Burgess Returns from AHIP Institute & Expo

Burgess recently returned from San Diego, where the company served as a select sponsor for the AHIP Institute & Expo 2018. President and Head of Product Greg Burgess presented at the event, with his speaking session entitled Leverage Design Thinking and Technology to Transform Your Reimbursement Models.

The presentation examined strategies to diminish payment integrity challenges and navigate change through technology and design thinking methodology.

Download our White Paper, Why Payers Need to Embrace Design

Our latest innovation, Burgess SourceTM, provides payers with a forward-thinking enterprise platform to manage payment rules and workflow. It incorporates business intelligence with real-time dashboards in the cloud to show you the impact of business decisions. Burgess Source delivers transparency to payers, their providers, and their partners, serving as a single source of truth, and a single point of accountability.

Request a demo of Burgess Source

Burgess is dedicated to improving healthcare payment operations through technology. We bring technology innovation and real-time data to an overlooked and critical part of the American healthcare system. Our scalable Payment AccountabilityTM platform, Burgess Source, integrates payer systems to transform payment workflows and provide powerful business intelligence to lift payer performance. The company is located in Alexandria, Va., with a satellite office in West Hartford, Conn., and online at burgessgroup.com.


Looking back at the Medicare Advantage Leadership Innovations Conference

Burgess recently returned from the Medicare Advantage Leadership Innovations event in Phoenix, where Chief Experience Officer Jared Lorinsky co-presented with HealthNet Senior Director, Operations, Michelle Puente on Tuesday, April 10. The case study examined how Burgess solutions help payers improve relationships with their providers while also improving their bottom line.

The presentation addressed how process automation, CMS and Medicare data integration, payment accuracy, and practical business intelligence can help payers easily achieve these goals. Some of the topics covered include:

  • Leveraging integrated systems
  • Process transformation and embracing a culture of design thinking
  • The importance of finding the right business partner

Our latest innovation, Burgess Source, introduces a new workflow solution to address healthcare payment inaccuracies, compliance, and rework. Designed from the ground up as a sole-source platform to natively manage and deliver claims editing, pricing, analytics, transaction audits, and bi-weekly regulatory data updates, Burgess Source provides health plans a next-generation approach to simultaneously improve both their bottom line and provider relations.

Request a demo of Burgess Source

Burgess is dedicated to improving healthcare payment operations through technology. We bring technology innovation and real-time data to an overlooked and critical part of the American healthcare system. Our scalable Payment Accountability platform, Burgess Source, integrates payer systems to transform payment workflows and provide powerful business intelligence to lift payer performance. The company is located in Alexandria, Va., with a satellite office in West Hartford, Conn., and online at burgessgroup.com.


Burgess Featured at RISE Nashville Summit

Nashville, Tenn. – Burgess served as a featured exhibitor at the 12th Annual RISE Nashville Summit, held from March 11-13. Chief Experience Officer (CXO) Jared Lorinsky was a presenter at the event, as he demonstrated how Burgess Source can help payers get away from questioning every claim and instead have total payment accountability.

Download the presentation

Burgess Source introduces a new workflow solution to address healthcare payment inaccuracies, compliance, and rework. Designed from the ground up as a sole-source platform to natively manage and deliver claims editing, pricing, analytics, transaction audits, and bi-weekly regulatory data updates, Burgess Source provides health plans a next-generation approach to simultaneously improve both their bottom line and provider relations.

Request a demo of Burgess Source

About Burgess
After 20 years, Burgess continues to design and build innovative and scalable solutions for healthcare payment operations. With headquarters in Alexandria, Va., and an office in West Hartford, Conn., the company serves many of the nation’s top health plans, including multiple BCBS, national, and regional payers.

For interviews and general press inquiries, please contact:

Matt Brady
press@burgessgroup.com
703-894-1800


Burgess Mentioned in Gartner Report on Payment Integrity

ALEXANDRIA, Va. – Burgess, an innovator in healthcare payment operations for over 20 years, announced that the company has been mentioned in Gartner’s report: U.S. Healthcare Payer CIOs Must Adopt Prospective Payment Integrity to Thwart Improper Claims Payment and Fraud.1

In the report, Gartner addresses the issue of payment integrity within the healthcare payment sphere. Gartner states that “CIOs can significantly improve the financial returns from payment integrity programs. By expanding solution capabilities to incorporate prospective — even pre-emptive — processes, CIOs can exponentially increase financial performance and improve provider relationships.” It adds that “with payer CIOs under pressure from CFOs to contain medical claims costs, the payment integrity program represents an immediate opportunity to deliver substantial financial improvement. Furthermore, CIOs can choose from a plethora of mature prospective payment solutions.”1

The report also states that “2018 is ripe for a payment integrity renaissance. Rising claims volume and complexity threaten the viability of current fragmented, manual clawback processes that alienate providers and network management executives, alike. Meanwhile, schemers and fraudsters continue to innovate ways to take advantage of payers’ trusting inclinations. Stacking solutions, a popular practice with Gartner clients, offer diminishing financial returns as operational cost increases with each vendor integration. Business stakeholders across the organization have competing and often conflicting interests. Something has to change.”1

The issue of payment integrity within the payer sphere was discussed by Burgess Chief Experience Officer Jared Lorinsky in his America’s Health Insurance Plans (AHIP) webinar entitled, “Eliminate Payment Integrity Challenges” on Dec. 6. During his presentation on solving payment integrity issues, Lorinsky recommended implementing a cloud-based integrated system based on a plan that emphasizes design thinking. Likewise, he suggested choosing a business partner not just based on attributes and cost, but on cultural considerations. We feel that Lorinsky’s views align with the Gartner report, in particular his emphasis on getting away from point solutions as a crucial step in addressing payment integrity concerns.

