Foreword
According to McKinsey in December 2023, Payment integrity in the age of AI and value-based care, they estimate the $9 billion (PI) industry has grown at a 7 percent CAGR in recent years, reflecting growth in US healthcare spending and persistent complexity in billing processes.
They further acknowledge the PI industry is poised for transformation in the coming years increasing the addressable market for PI companies and attracting continued investment and innovation. With this type of growth, a key sector of PI where our team sees strong focus is the incorporation of payment accountability.
Payment accountability is an enterprise-wide approach which focuses on everyone in the organization being accountable for accuracy along the payment integrity lifecycle. This approach encompasses root cause inaccuracies, claims accuracy rates at first pass, and post payment recovery to recoup misspent funds as well as drive upstream analysis.
In this article, we take a deeper dive on incorporating payment accountability into payment integrity offerings. We are focused on continually working with our health plan partners to manage their evolving payment integrity growth and landscape.