Amir Sokolowski
Global Director of Climate Change
CDP
Roundtable 1: Best Practices for Managing Escalating Surgical Implant Costs
While surgical implants are designed to be discreet and invisible for patients, for payers, implant costs can have a very noticeable impact on spending. Many health plans overpay for surgical implants due to lack of true cost transparency, national price variations, and incorrect billing for non-implantable items. The amount paid by health plans is often significantly higher than the provider’s true acquisition cost, equating to markups of 1,000% or more at times.
While off-the-shelf bill review solutions identify some savings, not all solutions are created equal. Comprehensive programs where the bill review process is managed end-to-end by industry experts and that are backed by the most up-to-date facility-specific implant cost data have been independently validated to deliver consistently greater savings.
Join this roundtable discussion to learn best practices for managing your surgical implant costs. We will cover what to look for when selecting a payment integrity partner to generate maximum cost savings, how to ensure durable and defensible savings that hold up through reconsiderations, and Paradigm’s industry-leading results.
The roundtable will be hosted by Matt Ruyter, Senior Director of Product from Paradigm. Paradigm has reviewed over $2.3 billion in total implant charges, resulting in hundreds of millions of dollars of savings for our clients.
Roundtable 2: Silos, Garbage, and Dominoes: Bridging the COB Disconnect
Alan Coulter will explain the history of how the payment integrity and revenue cycle issues with Coordination of Benefits began, provide examples of current problems, and what downstream impacts can occur if COB issues are not addressed at the member, group, and claims level for both payers and providers. He will also provide some tips for healthcare insurance companies wishing to maximize their processes to assist their provider partners and vice versa when caring for patients with multiple coverages.
Matt Ruyter
Senior Director of Product
Paradigm
Alan Coulter
VP of Business Development
Performant
Performant Healthcare Solutions®
Website: https://www.performantcorp.com/home/default.aspx
Performant Healthcare Solutions® is a leading independent provider of technology-enabled audit, recovery, and analytics services in the United States with a focus in the healthcare payment integrity industry. Performant Healthcare Solutions® works with healthcare payers through claims auditing and eligibility (coordination of benefits)-based services to identify improper payments. The Company’s commercial health plan clients include both national and regional payers that represent more than 100 million covered lives across all lines of business, including commercial, Medicare, and Medicaid coverages. Performant Healthcare Solutions® also supports numerous engagements with the Centers for Medicare & Medicaid Services, including multiple Recovery Audit Contractor contracts and the Medicare Secondary Payer Commercial Repayment Center contract, as well as a contract with the US Department of Health and Human Services, Office of the Inspector General for complex claim review nationwide. The Company also features a call center to serves clients with complex consumer engagement needs.
Powered by a proprietary analytic platform and workflow technology, Performant Healthcare Solutions® also provides professional services related to the recovery effort, including reporting capabilities, support services, customer care, and stakeholder training programs meant to mitigate future instances of improper payments. Founded in 1976, Performant Healthcare Solutions® is headquartered in Livermore, California. Visit www.performanthealthcare.com and follow us on Twitter: @PerformantCorp.
The session uses a case study to demonstrate the value of tracking audit, appeal, and overturn success rates. Lessons learned from audit response methods will be reviewed to highlight successful strategies in the early stages of the review process. Actionable and practical steps will be incorporated to illustrate how various stages of the audit and appeal process can be managed.
Track 2
Richelle Marting
Director, Managed Care Contracting
North Kansas City Hospital, Meritas Health Corporation
Track 1: Payment Integrity
David Flannery will talk about coding and documentation for telemedicine, payers' coverage policy (including private payers and Medicare) and regulatory aspects, including credentialling, licensing, and payment parity.
Track 2
David Flannery
Director of Telegenetics and Digital Genetics
Cleveland Clinic
David Flannery is a "pioneer" in telemedicine, having started telegenetics clinic in 1995 in Georgia. He’s currently the Director of Telegenetics and Digital Genetics at Cleveland Clinic. He has expertise with ICD-10 coding and CPT codes. He oversaw the revenue cycle management for the 300+ physician practice group at the Medical College of Georgia. He served on the American Medical Association's Digital Medicine Payment Advisory Group, developing new CPT codes for telemedicine and digital medicine.
Track 1: Payment Integrity
Dr. Michael Menen
Chief Medical Officer
MedReview
•Former Chief Medical Officer at Optum
•Bachelor of Science degree in theoretical mathematics from the University of California, Riverside
•Doctor of Medicine degree from the Medical College of Wisconsin
•Board-certified invasive cardiologist and a fellow of the American College of Cardiology
MedReview
Website: https://www.medreview.us/
MedReview sets itself apart with over 50 years of experience delivering physician-approved pre-pay and post-pay payment integrity services that prioritize billing and payment quality, accuracy, and precision. Every claim reassigned by MedReview is reviewed, approved, and documented by a team of physicians, resulting in the industry’s lowest appeal overturn rate.
Utilizing proprietary technology combined with extensive subject matter clinical and administrative expertise, we achieve a 40% or greater reassignment rate focused on our clients’ specific needs. MedReview provides the full spectrum of payment integrity solutions including DRG and clinical reviews, cost outlier audits, re-admission reviews, data mining and itemized bill reviews.
Partnered with clients across the country, MedReview offers a flexible approach, supporting both complete outsourcing and supplemental enhancements to existing programs. By optimizing recoveries, preventing overpayments, and improving the provider experience, MedReview empowers payors to navigate the complexities of payment integrity with confidence and measurable success.