In the dynamic landscape of healthcare, Payment Integrity is evolving beyond its traditional role of avoiding or recovering overpayments. This presentation explores how Payment Integrity can become the foundational driver of business intelligence within Payer organizations. Instead of perpetually avoiding or recovering overpayments, we propose harnessing the vast expertise of Payment Integrity audit professionals to identify, aggregate, and quantify key areas of continued overpayment. By working collaboratively with various stakeholders, these professionals can provide a roadmap, specific details, and root cause analysis to fix system edit issues, negotiate improved contract reimbursements, and align reimbursement and medical policies with industry benchmarks. This paradigm shift not only can significantly reduce the medical cost of care, optimizes financial performance but also, this approach and expanded role can foster a culture of continuous improvement and cost-effective healthcare.

Payment integrity analytics is a critical tool for organizations of all sizes to protect themselves from fraud, waste, abuse and error. In this session, attendees will learn about how to:

• Identify and assess common payment integrity risks
• Use analytics to detect, investigate, and mitigate suspicious activity
• Implement an integrated payment integrity solution to improve efficiency and effectiveness

• Itemized Bill Reviews (Led by Peformant, moderator TBC)
• DRG Validations
• The Changing World Of Payment Integrity As It Relates To VBC

• In healthcare to optimize skills, understanding, and expertise used to improve the value of products, it is essential to remove clinical and financial silos. Collaborating and aligning revenue teams with value analysis teams provide a platform to tell the entire business story in healthcare, decrease cost, and increase revenue. 
• Relationships in this arena generate opportunities to find billing and charging errors, and implement best practices into workflow, procedures, and buying trends. Collaboration benefits the teams by offering vital evidence that helps providers make judicious choices about the products they may want to bring into facilities.  A revenue cycle analyst can aid in the discovery of problems with processes or old ways of how and where procedures are performed. Using dashboards, reports, and charging and reimbursement data can be seamlessly be integrated into existing value analysis processes making it easy to collaborate on the best ways to achieve your revenue targets.

• Importance of accurate and complete clinical documentation
• Addressing common coding challenges and complexities faced by providers
• Driving revenue integrity with a robust CDI program