Healthcare Payment And Revenue Integrity Congress (HPRI West)

The Healthcare Payment And Revenue Integrity Congress (HPRI West) is dedicated to the integrity of claims, payer-providers relationships and the transition to value-based payments>.

Topics

• Developing A Payment Integrity Program From The Ground Up
  • Opportunities and the challenges of building and effectively managing PI programs that prevent, avoid, or recover billing errors, payment errors and other party liability errors
  • Developing a Payment Integrity Program from the ground up for a brand new Medicare Advantage Health Plan
  • Suggestions/ advice from our success, and lessons learned
• CMS Center for Program Integrity (CPI) Updates
  • The use of the Government Accountability Office Fraud Risk Management Framework to develop anti-fraud strategies and react to emerging threats, updates on our Marketplace fraud work, and opportunities for private-public collaboration
  • Insider`s view of CPI and CPI`s priorities
• Claims Audit - Payment Integrity
  • Archaeology amongst savings drivers? High $ treasures?
  • How does Claim Audit fit into the overall savings goals from PI?
  • Do underpayments matter?
  • Claim Audit Digs & Research - driving process improvement, not just savings
  • Partnering with other departments as a true "Partner" not an "Auditor."
  • How to keep finding treasure:
  • It will all be in a museum (creating reference materials)