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CDI and Denial Management – Collaborative Approaches To Reducing Claims Denials

- Understanding the importance of CDI in Modern Healthcare.

- The link between CDI and Denial Management.

- Collaborative Strategies.

- Technical Solutions & Data Analytics.

- My Succes Story & Key Takeaways.

Revenue Integrity

Author:

Vladimir-Ducarmel Joseph

CDI Program Manager

Beth Israel Lahey Health Hospital & Medical Center

Vladimir-Ducarmel Joseph is one of the Clinical Documentation Integrity Program Directors at Beth Israel Lahey Health, where he spearheads a dedicated team of CDI professional experts to optimize clinical documentation best practices. With almost a decade in CDI leadership across diverse healthcare environments, Vladimir-Ducarmel holds a Master of Health Administration from George Washington University and his expertise encompasses physician leadership, team dynamics, CDI provider education, and program management. A fervent advocate for healthcare excellence, Vladimir-Ducarmel is adept at bridging the gap between clinical and administrative roles. He is proficient in various healthcare-oriented analytical and business tools, leveraging them to drive impactful CDI outcomes.

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Developing A Payment Integrity Program From The Ground Up

Developing a Payment Integrity Program from the ground up for a brand new Medicare Advantage Health Plan
Covering both the opportunities and the challenges of building and effectively managing PI programs that prevent, avoid, or recover billing errors, payment errors and other party liability errors
Listing of suggestions/ advice from our success, and lessons learned

Payment Integrity

Author:

Monique Pierce

Payment Solutions & Operations

Cohere Health

Monique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.

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Networking Break

Read more about Networking Break

The Future of Payer-Provider Interactions

- Strengthening payer-provider relationships through improved communication around claims adjudication, providing transparency into denials, accelerating payments, automating data exchange, and reassessing denial
reversals

Payment Integrity

Revenue Integrity

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Executive Panel: Driving The Future Of Payment & Revenue Integrity

Join us for an engaging panel discussion featuring a lineup of industry experts as they tackle pressing questions at the intersection of health plan payment integrity and hospital revenue integrity. Discover the challenges and solutions in achieving payment accuracy and delve into the potential of collaboration and data sharing between health plans and hospitals. Explore critical topics, including the impact of payment inaccuracies on financial health, the role of technology and automation, navigating regulatory complexities. Gain insights into measuring success and envision the future of payment integrity in healthcare. Don't miss this opportunity to be part of a dynamic conversation that could reshape the healthcare landscape. Join us as we challenge conventional wisdom and seek innovative solutions to drive payment accuracy forward.

Payment Integrity

Revenue Integrity

Author:

Ritesh Ramesh

Chief Executive Officer

MDAudit

Author:

Conor McCauley

Director, Payment Integrity Clinical Capabilites

Highmark Health

My name is Conor McCauley. I am the Director of Payment Integrity Clinical Capabilities at Highmark. Being a Critical Care nurse, it is easy to see there are issues surrounding healthcare funding. Inserting clinical insights into reimbursement methodologies can lead to affordability and improved patient outcomes. Clinicians are well positioned to make a difference here. My passion is developing an engaged team, effective processes, and surrounding clinicians with the right technology, data, and market insights so they can work at the top of their licensure.