Change Healthcare Study Reveals Impact of Payment Audits on Payer-Provider Relationships
27 Januar 2020 - 3:00PM
Business Wire
Study finds audits process poses significant
costs and administrative burden to providers and reveals
opportunities for improvements to minimize abrasion, including
pre-submission notification
Today Change Healthcare (Nasdaq: CHNG)
published Payment Integrity Programs: A National Study on the
Impact of DRG Audits on Provider Sentiment and Abrasion, a report
on the impact payers’ audits of payments to providers have on their
business relationship and providers’ finances. Conducted by Frost
& Sullivan and commissioned by Change Healthcare, the study
reveals these “payment integrity” audits can cost providers as much
as $1 million in administrative costs annually and damage the
relationships between healthcare providers and their payers. The
good news: The research also found high provider satisfaction with
novel methods some payers are using to reduce audit costs and the
administrative burden for providers.
Among the findings: The process of ensuring that payments to
providers are accurate is a costly proposition for providers.
Payers or their third-party vendors routinely audit claims related
to a hospital stay to ensure providers applied appropriate care,
utilization, and billing codes to claims. But 8% of providers are
spending upwards of $1 million dealing with post-payment audits
each year. Another 10% spend between $500,000 and $1 million, and
46% spend $500,000 or less annually. More concerning: 4 out of 10
providers (37%) have no idea what the audit process is costing
their organizations.
In addition to high administrative costs, nearly a third of
providers (27%) report negative experiences related to audit
programs. Fueling that negativity: A high number of requests for
medical records, often used to validate accurate payment, was cited
by 92% of respondents as a source of dissatisfaction. One quarter
(24%) say they must respond to more than 500 to over 2,000 requests
monthly. And 25% of larger providers consider the overall number of
audits unreasonable.
On the upside: The research points to new ways payers can help
providers reduce the time, cost, and discontent incurred by audits.
Among them: “Pre-submission notification,” a process some payers
are now using to alert providers of potential errors before the claim is submitted for payment,
improves accuracy and reduces the potential for a post-payment
audit. Nearly half of providers (43%) say this practice can help
them reduce their organization’s administrative burden and
associated costs.
“The message for payers is clear: Those that adopt innovative,
provider-friendly techniques—such as pre-submission
notifications—and deliver a positive experience in these areas can
improve their relationships with providers, while still meeting
their audit requirements,” said Dave Cardelle, RPh, vice president,
Payment Integrity, at Change Healthcare. “You won’t find any
disagreement among payers or providers that payment audits are
tedious and expensive, but necessary. However, the challenge for
payers is also the opportunity—to make something inherently
objectionable to providers less intrusive and more cost-effective
for both parties.”
Frost & Sullivan reached out to 1,100 short-term acute care
hospitals in the U.S. via email and telephone for interviews. A
national sample of senior-level decision makers from these
organizations provided their opinions about payment integrity using
a web-based interview methodology.
The full report, Payment Integrity Programs: A National Study on
the Impact of DRG Audits on Provider Sentiment and Abrasion, is
available for download now.
For more information on Change Healthcare, please visit our
website, hear from our experts at Viewpoints; Follow us on Twitter;
Like us on Facebook; Connect with us on LinkedIn; and Subscribe to
us on Libsyn, Apple Podcasts, Google Podcasts, and YouTube. And to
learn how to manage healthcare costs with pre-submission claims
adjustment, visit the Coding Advisor resource page.
About Change Healthcare
Change Healthcare (Nasdaq: CHNG) is a leading independent
healthcare technology company that provides data and
analytics-driven solutions to improve clinical, financial, and
patient engagement outcomes in the U.S. healthcare system. We are a
key catalyst of a value-based healthcare system, accelerating the
journey toward improved lives and healthier communities. Learn more
at changehealthcare.com.
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Change Healthcare Kerry Kelly External Communications
339-236-2756 kerry.kelly@changehealthcare.com
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