How AI-based digital solutions help resolve staffing issues and improve efficiency in payment integrity
The healthcare industry faces mounting pressures to ensure payment accuracy in a complex and evolving environment. Payment integrity (PI) programs are pivotal for preventing fraud, waste, and abuse (FWA) while ensuring that providers are reimbursed accurately and efficiently. However, these programs are increasingly strained by staffing-related challenges. High employee turnover, the need for specialized expertise, and escalating workloads are creating a perfect storm that threatens the efficiency and effectiveness of PI operations.
Amid these challenges, artificial intelligence (AI), advanced digital solutions, and automation tools offer transformative solutions. By augmenting human expertise and automating repetitive, time-intensive tasks, these technologies not only alleviate staffing burdens but enable teams to work more strategically. As the healthcare industry evolves, your PI program should also evolve to utilize AI-driven technology to improve accuracy and efficiency.
Healthcare payers cite obstacles to PI success
According to a recent survey by EXL and Healthcare Dive, healthcare payers stated the most severe obstacles to success with their PI programs. The top two responses were high employee turnover rates, cited by 51% of survey respondents, and too many inaccuracies across the process, at 49%. Staffing shortages were also mentioned by 37% of respondents.
99% of payer executives have interest in technologies that could increase their staff’s claim auditing efficiency by over 50%. By working in partnership with digitally focused third-party vendors, healthcare payers can find the greatest improvements in accuracy and the most cost savings.
Automate processes to streamline operations and enhance efficiency
Organizations can leverage digital solutions and technologies to meet the growing demands of PI programs while fostering a more sustainable and efficient operational model. Using AI-driven technology, healthcare payers can proactively address staffing issues and improve efficiency by streamlining operations, automating workflows and enhancing decision-making processes.
Embed end-to-end intelligence within your complex audit operations
EXL’s audit management platform EXLMINE™ simplifies the manual, labor-intensive audit process by implementing automation and intelligence into the end-to-end audit workflow. This robust digital business process tool supports both pre-payment and post-payment modalities and is designed to help audit staff identify, manage, and act on potential improper claims payments.
EXLMINE is data-led and digitally enabled to achieve results:
- $2 billion in savings to our customers
- 60% increase in auditor productivity at the base level
- 2,000+ users driving incremental cost of care savings with reduced overhead
EXLMINE centralizes the claims audit process needed to manage your organization’s entire audit lifecycle--from data intake to overpayment recovery to reconciliation and reporting.
- Modular workflow management: Supports end-to-end assignment and routing of audits and provides transparency on audit status, findings, and tracking details
- Sophisticated selection module: Combines robust analytics with rules-based and sophisticated query-based algorithms to identify probable errors and overpayments
- Advanced security: Manages regulatory risk as HITRUST Certified, HIPAA and ISO 2700-1 compliant
- Built to scale: Accommodates increases in volume, new modalities, and growing auditor teams
- Provider support: Facilitates self-service medical record submission and streamlines communication between payers and providers
- Reporting: Generates summarized, personalized reports and detailed views of audit programs, outcomes, trends, and provider performance
Download our report and discover how to address staffing-related concerns head-on by optimizing workflows, improving accuracy, and empowering payment integrity professionals to focus on high-value activities.