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Hi, everyone. This is Lucas Voss with Becker's

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Healthcare. Thanks so much for tuning in to

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the Becker's Healthcare podcast series. It's great to

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have you. Today, we're talking about the evolution

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of payment integrity, and I'm very excited to

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welcome Jana Spence. She's the vice president of

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strategy at Saris with close to two decades

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of experience in client relationship management, partner revenue

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growth, and client advocacy. Jana serves as a

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trusted adviser to her customers and continues to

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advance payment integrity strategies for health care organizations

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nationwide.

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John, it's so great to have you again.

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Welcome to the podcast.

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Well, thank you for having me back. Absolutely.

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I wanna jump right in. There's quite a

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bit to talk about today here. You and

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your colleagues at Syrris frequently speak about prioritizing

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a moving

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left

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strategy and payment integrity.

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Can you just define that approach for our

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listeners here, and why has it become so

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important

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for health plans right now?

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Yeah. Sure. So when when we talk about

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moving left or you might even hear people

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say upstream

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Mhmm. At a high level,

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we're really talking about an easy way to

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say shifting PI activities

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to earlier in the claim life cycle.

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So they should be happening

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closer and closer to the moment of a

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claim being submitted or even adjudicated,

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or some are even talking about at the

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point of authorization.

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So this versus

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relying almost entirely on solely post payment audits.

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So, historically, you know, payment integrity has been

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very reactive.

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We pay the claim first, and then we

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go back later and say

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or ask ourselves, you know, was that correct?

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Moving left flips that question to

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how do we make sure it's correct before

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payment even goes out the door?

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Now what's important is that we're applying intelligence

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earlier

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through the use of better data,

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better analytics,

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better workflows.

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And so this means accuracy is built in

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rather than bolted on afterward.

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And this has become especially important right now

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for a few key reasons.

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You know, I'll set the stage a little

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bit, and then narrow it down to, I'd

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say, really kinda maybe three reasons why it's

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important.

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So the first I would say is financial

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pressure.

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The environment for health plans is, you know,

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that they are operating,

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in a space with rising medical costs,

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increased utilization,

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and then increased regulatory

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complexity just to top it all off. So

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the margin for error is incredibly thin.

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Look. Plans can't afford to let millions of

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dollars leak out the door and hope to

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recover a percentage of that later.

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Second, I would say this is an important

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strategy

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to manage changing provider dynamics.

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Providers are under the their own pressure,

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and tolerance for retrospective audits is just lower

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than it's ever been.

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Post pay recoveries, you know, they create an

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administrative burden,

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appeals,

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and just frustration,

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which ultimately

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strains that relationship between,

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plans and providers and and one that's very

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important to our plans.

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And then I'd say last,

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my third important

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call out is, you know, there's a maturity

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factor. Right? Technology

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and data availability,

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have evolved to the point where moving left

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is not only possible,

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it's expected.

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You know, plans that are not modernizing

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are going to fall behind those that do.

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Now you've highlighted the fact that this needs

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to be a proactive approach. Right? We need

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to move on from sort of the the

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post pay audit era, the post pay audit

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processes. Right.

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When we're looking at this traditional model in

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and of itself today,

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and you've touched on this a little bit,

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for you, what are the greatest limitations,

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right, when we're looking at it both from

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a financial perspective and a provider relationship perspective?

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Well, I think it's worth saying post pay

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audits have absolutely delivered value over the years,

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and they still have a purpose in PI.

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But as you said,

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it also has very real limitations.

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So, traditionally, the post pay model, again, kinda

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looks like, you know, claims are paid quickly

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so that they can meet the turnaround requirements,

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and then a subset of those claims are

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then selected weeks or months later for an

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audit.

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We identify errors,

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and then recovery efforts begin through offsets, refunds,

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or appeals, you know, that can take up

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to two years.

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The first limitation

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of that is financial. Right? So not not

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every identified overpayment is recoverable.

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Providers may dispute the finding.

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The statute of limitations may apply.

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And so those types of things, you know,

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kinda increase the cost to recover,

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and so then

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your recovery actually becomes less than

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what you maybe even originally expected.

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The second challenge,

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I would say is relational.

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You know, so from the provider's perspective,

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post pay audits can feel punitive and abrasive,

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even when they're justified.

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And so you you might even hear providers

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say, you know, if this was wrong, then

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why'd you pay it in the first place?

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And that kind of question erodes that trust

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that we have between plans and providers

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and increases friction.

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You know, what we're seeing today is that

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post pay works best as a backstop,

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not as the foundation of a payment integrity

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strategy.

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So it should catch what slips through, not

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be the primary way plans manage,

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you know, their their revenue cycle or, you

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know, the revenue cycle management.

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Mhmm.

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Now

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when there where there's post, there's also pre.

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And if what we what we've highlighted is

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the fact that we are trying to be

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more proactive. That's the approach here. Right?

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When we talk about shifting to that prepay

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model and process,

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what does that look like in practice?

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And then also, you've touched on the data

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piece and the analytics part of this. Right?

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How are then health plans also leveraging technology

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to really improve all of this

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before

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we have budget and monies go out the

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door?

