Despite new federal transparency rules, it’s hard to know what you’re paying for when medical claims and payments are automatically adjudicated. This lack of oversight creates countless opportunities for fraud, waste, and abuse, all of which increase costs for employers and plan participants.
Consider that the U.S. Department of Health and Human Services, which tracks and reports improper payment rates for Medicaid, noted that 21.7% of all healthcare claims were improperly paid in fiscal year 2021. Similar results were published by the Journal for the American Medical Association, which found that nearly 20% of U.S. healthcare spending is wasteful and fraudulent.
An effective solution to this predicament is payment integrity, which goes beyond simply ensuring that medical claims are accurate. Payment integrity adds transparency to all aspects of the billing and claims paying process to catch and eliminate errors before the claim is paid. And it’s a practice whose time has come.
Health plan administrators like Vitori Health combat this systemic overpayment using rigorous claims pre-payment control protocols. Real-world results show that self-funded plans can save more than 10% of their annual expenditure with this vigilance alone.