Waste that comes about in claims payment operations has become a significant issue in the healthcare industry. According to a Harvard Business Review study2, the health care industry would save $130 billion if administrative complexity was reduced to same level as other industries, such as the various consumer or automotive industries. Gartner’s report states “It’s no secret that healthcare in the U.S. has an expensive payment integrity problem, and that no line of business or payer segment is immune. In a testimony to Congress in 2016, Assistant Inspector General Ann Maxwell estimated improper payments by Medicare and Medicaid to exceed $88 billion annually.”1

Burgess was mentioned in the Gartner report among other vendors under the header, “Issue an RFP to Evaluate Vendor Capabilities.”

The company’s latest innovation, Burgess Source™, introduces a new workflow solution to address healthcare payment inaccuracies, compliance, and rework. Designed from the ground up as a sole-source platform to natively manage and deliver claims editing, pricing, analytics, transaction audits, and bi-weekly regulatory data updates, Burgess Source provides health plans a next-generation approach to simultaneously improve both their bottom line and provider relations.

For more information on Burgess Source and to discover how its unified approach can streamline payment operations in your organization, visit burgessgroup.com.

Gartner, U.S. Healthcare Payer CIOs Must Adopt Prospective Payment Integrity to Thwart Improper Claims Payment and Fraud, Analyst(s): Mandi Bishop, Bryan Cole, Published: 13 February 2018 ID: G00350050.

Sahni, N. R., Chigurupati, A., Kocher, B., Cutler, D. M. (2015) How the US can reduce waste in health care spending by $1 trillion. Harvard Business Review. Retrieved from https://hbr.org/2015/10/how-the-u-s- can-reduce-waste-in-health-care-spending-by-1-trillion

Gartner Disclaimer
Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

About Burgess
After 20 years, Burgess continues to design and build innovative and scalable solutions for healthcare payment operations. With headquarters in Alexandria, Va., and an office in West Hartford, Conn., the company serves many of the nation’s top health plans, including multiple BCBS, national, and regional payers.

For interviews and general press inquiries, please contact:

Matt Brady
matt.brady@burgessgroup.com
703-894-1800


Burgess Source Achieves HITRUST CSF® Certification to Further Mitigate Risk in Third Party Privacy, Security and Compliance

ALEXANDRIA, Va., February 15, 2017 – Burgess, an innovator in healthcare payment operations for over 20 years, today announced that Burgess Group’s Source Application has earned Certified status for information security by HITRUST.

“Receiving HITRUST CSF Certification for Burgess Source™ affirms our company’s ongoing commitment to deliver secure cloud-based payment accountability solutions to our clients,” says Greg Burgess, Founder and Chief Product Officer at Burgess. “Burgess Source significantly reduces the costly inefficiencies in first-pass payment inaccuracies that affect providers and payers today, and this certification is another step in our mission of achieving real change in our industry.”

HITRUST CSF Certified status demonstrates that Burgess Group’s Source Application has met key regulations and industry-defined requirements and is appropriately managing risk. This achievement places Burgess among the top tier of organizations worldwide that have earned this certification. By including federal and state regulations, standards and frameworks, and incorporating a risk-based approach, the HITRUST CSF helps organizations address these challenges through a comprehensive and flexible framework of prescriptive and scalable security controls.

“HITRUST has been working with the industry to ensure the appropriate information protection requirements are met when sensitive information is accessed or stored in a cloud environment,” said Ken Vander Wal, Chief Compliance Officer, HITRUST. “We are pleased that Burgess has taken the steps necessary to achieve HITRUST CSF Certified status, and we expect their customers to have confidence in this designation.”

Burgess’ latest innovation, Burgess Source, introduces a new workflow solution to address healthcare payment inaccuracies, compliance, and rework. Designed from the ground up as a sole-source platform to natively manage and deliver claims editing, pricing, analytics, transaction audits, and bi-weekly regulatory data updates, Burgess Source provides health plans a next generation approach to simultaneously improve both their bottom line and provider relations.

For more information on Burgess Source and to discover how its unified approach can streamline payment operations in your organization, visit burgessgroup.com.

About Burgess
After 20 years, Burgess continues to design and build innovative and scalable solutions for healthcare payment operations. With headquarters in Alexandria, Va., and an office in West Hartford, Conn., the company serves many of the nation’s top health plans, including multiple BCBS, national, and regional payers.

