Podcast: Payment Integrity and Driving Down the Cost of Billing Errors for Insurers and Providers

A conversation between Karen Jagoda of Empowered Patient Podcasts and Steve Palma, President Medical Cost Solutions at Goodroot


Steve Palma discusses the impact of medical billing errors on increasing healthcare costs. Steve also shines a light on hospital financial assistance programs and how they are not being used enough to help patients pay high medical bills.


Steve provides some details, "Well, the billing errors include the cost of payers overpaying or underpaying claims, and the cost to the providers in billing correctly and then dealing with all the administrative headaches around audits by payers, and getting that claim ultimately right. These add a tremendous amount of administrative cost on both sides. It ends up getting passed to the consumer."


"You'll hear some people on the health plan side say it's all abusive provider billing practices, whether it's fraud or potentially maximizing coding in a complex coding environment. On the provider side, often, they'll say it's health plans intentionally underpaying or playing their own types of games."


"I think, over the years, what I've really come to conclude, is that, for the most part, people on the health plans and the providers are trying to do the right thing, from a coding perspective, but it's extremely complicated. So, the complication of the billing, the regulatory environment where payers have to pay those claims very, very quickly and get them out the door, it just causes an error on both sides, frankly."

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