All Systems Go: Aligning Payment Integrity Efforts For Greater Results

In order to ensure their payments to providers are accurate, payers employ a variety of solutions including: data mining, clinical auditing, and special investigations units (SIUs). 

Each of these payment integrity solutions and more were initially created to address a specific improper payment issue. However, just as claim FWA continually shifts over the years, so too does the focus, responsibilities, and tactics of these departments. 

Over time, each area’s natural evolution to keep pace with claim FWA carried the unintended side effect of generating both redundancies and blind spots for the payer. Viewed as a whole, it is clear that payment integrity efforts are increasingly disjointed, inefficient, and unable to handle the complex FWA schemes we encounter today. Unless we facilitate a paradigm shift in how we support all of the stakeholders involved, we risk further diminishing returns from our efforts. 

We invite you to join us for a complimentary webinar where our experts will discuss how to foster a culture of cross-department collaboration, align payment integrity efforts, and achieve greater results more efficiently. 

Specific topics will include:

  • Robotic Process Automation
  • Holistic Claims Auditing
  • Universal Logic/Rules Engine
    • Advanced Fraud Algorithms
  • Incremental Provider Behavior Modification

REGISTER NOW: 

Speakers:

  • Leslie Vairo, Manager Product Management Reimbursement Optimization
    Leslie manages the entire product lifecycle from strategic planning to tactical activities for SCIO’s Reimbursement Optimization platform, SCIOMine. In this role she leads the planning and activities that involve working directly with clients, technology, analytics, and business operations to develop new products and enhance existing solutions. Prior to joining SCIO, Leslie spent over 20 years in healthcare consulting, supporting reimbursement integrity for healthcare providers nationwide.
  • Ricky D. Sluder, CFE, Vice President, Healthcare Solutions
    Ricky draws from 20 years of combined experience within Criminal Investigations, Medicare/Medicaid Program Integrity, Healthcare FWA Solution Design, and Business Consulting fields.  He successfully developed an analytic and operational model that led to over $400 million in improper payment recoveries and over $1 billion in fraud prosecutions in the year of 2011, for the Centers for Medicare and Medicaid Services (CMS).  At EXL, Ricky serves as Vice President of Healthcare Solutions where he drives the creation of Programmatic Solutions for Healthcare Program/Payment Integrity.
Some additional information in one line