For interviews and general press inquiries, please contact:

Matt Brady
matt.brady@burgessgroup.com
703-894-1800


Join Burgess at the 12th Annual RISE Nashville Summit

During the 12th Annual RISE Nashville Summit, Burgess Chief Experience Officer, Jared Lorinsky, will be a featured presenter at the technology round tables on Tuesday, March 13th from 8:00-9:00 a.m. CST.  Our round table entitled Payment Accountability: A New Standard in Healthcare, will explore how our software, Burgess Source, can help payers get away from questioning every claim and instead have total payment accountability.

Burgess will also be exhibiting throughout the duration of the event at booth #84 for those looking to learn more about Burgess Source.  The 12th Annual RISE Nashville Summit runs from March 11-13, 2018 at the Omni Downtown in Nashville, Tenn.  If you are interested in learning more about what Burgess can do for your organization, please fill out the form below.

Learn more about the event here.

Schedule a Demo

About Burgess

Burgess is dedicated to improving healthcare payment operations through technology. We bring technology innovation and real-time data to an overlooked and critical part of the American healthcare system. Our scalable Payment Accountability platform, Burgess Source, integrates payer systems to transform payment workflows and provide powerful business intelligence to lift payer performance. The company is located in Alexandria, Va., with a satellite office in West Hartford, Conn., and online at burgessgroup.com.


Burgess Mentioned in Gartner Report

ALEXANDRIA, Va. – Burgess Group, an innovator in healthcare payment software for the last 20 years, announced that it has been mentioned in Gartner’s report: Strategic Automation Decision Framework Accelerates Journey From RPA to AI for Healthcare Payer Transformation.1

Burgess believes it was mentioned in the report because of its use of intelligent automation within the claims process in the payer space. Gartner analyst Mandi Bishop writes, “Gartner survey research indicates that 64% of organizations across industries have deployed or are planning to deploy AI-driven process automation, with 74% evaluating or implementing AI for decision making. To catch up to their peers in other industries, healthcare payer CIOs should seek ways to adapt and apply cross-industry use cases that are successfully leveraging intelligent automation at scale.”

The company’s latest innovation, Burgess Source, uses streamlined operations to help eliminate the cost and waste associated with errors during the process. The cloud-based platform has the ability to connect multiple systems and has platform universality, eliminating transposition errors that can occur when different systems improperly interface. The system also allows clients to bring claims editing, pricing and analytics into a single source to ensure payment accountability to help improve the company’s bottom line.

For over two decades, Burgess has been a software and innovation leader in the healthcare industry. With headquarters in Alexandria, Va., and an office in West Hartford, Conn., more than half of the company’s dedicated client base has been with Burgess for more than nine years. The company serves many of the nation’s top health plans, including multiple BCBS, national, and regional payers.

For more information on Burgess Source and to request a demo, visit BurgessGroup.com or follow us on Twitter and LinkedIn.

1 Gartner, Strategic Automation Decision Framework Accelerates Journey From RPA to AI for Healthcare Payer Transformation, Analyst(s): Mandi Bishop, Published: 14 November 2017 ID: G00345609.

Gartner Disclaimer
Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

About Burgess
Burgess is dedicated to improving healthcare payment operations through technology. We bring technology innovation and real-time data to an overlooked and critical part of the American healthcare system. Our scalable Payment Accountability platform, Burgess Source, integrates payer systems to transform payment workflows and provide powerful business intelligence to lift payer performance. The company is located in Alexandria, Va., with a satellite office in West Hartford, Conn., and online at burgessgroup.com.

For interviews and general press inquiries, please contact:

Matt Brady
matt.brady@burgessgroup.com
703-894-1800


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 is dedicated to improving healthcare payment operations through technology. We bring technology innovation and real-time data to an overlooked and critical part of the American healthcare system. Our scalable Payment Accountability platform, Burgess Source, integrates payer systems to transform payment workflows and provide powerful business intelligence to lift payer performance. The company is located in Alexandria, Va., with a satellite office in West Hartford, Conn., and online at burgessgroup.com.

For interviews and general press inquiries, please contact:

Matt Brady
matt.brady@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 is dedicated to improving healthcare payment operations through technology. We bring technology innovation and real-time data to an overlooked and critical part of the American healthcare system. Our scalable Payment Accountability platform, Burgess Source, integrates payer systems to transform payment workflows and provide powerful business intelligence to lift payer performance. The company is located in Alexandria, Va., with a satellite office in West Hartford, Conn., and online at burgessgroup.com.

For interviews and general press inquiries, please contact:

Matt Brady
matt.brady@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 is dedicated to improving healthcare payment operations through technology. We bring technology innovation and real-time data to an overlooked and critical part of the American healthcare system. Our scalable Payment Accountability platform, Burgess Source, integrates payer systems to transform payment workflows and provide powerful business intelligence to lift payer performance. The company is located in Alexandria, Va., with a satellite office in West Hartford, Conn., and online at burgessgroup.com.

For interviews and general press inquiries, please contact:

Matt Brady
matt.brady@burgessgroup.com
703-894-1800