Dr. Emad Rizk: 3 tips for moving from retrospective to prospective payment integrity

While many health plans have pre-pay automated claim editing in place, other aspects of their payment integrity programs still take a "pay now, review later" approach. This can lead to significant abrasion when the plan identifies an overpayment and goes to collect it from the provider—and any savings are often significantly reduced. That's why Cotiviti CEO Emad Rizk, M.D., offers three strategies in MedCity News to help payers move from inappropriate payment recovery to prevention.

Read his article to learn:

• How health plans benefit from strengthening their payment policies and improving transparency
• Why electronic eligibility data is critical
• What clinical claim coding validation can do to address complex claims that can't be auto-adjudicated