Two key claim trends and their impact on payment integrity

Healthcare billing practices are constantly evolving, significantly impacting payment integrity for health plans seeking to prevent inappropriate spend and protect their members’ benefits. In particular, emergency department billing and medical drug wastage have become significant contributors to rising expenditures, as evidenced by trends observed directly in claims payment data over the past several years.

Here, we examine these trends in detail and offer strategies for payers to protect against inappropriate billing, helping to ensure claims are paid appropriately the first time and reducing the need to pursue overpayment recovery.