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Yeah. No. Good question. So simply put, prepay

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means applying that technology and that intelligence before

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payment is released.

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And then that intelligence,

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you know, or technology

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can take many forms.

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You know, payment integrity,

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and specifically,

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Cirrus, you know, we focus on, you know,

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clinical and coding validation,

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policy and contract alignment, or even compliance of

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the contract,

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and predictive

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risk scoring of claims that are likely to

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be paid wrong.

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Now what's changed in the last five years

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is that that technology now allows this to

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happen in near real time. So health plans

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are leveraging advanced analytics,

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things like machine learning,

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to identify claims that are high risk but

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low volume.

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These are the claims where even small mistakes

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can mean a lot of money going out

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the door inappropriately.

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So instead of reviewing everything, plans can focus

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on the claims that really matter.

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And the key point really is targeting. We

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don't wanna stop every claim.

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Ideally, we're only stopping the ones that we

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truly suspect have errors and let low risk

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claims flow straight through and kinda follow more

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of that, post pay model.

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Another key is to apply automation

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anywhere possible

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and really only relying on human expertise where

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it adds real value,

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like the validation stage, right, our nurses and

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our auditors.

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And then this allows us to improve accuracy

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and preserve

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the speed

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of getting that claim paid, two things that

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historically

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have been a a real challenge to balance.

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From your experience and the conversations that you're

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having

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with organizations

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right now, is there a particular workflow

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that you're seeing where you think, hey. There's

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there's more opportunities. There's there's the greatest opportunity

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potentially

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for leaders to really say, okay. We have

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this technology. We need to leverage it more

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efficiently. What's that workflow for you that really

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sticks out?

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Easy. The biggest opportunity we see is in

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those complex high dollar claims. Right? That's that's

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the workflow.

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And, honestly, that doesn't change from from post

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pay to prepay,

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you know, when we're talking about a chart

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audit.

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Inpatient admission

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admissions and outpatient surgeries, those types of bills,

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you know, where,

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documentation,

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nuances,

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and some, we'll say, coding decisions can overlap.

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And these are claims

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often correct, but when they're not,

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the financial impact is is fairly large.

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So

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technology,

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I'll say, can help plans identify some of

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these mismatches

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between diagnoses

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and the level of care and coding that's

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actually being used,

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and then also services that don't align with

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clinical and reimbursement policy.

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Now,

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then I'd say with the technology, you know,

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plans can intervene early and collaboratively, right, rather

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than months later,

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the recovery later. And that's really the goal.

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Yeah. It enables the proactive approach. Right? It's

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it's going to make things a lot easier,

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as we've talked about on the front end

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to be able to eliminate some of this

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friction.

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As we were looking to the future, we

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know that, again, technology isn't going away, right,

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especially when we talk about some of the

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automation pieces to this. It's going to evolve,

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over the next couple of years tremendously fast

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most likely.

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How do you see payment integrity evolving here?

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And, again, what will ultimately differentiate

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leading health plans from the rest in all

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of this?

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Well, call me an optimist.

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But to me, the future of payment integrity

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is

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proactive

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and collaborative,

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and then more maybe even more importantly,

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integrated in the platforms.

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First key element's gonna be early adoption.

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Right? So I'd say recently maybe I'll share

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a story. So recently, I listened to a

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podcast

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on AI adoption,

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completely unrelated to health care. Mhmm. And the

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message was simple.

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Get on board early or you'll fall so

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far behind that catching up becomes

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impossible

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or at a minimum incredibly difficult.

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Payment integrity is no different.

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Applying PI further upstream

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isn't a future concept.

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It's already happening,

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and it's going to continue to move earlier

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in the process.

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So we're seeing it push into as early

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as clearinghouses

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today,

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into authorization workflows.

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And some even argue, ultimately, it'll be at

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the point of care of the patient

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that they're already flagging errors.

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And health plans that aren't laying that foundation

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now through, again, data strategy,

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technology, and process design, they will be far

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behind those that are putting those things in

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place, and those planes will be better positioned

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to take that next step.

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So for them, moving further left becomes an

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evolution,

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you know, those that are executing on this.

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And then for those that wait, it becomes

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a much heavier lift.

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Yeah.

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You have to start now. You have to

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be pro as we've talked about, you have

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to be proactive now to be able to

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look ahead, and that goes for for technology,

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but overall the organizational mentality too when it

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comes to some of these processes that we've

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discussed. John, it's so great to have you.

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Anything else that comes to mind that that

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is important for our listeners that might be

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important to touch on that we we haven't

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talked about?

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No. I would say this has been a

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great conversation. I think I say it every

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time, you know, I meet with you,

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but, you know, Sirius is here to collaborate.

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We love it.

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I personally have a a passion for getting,

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you know, great minds together. So if anyone

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ever wants to brainstorm,

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don't hesitate to reach out, to myself or

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to anyone here at Sirius.

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We talked about partnerships and relationships, so crucial

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in this space.

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Yes.

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Jonna, it's so great to have you again,

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and we also want to thank our podcast

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sponsor, Sirius. You can tune in to more

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podcasts from Becker's Healthcare by visiting our podcast

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page at beckershospitalreview.com.