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.
Track 2: Revenue Cycle Management & Revenue Integrity
Track 1: Payment Integrity
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