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Payment Integrity Programs: A National Study On The Impact Of DRG Audits On Provider Sentiment And Abrasion

posted by Change Healthcare

on February 10, 2020

Project Overview

Do healthcare providers think payment integrity programs are complex, frustrating, or laborious; or do they find them to be a relatively painless process? How do payment integrity programs affect the payer-provider relationship? How can payment integrity audits be improved? And most important, can these programs become a means to improve the payer-provider relationship, or are they doomed to degrade it?

To answer these and other questions, Change Healthcare commissioned Frost & Sullivan to assess provider sentiment toward traditional and non-traditional tactics that health plans use to operate payment integrity programs. Traditional tactics include Diagnosis Related Group (DRG) audits, post-pay review, on-site audits, and more.

Non-traditional tactics focused on the pre-submission review. The goal: to better understand how, where, and why payment integrity programs cause friction with providers; and to identify tactics that can reduce provider abrasion and costs for both parties, all in the interest of helping payers improve the provider experience without adversely affecting audit results.

This national study is, to our knowledge, the first time any organization has “taken the temperature” of providers regarding their feelings about, reactions to, and impact of payment integrity programs on their business. Armed with these insights, innovative payers can start to improve the alignment of their payment integrity programs with their provider networks’ needs.

Click below to download the whitepaper

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