Erin Picton, AHFI, Investigations Manager, General Dynamics Health Solutions
Building and maintaining an effective pre-payment claims review program can be challenging without leveraging prior inappropriate billing patterns or checks against fraud trends that were previously identified during post-payment claims reviews. In this session, participants will learn the importance of gathering and leveraging information from post-payment reviews to significantly strengthen pre-payment review programs, as well as the use of ICD-10 codes and outliers that can help generate new leads based on current billing trends and better address claims system vulnerabilities.
James Ullom, MRR Services Manager, General Dynamics Health Solutions
Retrieving medical records from providers can be the most challenging aspect of the HEDIS hybrid measure season and its success can have the most direct impact on hybrid rates. Learn ways to improve your chart retrieval processes to increase your success at receiving your member’s medical records during the busy HEDIS season.
Ken Georgi, Vice President, Healthcare Enterprise Systems, General Dynamics Health Solutions
Based on our extensive integration experience and deep partnerships with a broad array of cloud service providers, General Dynamics Health Solutions supports customers in identifying the right solution to meet technical requirements, business functionality and budget. Whether you are moving to the cloud, already in the cloud or managing multiple clouds, we can guide your organization to the optimal solution for your unique mission and budget.
Today’s challenging healthcare environment demands that we find new ways to improve the quality of care, ensure efficiency and transform healthcare services. Learn how General Dynamics Health Solutions helps organizations successfully navigate this changing landscape and thrive in a new world committed to measuring outcomes and value.
Whether you are moving to the cloud, already in the cloud or managing multiple clouds, General Dynamics Health Solutions can guide your organization to the optimal solution for your unique mission and budget. Offering a portfolio of cloud solutions, we provide the choice and confidence to select the most cost-effective, functional and low-risk environment to meet business needs and requirements.
Jessica Gay and Mark Starinsky, Service Delivery Managers, General Dynamics Health Solutions
In the absence of fraudulent providers’ confessions, data analysis is the backbone of successful FWA investigations. This session explores effective techniques for spotting red flags, using associated data analysis techniques, and detecting FWA across various provider specialties from different angles, including pooled data and public records.
General Dynamics Health Solutions, part of General Dynamics Information Technology, provides end-to-end solutions and professional services to health organizations in the defense, federal civilian government, state and local government, commercial and international sectors. Headquartered in Fairfax, Va., with major offices worldwide, company capabilities include Health Data Management and Analytics, Multi-Channel Health Communications, Health Facility Outfitting and Logistics, Clinical Staffing and Medical Research Services, Healthcare Administrative Services, and IT Services and Infrastructure.