Payment accuracy is a multi-layered function that is only growing more complex as healthcare policies and payment models shift. Determining payment liability and, in turn, ensuring the accuracy of billing and payment, remain significant challenges, as fragmented workflows and data silos continue to serve as barriers to coordination of benefits (COB) and payment integrity.
New and emerging technologies — e.g., artificial intelligence, machine learning and robotic process automation — are helping to streamline payment accuracy processes to reduce administrative burden, control costs and, in the case of COB, enable better care coordination. But as healthcare costs rise to unstainable levels, innovation must transcend technology to fully address many of healthcare’s lingering issues and fundamentally change our systems for the better.
Innovation in Data Aggregation, Sharing & Use
While data is undoubtedly one of the most powerful tools in the ongoing effort to reduce costs and improve outcomes, wielding that power remains one of healthcare’s greatest challenges. From verifying coverage eligibility and payment liability in COB to identifying and mitigating fraud, waste and abuse in claims processing, data sharing is vital to the efficiency and sustainability of today’s healthcare programs. As the industry works to achieve true interoperability, health IT developers must look to expand data sources and identify new ways to leverage existing data to drive value across the care continuum.
Innovation in Government Relations
Today’s health technology innovators have an increasing responsibility to not only develop solutions that meet the evolving needs of healthcare organizations and their consumers, but also to advocate for policies that are in the best interest of the sector and its stakeholders. Championing improvements to the third-party liability (TPL) landscape, for example, helps to ensure the integrity of state and federal health programs and, more importantly, their ability to provide coverage to those who need it most.
Vendors serving both public and private payers and providers are particularly well-positioned — and entrusted — to prioritize the development of solutions that advance payment accuracy objectives, while also supporting the types of policies that maximize use of available health technology.
Innovation in Workflow, Collaboration
As the industry shifts from volume to value, payment accuracy and many other vital healthcare functions are becoming more of a shared responsibility among payers, providers and even consumers. But achieving productive and widespread collaboration isn’t possible within the confines of the traditional fee-for-service environment, requiring infrastructural changes to break down remaining silos.
This is an effort that must be both technology-focused and relationship-driven — for example, developing solutions that optimize workflows and reduce abrasion, while also engaging stakeholders on all sides of healthcare to help manage expectations and resources around payment accuracy processes.
Innovation in COB
In a new white paper, HMS, a leading provider of payment accuracy and population health management solutions, discusses the vital role of COB in both the current and future healthcare landscape, outlining a number of innovative approaches transforming the time-honored process from administrative burden to real-time solution. Download the white paper here.