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Get Payment Integrity Right the First Time eBook

Get Payment Integrity Right the First Time: A Comprehensive Approach for Maximized Savings

Rising U.S. healthcare costs are reaching crisis levels. The United States spends more on healthcare per capita than any other country, and total spend as a percentage of gross domestic product (GDP) is increasing annually. In 2018, healthcare costs comprised 17.7% of total GDP. By 2028, this is expected to increase to nearly 20%, totaling $6.19 trillion.1

While price increases in medical products and services are expected to account for much of this growth, administrative waste, if allowed to carry on unchecked, will continue
to impose staggering costs on the healthcare system each year.

This playbook covers:

• The complexities of claims cost management for payers and the inefficiencies of post-payment claims administration.
• How managing multiple systems, technologies and multiple
vendors can lead to waste.
• An example of how Zenith American Solutions improved claims
management efficiency and effectiveness after implementing a
comprehensive pre-payment solution.
• The importance of choosing a technology architecture that ensures
accurate and prompt payment, either through a complete integration
of claim services, or a best of breed pre-payment system.
• Why flexibility and technology customization are critical in a complex
claims environment where one size doesn’t fit all for payers.

This playbook will discuss how a comprehensive pre-payment solution for improving claims payment integrity can reduce costs, create efficiencies and eliminate some the complexities of claims cost management in an ever changing ecosystem.

1 Tikkanen, R., Melinda K. Abrams, M.K. U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? Commonwealth Health Fund. https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

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