Imagine you’ve been hired as the CFO of a well-known regional health system. You’re told during your interview that they’re looking for someone who can make difficult changes to address systemwide financial and accounting issues.
So, you dig into the known issues and find even more problems with inaccurate billing practices. You raise the flag about super-high error rates and the likelihood of repaying more than $5 million to correct the systemic errors. And then, BAM! You’re fired!
As crazy as this seems, it demonstrates how hard it is to change entrenched (and illegal) industry-wide practices that have thus far worked to your advantage. And give money back? Never! But there are things plan sponsors can do to start changing bad behavior.
The Value of Pre-Payment Integrity Controls
Employee health plans can directly combat egregious billing practices begin by knowing and validating care costs before paying any claim. They can eliminate price-blind buying and use transparent algorithms to establish payment rates that are fair for providers, employers, and plan members. And then they can scrutinize every claim to ensure accurate billing and reimbursement.
It’s time to change the buyer-seller relationship. We can’t rely on the industry to police itself, so buyers must align with a conflict-free health plan administrator who will fight on their behalf for transparency and payment integrity and take decisive steps to ensure they aren’t victimized by unfair billing practices.