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From Health Law Daily, August 21, 2015

Agencies lose money verifying eligibility, lack of data integration to blame

By Sarah E. Baumann, J.D.

Information technology (IT) executives and case/program managers (collectively, managers) working with health care and other social service benefits estimate that 20 percent of health care benefits are lost each year due to improper payments resulting from benefit eligibility and verification issues, according to a study published by MeriTalk and underwritten by MarkLogic® Corporation. According to the study, more managers attribute issues with timeliness, accuracy, and legacy IT to a lack of data integration than any other cause. The study authors calculate the estimated loss to amount to $342 billion annually.

Verification challenges. MeriTalk conducted online and phone surveys of 155 managers in June 2015. Forty-four percent reported that they are not able to leverage all available data due to system and/or integration challenges, resulting in timeliness challenges and accuracy issues. Managers reported that it takes agencies an average of 16 business days to confirm health care benefit eligibility for new recipients and 14 days to verify the states of current recipients. Further, managers estimate that only 89% of their beneficiary lists are accurate, meaning that 11 percent of beneficiaries should not be receiving benefits.

Suggestions for improvement. Forty-seven percent of managers suggested improving data integration to improve performance; forty-eight percent suggested hiring additional staff and 45 percent suggested improving automation. However, the authors suggested that if data systems were able to fully integrate necessary data, each person would be able to complete nine additional hours of work per week. The study authors claim that the increase in productivity would be the equivalent of hiring 1,300 new employees at CMS alone. However, 59 percent of managers believe such an ideal system is at least three years away.

Report recommendations. Based on the responses, the report authors suggest auditing current systems and processes, prioritizing data integration, and improving collaboration. Two-thirds of respondents said they had never before been asked to provide feedback on IT systems and polices related to eligibility and benefits verification. “For technology improvements to take hold,” however, the authors state, “case workers and IT must come together to define needs, devise solutions, and justify investments.”

Companies: MeriTalk;MarkLogic® Corporation

MainStory: TopStory GeneralNews HITNews

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