Data Marshall is a tech enabled Revenue Cycle platform headquartered in Franklin, TN with a global presence. We have been operating successfully for 20 years, specializing uniquely in both payer and provider services to give us a 360-degree understanding of the claim life cycle. Data Marshall has launched a 2.0 version of our organization, making significant strategic investments in talent and technology, and taking the most aggressive pricing approach in the industry. We are taking full revenue risk against our SLAs. Simply put, we perform or we don’t get paid. We prioritize our clients’ goals as our own, whether it is increased enterprise valuation, cost reduction, or operational continuity. We are confident that we are the best partner possible for provider platforms.
The youngest child of Holocaust survivors, Ed moved to the United States at age 10. At 16, he served as a medical clinic janitor where he discovered his healthcare calling. Ed took successive positions as combat medic, anesthesia tech, strategic planner and technology manager. He quickly learned how the convergence of clinical, business and digital saved lives. His passion ignited, he jumped feet first into technology and operations in the C-Suite of Cleveland Clinic, NYC Health & Hospitals, Texas Health Resources and University Hospitals.
Intermixed, Ed served the supplier side as well. He was CEO for consulting firm Divurgent, global CDO for Tech Mahindra Health & Life Sciences and CIO of the Advisory Board. Concurrently, he served 15 years as an Army combat engineer officer and combat medic. Today, Ed is focused on his own advisory practice.
Ed does a fair amount of speaking, writing and podcasting. He authored healthcare bestsellers including “Voices of Innovation” and “Healthcare Digital Transformation”. He is currently writing a book for Mayo Clinic on “Patient Experience” and “Voices of Innovation - Payers”. His podcast “DGTL Voices” is “Top 3%” globally. His Blog, CEO Unplugged, surpassed 1M views. Ed recently started a YouTube channel to expand his audience.
Most importantly, Ed is husband to Simran who holds a Doctor of Nursing (DNP). They love to dance and climb mountains. They have 5 grown children and 4 grandchildren. To stay fit, he is captain of TeamUSA Triathlon.
For more career information you can find me:
Twitter https://twitter.com/marxtango
LinkedIn https://www.linkedin.com/in/edwardmarx/
Website https://www.marxadvisory.com/
The youngest child of Holocaust survivors, Ed moved to the United States at age 10. At 16, he served as a medical clinic janitor where he discovered his healthcare calling. Ed took successive positions as combat medic, anesthesia tech, strategic planner and technology manager. He quickly learned how the convergence of clinical, business and digital saved lives. His passion ignited, he jumped feet first into technology and operations in the C-Suite of Cleveland Clinic, NYC Health & Hospitals, Texas Health Resources and University Hospitals.
Intermixed, Ed served the supplier side as well. He was CEO for consulting firm Divurgent, global CDO for Tech Mahindra Health & Life Sciences and CIO of the Advisory Board. Concurrently, he served 15 years as an Army combat engineer officer and combat medic. Today, Ed is focused on his own advisory practice.
Ed does a fair amount of speaking, writing and podcasting. He authored healthcare bestsellers including “Voices of Innovation” and “Healthcare Digital Transformation”. He is currently writing a book for Mayo Clinic on “Patient Experience” and “Voices of Innovation - Payers”. His podcast “DGTL Voices” is “Top 3%” globally. His Blog, CEO Unplugged, surpassed 1M views. Ed recently started a YouTube channel to expand his audience.
Most importantly, Ed is husband to Simran who holds a Doctor of Nursing (DNP). They love to dance and climb mountains. They have 5 grown children and 4 grandchildren. To stay fit, he is captain of TeamUSA Triathlon.
For more career information you can find me:
Twitter https://twitter.com/marxtango
LinkedIn https://www.linkedin.com/in/edwardmarx/
Website https://www.marxadvisory.com/
Medical implants and biologics are a critical part of modern healthcare, but the FDA approval process for these devices is flawed creating provider and payor policy coverage confusion. Many implants are approved through the 510(k) pathway, which allows new devices to be cleared based on similarity to existing products and real world evidence data, rather than requiring clinical trials to demonstrate safety and efficacy.
This presentation will provide an in-depth look at the issues with the current FDA approval framework for implantable devices. We will examine case studies of problematic implants that have led to patient complications, and discuss the lack of reliable evidence required for many products. Attendees will learn about the criteria for reliable evidence that health plans should utilize to create coverage policies.
The session will address considerations for payors to protect members and ensure appropriate care, highlighting the role of payment integrity teams in identifying and validating implant charges.
By the end of this session, attendees will have a comprehensive understanding of the systemic issues with medical implant and biologics regulation, and practical approaches their organizations can implement to ensure appropriate utilization.
Learning Objectives/Key Takeaways of the Session (max 50 words, 2-3 bullet points):
Ellen is a registered nurse with extensive experience spanning clinical care and the health insurance industry, making her an expert in payment integrity and claims review. She has served as a clinical leader and consultant for payors and payment integrity companies. She excels in auditing high-value claims for third-party administrators and stop-loss carriers, while also providing clinical support to clients and addressing claim-related inquiries.
At MedReview, Ellen oversees the planning and development of Medicare and Medicaid hospital bill and DRG validation reviews and is also responsible for the oversight of the foreign and domestic nurse auditor teams conducting those reviews. An authority on Medicare and Medicaid policies, Ellen’s expertise also includes quality assurance oversight, peer review programs, and health plan contract interpretation.
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.
This presentation will delve into the latest trends and tactics employed by fraudsters, providing actionable insights to safeguard your organization. Attendees will gain a comprehensive understanding of the evolving threat landscape, learn to identify red flags and implement effective prevention strategies.
Maxillofacial surgeries and advancements with cutting edge technologies have evolved into an area of cosmetic and non-covered benefit abuse when billed to medical plans. Venture capitalists are disrupting the dental industry by purchasing large practices, promoting unnecessary procedures and opening Wellness Centers within dental practices. This presentation will identify the most common oral surgery procedures billed to medical plans, identify clinical schemes and misrepresentations being used to bypass edits. Holistic dental procedures will be addressed. This will allow medical review staff to gain an understanding into the complex language of dentistry to enhance investigations.
Artificial Intelligence (AI) and generative AI have the transformative potential to revolutionize the payment integrity industry. These advanced digital capabilities are no longer visionary concepts but live practices that empower team members to work at the top of their licenses. By employing a human-in-the-loop approach to AI, payment integrity professionals can operate beyond gathering and collating data and focus on making critical decisions while staying at the forefront of these industry-changing innovations. This session will share real-world use cases on how these technologies are enabling transformative change – and ultimately driving improved outcomes – including how to access and interpret both structured and unstructured data, automate the distillation of critical insights from data into actionable information, and expose payment integrity vulnerabilities and accelerate mitigation initiatives.
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have over 57,000 employees spanning six continents. For more information, visit www.exlservice.com.
