Flop House Musings:
What a Bowery Documentary Taught Me About Payment Integrity
“Miss a detail, lose a customer.”
That’s a survival rule. And weirdly enough, I learned it from a flop house. Years ago, I watched Sunshine Hotel, a documentary about one of the last flop houses on the Bowery in NYC. (Yes, apparently people really do say “on the Bowery.” Who knew?)
Bruce Davis, one of the voices in the film, dropped a line that’s lived rent-free in my head ever since:
“Defend your customer’s money better than you’d defend your own.”
You don’t need to manage an investment portfolio to live by that. If you’re managing projects, timelines, leads, or caseloads—you’re managing money. Time is money. Rework is money. Sloppy handoffs? Also money. And miss a detail? You’re not just risking a deliverable, you’re risking trust.
Our team is an operating system. We guard client dollars like they’re our last dollars. We treat every lead, claim, and control as if a bad actor is trying to walk through it. And we obsess over completeness and accuracy, because in healthcare, a missed detail doesn’t just mean “oops.” It means:
– Millions lost to fraud, waste, and abuse
– Compliance exposure that snowballs overnight
– A customer who never comes back
Customer service is precision, proactivity, and relentless follow-through.
Here’s how we put it into practice for health plans:
1) Precision at Intake: Clear acceptance criteria, stronger triage, and complete case packets so investigators start with everything they need, no scavenger hunts.
2) Evidence-First Investigations: Standardized investigative steps, defensible audit trails, and rigorous linkage between case notes and artifacts. If it’s not tied down, it’s not real.
3) Two-Layer QA: Completeness and accuracy checks on every case before FPR review—because quality upstream prevents rework downstream. (And no one has time for déjà vu mistakes.)
4) Responsible Prepay Controls: Use prepay edits only when justified and remove them when behavior changes. Stewardship means calibrating, not carpet-bombing.
5) Documentation Discipline: If it isn’t in the case management tool, it doesn’t count. Our mantra: Findings = Evidence + Location.
6) Transparency & Outcomes: We track the metrics that matter. Avoidable rework, cycle time, recoveries-to-cost, first-pass quality, and backlog burn-down. If you don’t measure it, you’re just guessing.
The result? Fewer misses. Faster resolutions. Stronger recoveries. Leaders who actually sleep at night.
Because at the end of the day, “Miss a detail, lose a customer” it’s a promise we refuse to break.
If you’re ready to harden your SIU/PI operations around precision and stewardship, let’s talk.
By Jeanmarie Lore | CEO of Advize Health