In Episode 498, host Stacey Richter converses with Mark Noel of ClaimInsight about the critical aspects of payment integrity within self-insured employers and plan sponsors, focusing on the arms race with revenue cycle management (RCM).
The discussion reveals three main insights: the substantial impact of small claim errors, the inherent flaws and conflicts within prepayment analysis by TPAs, and the problematic financial incentives influencing claim processing. Noel emphasizes the importance of prepayment integrity for both plan savings and protecting members, underscoring the need for meticulous oversight and proactive management in payment processes.
=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP498
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07:46 EP486 with Stan Schwartz, MD.
09:10 How to get to payment integrity prepayment.
11:20 How payment processing efficiency is necessary to payment integrity.
13:59 How TPAs fit into the claims payment process and how they can add to payment integrity.
15:59 LinkedIn post from Chris Deacon.
16:50 EP433 with Justin Leader.
17:04 LinkedIn post from Justin Leader.
17:10 How shared savings incentives can be perverse incentives.
23:05 How employers are doing retrospective reviews.
24:29 How employers should be negotiating their TPA contracts.
25:41 EP285 with Dawn Cornelis.
25:43 EP480 with Kimberly Carleson.
27:40 Why it's imperative that payment integrity vendors are up-to-date on all policies.
30:00 EP497 with Zack Kanter.
31:13 What should self-insured employers do to assess their payment integrity?
