Question

Do you think COB has a positive or negative impact on the healthcare system and cost?

Answer 1

Ans) Health plans face a number of challenges when it comes to ensuring the right care is provided to the right member for the right amount.

- Complex billing processes, changing regulations, outdated and disparate data systems, and overlapping coverage all contribute to improperly paid claims.

- Today, nearly a third of claims are paid incorrectly, leading to billions in administrative waste.

- In 2020 and beyond, we anticipate health plans will continue to struggle with rising healthcare costs, numerous competing priorities, and a lack of resources.

- Furthermore, changing regulations and mandates will continue to add layers of administrative and clinical complexity to a system already bogged down in paperwork.

- While there is no clear path to cost containment, there are ways health plans can work toward transforming their payment integrity approaches. An example is leveraging advanced technologies to move from retrospective payment to prospective payment—by detecting improper claims before they are paid, health plans can keep costs in check, increase member satisfaction, and most importantly, cultivate healthy provider partnerships.