On the path to eliminating challenges of Payment Integrity

10.12.2017 | Burgess CXO Addressed How Leveraging Technology, Design and Partner Relationships Can Create Meaningful Change in Healthcare at AHIP’s National Conference

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.

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