Results presented in "Payment Integrity Programs: A National Study on the Impact of DRG Audits on Provider Sentiment and Abrasion", conducted by Change Healthcare and Frost & Sullivan, indicate that some providers are paying upwards of $1 million per year on audit compliance costs and experiencing routine relationship damage with payers.
The data does present an optimistic opportunity: providers report openness and satisfaction with new payer methods that reduce audit costs, and some providers are in good positions for education on new cost-and time-saving methods.
“The message for payers is clear: Those that adopt innovative, provider-friendly techniques—such as pre-submission notifications—and deliver a positive experience in these areas can improve their relationships with providers, while still meeting their audit requirements,” said Dave Cardelle, RPh, Change Healthcare’s vice president of payment integrity in a statement. “You won’t find any disagreement among payers or providers that payment audits are tedious and expensive, but necessary. However, the challenge for payers is also the opportunity—to make something inherently objectionable to providers less intrusive and more cost-effective for both parties.”