Using Post-payment Insights to Build Strong Pre-payment Claims Review Programs

Presented by

Erin Picton, AHFI, Investigations Manager, General Dynamics Health Solutions

About this talk

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.

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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.