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FWA, payment integrity and improving financial performance: A health plan case study

Event Date: 1/20/2022

Event Overview

Thursday, 1/20/2022
1:00 PM CT – 2:00 PM CT (60 minutes)
Hosted by: MedReview

Today’s provider-sponsored health plans face multiple challenges, but the deployment of a payment integrity solution shouldn’t be one because it’s mission-critical for every health plan. When managed correctly, a payment integrity solution respects the balance between the facility performing the service and the fiduciary responsibility of the health plan. 

In this session, we will showcase how one provider-sponsored health plan leveraged its payment integrity solution to validate medical services rendered and ultimately enhance the quality for its members. Then, we will examine how an in-patient medical claim is reviewed by a clinically focused payment integrity solution with the resulting documentation diminishing provider abrasion. Finally, attendees will learn how to positively impact the financial performance of their own health plans using the right payment integrity strategies.

Audience

 

This event is designed for those involved in finance, payment integrity, claims management, medical management, and fraud, waste and abuse.  Others who would have an interest are in strategic planning, IT and vendor management.

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Attendees

Below is a list of all delegates registered to date for this event

  • Robyn Anderson
  • ALLIANCE MEMBER
  • Delegation Oversight Auditor at Health Alliance Plan (HAP)
  • Ann Bain
  • ALLIANCE MEMBER
  • Compliance Coordinator & Privacy Officer at Avera Health Plans
  • Michael Baumann
  • ALLIANCE MEMBER
  • Director of Compliance at Baylor Scott & White Health Plan
  • Pat Bremer
  • ALLIANCE MEMBER
  • Supervisor, Special Investigation Unit at Paramount Health Care
  • Ngoc Bui-Tong
  • ALLIANCE MEMBER
  • Chief Health Equity and Strategy Officer at Santa Clara Family Health Plan
  • Charniece Carter
  • ALLIANCE MEMBER
  • Risk Adjustment Operations Supervisor at Health First Health Plans
  • Nadine Casey
  • ALLIANCE MEMBER
  • Compliance Consultant - Fraud, Waste and Abuse Program at IU Health Plans
  • Tammy Chadd
  • ALLIANCE MEMBER
  • Compliance Manager at IU Health Plans
  • Karla Colasacco
  • ALLIANCE MEMBER
  • CPhT at FirstCarolinaCare Insurance Company
  • Kimberly Cooney
  • ALLIANCE MEMBER
  • Sr. Provider Data Management Specialist at Health New England
  • Amy Cornett
  • ALLIANCE MEMBER
  • VP, Compliance at Baylor Scott & White Health Plan
  • Kathy Coslett
  • ALLIANCE MEMBER
  • SIU Manager at Geisinger Health Plan
  • Deb Curry
  • ALLIANCE MEMBER
  • Director Risk Adjustment & Recoveries at Paramount Health Care
  • Esther D'Arezzo
  • ALLIANCE MEMBER
  • RN, Clinical Supervisor Risk Adjustment at Neighborhood Health Plan of Rhode Island
  • Lisa Denney
  • ALLIANCE MEMBER
  • FWA Supervisor at Johns Hopkins Health Plans
  • Sherri Doebel
  • ALLIANCE MEMBER
  • Key Account Manager at Physicians Health Plan
  • Jessica Dupont
  • ALLIANCE MEMBER
  • Vice President of Government Programs at Alliant Health Plans
  • Mary Eldridge
  • ALLIANCE MEMBER
  • General Counsel at Neighborhood Health Plan of Rhode Island
  • Jeremy Fejfar
  • ALLIANCE MEMBER
  • Pharmacy Director Government Programs at Quartz Health Solutions
  • Mary Glasgow
  • ALLIANCE MEMBER
  • Senior Corporate Compliance Auditor at Physicians Health Plan
