Lyric CEO Rajeev Ronanki, M.S., on Upcoding
"All kinds of enhancements" have crept into claims from providers, Ronanki said, and health plans have responded. But his company is impartial about the net value and strives to make the claim accurate in the first place, he said.
In the third segment from an interview with Managed Healthcare Executive, Lyric CEO Rajeev Ronanki, M.S., discusses revenue cycle management (RCM) and "disarming both sides to where RCM goes back to its roots of making sure that the billing for whatever services are rendered is accurate."
Ronanki said that provider RCM started out with the intent of making sure billing was accurate but "all kinds of enhancements have crept in." Health plans responded with efforts to detect and weed out claims that were too high. "It's a zero-sum game where neither party wins in the process," he said.
Lyric's customers are health plans. But the company is focused on accuracy, Ronanki said. In some cases, that might mean determining that a provider deserves a higher payment than what was billed for. In others, Lyric might find that the provider has "additional charges that don't seem to fit the pattern of what this claim should look like," he said.
"Our core philosophy is that we're impartial to the net value of what we're rendering judgment on," and to make sure the claim is accurate, Ronanki said.
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