re starting to question the effectiveness of your current PI technology, here are three key signs that it might be time for an upgrade:
1. Provider abrasion is becoming a significant pain point
If provider abrasion is on the rise and your PI technology is unable to mitigate the issue, it’s a clear sign that an upgrade might be necessary. One of the major causes of provider abrasion is overlapping audits, where multiple payment integrity companies target the same claim, leading to significant disruption. Innovative Software as a Service (SaaS) platforms are designed to alleviate this problem by enabling exclusions of claims under review by another vendor, minimizing confusion and disruption, and thereby reducing provider abrasion. If your current solution isn’t addressing this, it’s time to consider a switch.
2. Manual processes are still the norm
One of the significant advantages of an intelligent PI technology is its ability to streamline and automate processes. If you’re still manually collating data from disparate systems or waiting on external IT or developer support to make necessary changes, it’s a strong indicator that your technology needs an upgrade. Modern PI systems are designed with user empowerment at their core, allowing non-technical users to develop, edit, and test things like letter correspondence and audit scenarios effortlessly. They also offer consolidated platforms that bring information from various systems into one, enabling real-time reporting of key metrics. This level of automation and efficiency can save significant time, money, and resources.illing and coding errors are persistent, and their root-causes are unclear
3. Billing and coding errors are persistent, and their root-causes are unclear
If you’re constantly grappling with billing and coding errors and unable to identify their root-causes, your current PI technology may not be serving you well. Understanding why these discrepancies occur is critical for prevention and future mitigation. The next generation of PI technology equips health plans with the necessary tools and insights to identify billing and coding errors and understand their origins. If your current system isn’t providing you with this level of understanding and capability to implement corrective changes, it might be time for an upgrade.
At the end of the day, your PI technology should empower you and your team, not hinder you. If you’re dealing with increased provider abrasion, relying on manual and time-consuming processes, or struggling to understand the root-causes of billing and coding errors, it may be time to reassess your PI technology. Fortunately, the market is teeming with innovative solutions designed to help you tackle these challenges head-on, streamline your processes, and enhance your overall performance.
Editor’s Note:
One such innovative solution is ClearBridge from Penstock. As a comprehensive SaaS platform, ClearBridge offers a way to handle payment integrity in-house. It simplifies the entire process, serving as a one-stop-shop for audit management, streamlining claim reconciliation, and enabling health plans to build and test their own audit scenarios. Moreover, it provides users with the necessary tools to understand the root-causes of billing and coding errors, correct them, and implement changes for future discrepancy mitigation. If you’re considering an upgrade, ClearBridge presents a powerful option.
