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.”
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.
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