Empowered Patient Podcast Payment Integrity Means Getting to the Root Causes of Errors in Healthcare Claims with Ryan Mooney HealthEdge
Ryan Mooney is the Executive VP and General Manager of Burgess Source, the payment integrity business unit of HealthEdge. Ryan sheds light on the root causes that lead to waste and errors in the process of providing and paying for healthcare. He points out the need for better data management and clear lines of communication for all participants in the system, including patients, providers, and payers.
Ryan says, "I spent 23-plus years working in strict payment integrity. That is a kind of gain share model and contingency where you go, and you identify issues, and you recover them, or you prevent them from happening. The outside vendor keeps a percentage of that recovery and so on. And that way of thinking goes directly to the way that your question was asked, which is, where's the most waste? And I spent over two decades thinking in that same way."
"But another way of framing that question is, what is leading to all of these downstream issues? And in the current project with Burgess Source and HealthEdge, we're trying to take payment integrity, this whole world of knowledge, of the ways that things break and where there's waste and where there are broken things, and apply that intelligence to paying things correctly. This means getting down to the root cause and fixing those things so that there is no waste downstream or we're reducing waste downstream."
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