On the path to eliminating challenges of Payment Integrity

Washington, D.C. – Burgess’ Chief Experience Officer (CXO), Jared Lorinsky, outlined the mistakes and complexities plaguing health insurance payments at AHIP’s 2017 National Conferences on Medicare, Medicaid & Duals. After reviewing what is broken in the current process, Lorinsky discussed what can be done to create more accountability and accuracy.

“Industry pain points driven by mergers and acquisitions, over and under payments, inefficiencies in technology, and a lack of payment transparency, can be remedied with the correct approach,” he explained. “The answer lies in leveraging the right integrated systems and business partners which can bridge the gaps between disparate technologies used by payers, providers, and government agencies,” Lorinsky added. With the right partners, Lorinsky suggested that organizations can better assess their strengths and weaknesses and target technology purchases from like-minded organizations that solve key business problems and enable new intelligence.

Emphasizing the need to foster a productive design culture, Lorinsky suggested that improving an organization’s design-thinking, building a cross-functional team championing the effort, and not losing touch of the human element are all critical pieces to designing a successful payment integrity program. “The right design,” he said, “will establish correct and realistic goals, provide enterprise-wide value and has the ability to bring people together.”

Lorinsky concluded that, “payment integrity can only be achieved when payers utilize contemporary technology with rich content that is designed to go beyond accuracy and process automation. Today’s health plans should be looking at artificial intelligence as a means to detect improper billing and payment trends earlier than ever before. Only then can we say with confidence that we are on the road to eliminating incorrect claims payments between providers and payers.”

About Burgess

Burgess operates at the intersection of healthcare, finance and technology. Our enterprise software dramatically improves payment integrity, compliance, and financial accuracy for health plans with government programs. This unified approach allows clients to make payments with total confidence, and make business decisions with real intelligence. The company is headquartered in Alexandria, VA and online at burgessgroup.com.

For interviews or general press contact:

Sarah Melnick
sarah.melnick@burgessgroup.com
703-894-1800


Burgess to Speak at AHIP’s 2017 National Conferences on Medicare, Medicaid & Duals

This session explores the current state of disconnectedness in the American healthcare system, and how a combination of technology, design and strategic business partnerships can reduce costly errors, distress, and shift the focus to collaboration and business intelligence. Attendees will learn what payment integrity entails and how it pertains to their organization and the health care system as a whole. Mr. Lorinsky will demonstrate the pivotal strengths of a unified platform, and how the future of health care can be streamlined and simplified for payers and providers.

Payment Integrity Challenges speaking session
1:35pm – 2:25pm
September 25, 2017

AHIP’s 2017 National Conferences on Medicare, Medicaid & Duals
JW Marriott, Washington D.C.
Burgess: Booth #23
September 25-28

About Burgess

Burgess operates at the intersection of healthcare, finance and technology. Our enterprise software dramatically improves payment integrity, compliance, and financial accuracy for health plans with government programs. With our cloud-based automated claims payment application, reimbursement rates and policies are in production on or before their effective dates. A sophisticated audit trail for each claim includes transmittals and supporting documentation to assist with provider relations while real-time analytics and modeling give your organization meaningful business insights. This unified approach allows clients to make payments with total confidence, and make business decisions with real intelligence. The company is headquartered in Alexandria, VA and online at burgessgroup.com.

To schedule an interview, exploratory call or demo, please contact Sarah Melnick or click here.

Sarah Melnick
sarah.melnick@burgessgroup.com
703-894-1800


Burgess® Launches Burgess Source™

Live demos of Burgess Source will be presented at booth #1413 at AHIP Institute & Expo 2017, Austin, TX on June 7-9.

ALEXANDRIA, VA – Burgess, a leading cloud-based solution provider serving healthcare payers, introduces Burgess Source, a first of its kind platform that natively brings together payment integrity, pricing, contract terms configuration, audit and real-time business intelligence. By combining these fragmented elements into one system, Burgess Source is the most effective way to prospectively avoid inappropriate and inaccurate reimbursement, maintain a point to point compliance trail and model healthcare payments.

According to the Harvard Business Review, the U.S. healthcare system would save $130B if insurance administrative complexity were reduced to the same levels as other service industries. Moreover, the American Medical Association (AMA) reports that it would save the system $14B if every claim was paid correctly the first time.

Incorporating technology to solve many of these industry inefficiencies, the Burgess Source platform is built from the ground up to eliminate non-communicative disparate point solutions and promote a new standard in transparency and payment accountability. The unique design also models claims data, providing real time business intelligence, helping ACOs and health plans make smarter decisions. Highly configurable, it allows users complete control to adapt the platform to each plans’ specific requirements while the Burgess Source team keeps the data and regulatory policy management up to date and compliant.

Currently 17.8% of every premium goes to operating costs, according to AHIP’s Center for Policy and Research. By shifting money from inefficient and inaccurate payment transactions to delivering high quality defensible business outcomes, Burgess Source is designed to promote lower costs and innovate operations across the industry.

“Non-communicative payment platforms lead to waste, repeat work and frustration among payers, providers and members. Through advanced and previously unavailable technology, analytics and a sophisticated data delivery model, we’ve reinvented the current complex claims payment integrity and pricing process to dramatically improve first pass payment accuracy and compliance, which impacts all stakeholders in healthcare,” says Greg Burgess, Founder and Chief Product Officer at Burgess. “Burgess Source will provide a new standard in payment accountability, which was previously non-existent,” he adds.

Burgess Source is reinventing reimbursement and accountability between payers and providers to:

  • Prospectively limit errors and markedly improve payment accuracy through cost avoidance.
  • Improve operational efficiencies and financial performance.
  • Maintain for instant recall a claim’s full audit trail including regulatory citations, the specific contract terms in effect when processed, all payment integrity edit definitions, and pricing terms employed at the exact moment the claim is processed.
  • Promote transparency and accountability with providers while supporting both internal and external audits.
  • Monitor the impact of policy changes before making them with real time analytics.
  • Offer “what if” scenarios using historical claims data to model various services using comparative analytics.
  • Limit rework by parallel processing all payment integrity edits in a single pass to tell a provider everything that’s right or wrong with a claim.

About Burgess

Burgess operates at the intersection of healthcare, finance and technology. The company helps leading American health insurers and ACOs set a new standard: Payment Accountability. The company’s cloud-based platform, Burgess Source, is the only solution that natively brings together up-to-date regulatory data, claims pricing and editing, and real-time analytics tools. This unified approach allows clients to make payments with total confidence, and make business decisions with real intelligence. The company is headquartered in Alexandria, VA and online at burgessgroup.com.

To schedule an interview, exploratory call or demo with Greg Burgess contact:

Sarah Melnick
sarah.melnick@burgessgroup.com
703-894-1800


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