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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

Author:

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

... read more

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

 

Michael Devine

Director Special Investigations Unit
L.A Care

Michael Devine

Director Special Investigations Unit
L.A Care

Michael Devine

Director Special Investigations Unit
L.A Care
  • 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.

Author:

Lori Jensen

Director of Value Analysis
University of Utah Health
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Lori Jensen

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

Author:

Stacy Reck

Director of Clinical Documentation Improvement and Utilization Review
Avera Health
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Stacy Reck

Director of Clinical Documentation Improvement and Utilization Review
Avera Health
 

Stacy Reck

Director of Clinical Documentation Improvement and Utilization Review
Avera Health

Stacy Reck

Director of Clinical Documentation Improvement and Utilization Review
Avera Health

Stacy Reck

Director of Clinical Documentation Improvement and Utilization Review
Avera Health
 

Stina Redford

Director of Payment Innovation
Blue Cross of Idaho

Stina Redford

Director of Payment Innovation
Blue Cross of Idaho

Stina Redford

Director of Payment Innovation
Blue Cross of Idaho
 

Victoria Friedman

Managing Partner & Director- USA
Dennemeyer & Associates

Victoria Friedman is an IP attorney specializing in client counseling, procurement and management of intellectual property. Her day-to-day practice involves patent and trademark preparation and prosecution, opinions of counsel, portfolio strategy and management, licensing, business transactions and much more. Her technical background is in Computer Information Systems and her patent practice primarily focuses on software, telecommunications, computer, search, email and social network arts.

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Victoria Friedman

Managing Partner & Director- USA
Dennemeyer & Associates

Victoria Friedman

Managing Partner & Director- USA
Dennemeyer & Associates

Victoria Friedman is an IP attorney specializing in client counseling, procurement and management of intellectual property. Her day-to-day practice involves patent and trademark preparation and prosecution, opinions of counsel, portfolio strategy and management, licensing, business transactions and much more. Her technical background is in Computer Information Systems and her patent practice primarily focuses on software, telecommunications, computer, search, email and social network arts.

In her trademark practice, she manages international portfolios for top global brands in various industries. Friedman is one of a handful of attorneys who have been successful in registering a color mark. She enjoys developing and implementing efficient, practical solutions to her clients' IP challenges.

Victoria Friedman speaks English and Russian and has been active in the field of IP since 2003.

 

Mimi Diemmy Dao

Managing Director- IP
Applied Materials

Mimi Diemmy Dao

Managing Director- IP
Applied Materials

Mimi Diemmy Dao

Managing Director- IP
Applied Materials