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Payment Integrity Analysis

HealthLeaders magazine, September 13, 2013

The U.S. healthcare system is replete with waste. The key to avoiding waste in this area is meticulous attention to payment integrity issues. That is, making sure that the correct payment is made for the correct member for the correct service to the correct provider. For this study, Truven Health Analytics identified six payment integrity algorithms with the highest potential for savings. In addition to identifying potential waste, some of these algorithms have a clinical integrity dimension. Care that is wasteful or potentially fraudulent is also often of poor quality.

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