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Who Should Be Responsible for Health Care Payment Integrity?

Blog: Enterprise Decision Management Blog

Medical insurance claim form

Health care payers typically focus intently on assuring that they are paying the right health care providers for the goods and services that they should pay for, for the correct price, and for the care of the members or beneficiaries who are entitled to these benefits.  Given the negative impact of fraud, waste and abuse on health care, it’s in every payer’s interest to focus on these problems too.

But who should the payer task with this responsibility?

Here are four examples of how we have seen payers assign responsibility for payment integrity:

Which is the best approach for you? We recommend that you consider the following things:

We welcome your comments.  Stay tuned for our next blog on health care fraud, waste and abuse.

The post Who Should Be Responsible for Health Care Payment Integrity? appeared first on FICO.

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