  • Kaitlyn Hammond
  • ALLIANCE MEMBER
  • Director of Government Programs at Cox HealthPlans
  • Kristen Hankins
  • ALLIANCE MEMBER
  • Director of Network Strategy - Confluence Health at Health Alliance Medical Plans
  • Holli Hansen
  • ALLIANCE MEMBER
  • Contracting Analyst at Avera Health Plans
  • Karen Hoffmann
  • ALLIANCE MEMBER
  • Director of Operations at Medical Associates Health Plans
  • Kim Hunn
  • ALLIANCE MEMBER
  • Senior Business Analyst at Samaritan Health Plans
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Tracy Jones
  • ALLIANCE MEMBER
  • Chief Compliance Officer at SummaCare
  • Shannon Kast
  • ALLIANCE MEMBER
  • PIU Analyst at Prominence Health Plan
  • Thomas Lauzon
  • ALLIANCE MEMBER
  • Manager of Healthcare Affordability at Health Alliance Plan (HAP)
  • Alan Lederman
  • ALLIANCE MEMBER
  • Chief Operating Officer at Community Health Plan of Washington
  • Flora Lewis
  • ALLIANCE MEMBER
  • Sr. Investigative Analyst at MediGold
  • Cindy Macdonald
  • ALLIANCE MEMBER
  • Audit and Recovery Specialist at Community Health Options
  • Mary McMaster
  • ALLIANCE MEMBER
  • Lead Investigator at CommunityCare
  • Tammy Miller
  • ALLIANCE MEMBER
  • Business Analyst at Baylor Scott & White Health Plan
  • Jaquelynn Mokry
  • ALLIANCE MEMBER
  • Physician Compliance Auditor at Baylor Scott & White Health Plan
  • Mai-Phuong Nguyen
  • ALLIANCE MEMBER
  • FWA Program Manager at Santa Clara Family Health Plan
  • Carol Pawlosky
  • ALLIANCE MEMBER
  • RN, BSN, SIU Program Manager at MediGold
  • Leslie Pels-Beck
  • ALLIANCE MEMBER
  • Chief Operations Officer at Sharp Health Plan
  • Lisa Potter
  • ALLIANCE MEMBER
  • Risk Adjustment coder/ Educator/MA Abstract Analyst II at Health Alliance Plan (HAP)
  • Teresa Prevost
  • ALLIANCE MEMBER
  • Vice President, Contracting at Alliant Health Plans
  • Cindy Ramos
  • ALLIANCE MEMBER
  • Health Care Investigator at MetroPlusHealth
  • Traci Rhodes
  • ALLIANCE MEMBER
  • Quality Improvement and Accreditation Manager at Cox HealthPlans
  • Celeste Richards
  • ALLIANCE MEMBER
  • Chief Operating Officer at Alliant Health Plans
  • Allison Runyan
  • ALLIANCE MEMBER
  • Supervisor of Risk Adjustment Operations at Health First Health Plans
  • Melissa Rusk
  • ALLIANCE MEMBER
  • Vice President Operations at SummaCare
  • Sherie Simmons
  • ALLIANCE MEMBER
  • Manager MAHP Claims at Medical Associates Health Plans
  • Kelly Skifton
  • ALLIANCE MEMBER
  • Assistant Vice President, Compliance & Government Regulatory Operations and Privacy at Quartz Health Solutions
  • Jeanne Skinner
  • ALLIANCE MEMBER
  • Manager, Appeals & Grievance at Network Health
  • Caryn Smith
  • ALLIANCE MEMBER
  • Director of Risk Adjustment at HealthTeam Advantage
  • Kristy Strain
  • ALLIANCE MEMBER
  • Administrative Fellow at Geisinger Health Plan
  • Hao Tian
  • ALLIANCE MEMBER
  • Senior HeathCare Financial Analyst at Santa Clara Family Health Plan
  • Monica Vizconde
  • ALLIANCE MEMBER
  • Compliance Specialist at Central Health Plan of California
  • Susan Waterman
  • ALLIANCE MEMBER
  • Director, Risk Adjustment at Baylor Scott & White Health Plan
  • Stephanie Wiegman
  • ALLIANCE MEMBER
  • Customer Experience Coordinator at Samaritan Health Plans
  • Todd Williams
  • ALLIANCE MEMBER
  • Director, SIU at Capital District Physicians' Health Plan (CDPHP)
  • Leona Zhu
  • ALLIANCE MEMBER
  • Risk Adjustment Coder at CCHP
  • Cheryl Zingaro
  • ALLIANCE MEMBER
  • Manager, AS&I and Subrogation at AvMed
Speakers