In the evolving landscape of healthcare finance, payment integrity programs play a crucial role in ensuring that claims are paid correctly and efficiently. Historically, many organizations have relied on post-payment audits to identify and correct discrepancies after payments have already been made. Especially for clinical reviews as these reviews are labor and time intensive. However, there is a growing recognition of the advantages of shifting these efforts to a pre-payment model, especially with the rise of artificial intelligence to help speed up time intensive clinical reviews. Here’s why pre-payment programs are increasingly seen as the better approach for maintaining payment integrity.

Reduced Administrative Costs

Chasing down funds that have already been paid out is both time-consuming and resource-intensive. Post-payment processes often involve extensive audits, legal proceedings, and negotiations to recover erroneous payments. In contrast, pre-payment checks streamline the process, reducing administrative burdens and associated costs. By catching errors before payments are made, organizations can significantly cut down on the manpower and costs required for recovery efforts.

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Reduced Provider Abrasion

By ensuring that payment is correct at the first instance, pre-payment programs contribute to better relationships with  providers. Post-payment audits can lead to tensions between payers and providers due to disputes over recoupment and the accuracy of retrospective claim adjustments. Pre-payment verifications, on the other hand, provide clarity and transparency, fostering trust and cooperation between parties.

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Faster Realized Savings

Pre-payment integrity programs preventing money from being tied up in recovery processes. This approach ensures that funds are only disbursed for valid claims, which helps maintain a healthier financial state. Effective cash flow management is crucial for the financial stability of healthcare payers, particularly in a sector where margins can often be tight. For payment integrity companies savings are realized faster, and companies operating on a contingency basis are able to see payment earlier.