Tesco
Animal Health Institute
- Update on new CPT codes and "old" CPT codes and how to document
- Learning Objectives:
- Learn about new CPT codes coming January 2025
- Understand the documentation required for the codes
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.
9: 30 – 11 – AI Symposium
9:30 – Introduction
9:30 – 10:30 – The Future of AI in Healthcare Payments (Panel)
Panellists: Monique Pierce, Conor McCauley, Frank Shipp, Tom Everett
Moderator: David Ott, CGI
10:30 – 10:50 – Vendor Demos of AI Capabilities
10:50 – 11:00 – Optimizing AI in Healthcare Payment Integrity
Speaker: Natalie Clayton, Private Consultant
Monique Pierce
Payment Solutions & Operations
Cohere Health
Monique started her Payment Integrity career in COB at Oxford HealthPlans. After the merger with UnitedHealthcare, she led multiple teams and was responsible for creating innovative programs. Monique joined SCIO Health Analytics in 2014 and was responsible for system and process improvements before being promoted to VP of client engagement and business optimization In 2020, Monique joined start-up Devoted Health and created a full suite of programs from the ground up. Based on a passion for metrics and measuring performance, she centralized and standardized all programs reducing implementation time and maximizing savings. Today, Monique is driving opportunities to improve claim payment by designing and developing new prior auth and claim reconciliation products at Cohere Health.
Conor McCauley
Director, Payment Integrity Clinical Capabilites
Highmark Health
My name is Conor McCauley. I am the Director of Payment Integrity Clinical Capabilities at Highmark. Being a Critical Care nurse, it is easy to see there are issues surrounding healthcare funding. Inserting clinical insights into reimbursement methodologies can lead to affordability and improved patient outcomes. Clinicians are well positioned to make a difference here. My passion is developing an engaged team, effective processes, and surrounding clinicians with the right technology, data, and market insights so they can work at the top of their licensure.
Frank Shipp
Executive Director
Johns Hopkins Medicine
Frank E. Shipp currently serves as Executive Director of the Johns Hopkins Clinical Alliance, the clinically integrated network of Johns Hopkins Medicine. The network includes over 3,000 providers, consisting of both employed and independent practices.
Frank transitioned to value-based care after 25 years of hospital-based operations experience in both community and academic health systems. During the past nine years, Frank has held executive positions in a Payor-Provider Organization in NYC and has built a highly successful CIN over a five-year period in Northern New Jersey. Frank speaks regular at national healthcare conferences regarding value-based care strategies and tactics.
Frank completed his MBA at Fairleigh Dickinson University, is a certified Fellow of the American College of Healthcare Executives and a trained Black Belt in Lean Six Sigma from Villanova University.
Thomas Everett
Subject Matter
Expert Independent
David Ott
Director Consulting Payment Integrity
CGI
David Ott has over 28 years of experience in the healthcare and financial services industries. David has provided leadership and direction to department leaders and teams that support a variety of functions, including business development, payment integrity, claims processing, global project management and quality practices.
CGI
Website: https://www.cgi.com/us/en-us
Founded in 1976, CGI is among the largest IT and business consulting services firms in the world. We are insights-driven and outcomes-based to help accelerate returns on your investments. Across hundreds of locations worldwide, we provide comprehensive, scalable and sustainable IT and business consulting services that are informed globally and delivered locally.
This presentation will explore the various factors impacting claims trends, including utilization rates, unit costs, provider billing issues, claim payment mishaps, and inaccuracies in loading member benefits and provider rates. A key strategy to address these issues is the implementation of a robust payment integrity process. By combining the efforts of internal staff and expert vendors, payment integrity processes can significantly influence claims trends, thereby enhancing the overall profitability of health plans.
We will delve into specific examples to assess whether payment integrity efforts have successfully bent the claims trends or maintained them at a steady level. Additionally, the presentation will cover effective communication strategies with actuaries to ensure accurate data analysis and reporting. This dialogue is crucial for aligning strategic objectives and operational tactics with the actuarial insights necessary for informed decision-making in health plan management.
- Understanding of how to assess changes in claim trends
- How to effectively communicate with actuary teams to ensure accurate data analysis and reporting
Harold Davis
VP, Product Growth
Rialtic
Rialtic
Website: https://www.rialtic.io/
Rialtic is a next-generation platform that equips and enables players with the technology to take control of and execute their payment accuracy strategy. Rialtic’s first solution on the platform is a comprehensive code editing capability that combines the scope of editing typically found with both primary and secondary editors and merges it into a single platform supported by a modern user experience for managing policies, deviations, reporting, and provider inquiries. Our solution champions transparency — enabling greater understanding and control of your payment accuracy program and empowering payment accuracy teams to collaborate more effectively within their organization and with provider partners and employer groups.