The healthcare landscape is fraught with complexity and financial pitfalls and small-to-medium-sized health plans often find themselves vulnerable to inflated claims, hemorrhaging millions annually.
Payment integrity products like DRG Coding and Clinical Validation, Hospital Bill Audits, Data Mining, and more, can offer immediate reinforcement against dubious claims. But which products should be deployed, when should they be implemented, what are the best practices for their utilization, and how do you effectively evaluate their impact?
In this session, discover how merging clinical expertise with AI technology enhances payment integrity solutions and evaluate in-house, outsourced, or combined approaches based on reassignment and appeal overturn rates for optimal financial protection.
In a world where healthcare fraud runs rampant and financial losses mount, a strategic plan for payment integrity stands as a beacon of hope for small to medium-sized health plans, offering a formidable defense against the forces of fiscal depletion. This discussion will provide a framework for developing a strategic approach to financial stability.
Ted Pitynski
As the Chief Commercial Officer, Ted is responsible for the commercial growth of the company through his leadership of sales, marketing, and product management. Ted brings a wealth of knowledge from more than two decades of experience developing go-to-market strategies for selling complex healthcare solutions to payers, government agencies, benefit trusts and employers. Ted collaborates with sales teams, prospects, partners, and customers to capitalize on revenue-enhancing opportunities, setting new standards in the payment integrity industry.
Prior to joining MedReview, Ted transitioned from the finance sector to healthcare with a fervent commitment to revolutionizing the healthcare landscape. He was previously the Vice President of Self-Insured Solutions and Partnerships for ArmadaHealth, where he developed and executed the company’s distribution strategy. Ted also spent eight years as the Director of Health Plan Partnerships for HealthMedia, a wholly owned subsidiary of Johnson & Johnson.
MedReview
Website: https://www.medreview.us/
MedReview sets itself apart with over 50 years of experience delivering physician-approved pre-pay and post-pay payment integrity services that prioritize billing and payment quality, accuracy, and precision. Every claim reassigned by MedReview is reviewed, approved, and documented by a team of physicians, resulting in the industry’s lowest appeal overturn rate.
Utilizing proprietary technology combined with extensive subject matter clinical and administrative expertise, we achieve a 40% or greater reassignment rate focused on our clients’ specific needs. MedReview provides the full spectrum of payment integrity solutions including DRG and clinical reviews, cost outlier audits, re-admission reviews, data mining and itemized bill reviews.
Partnered with clients across the country, MedReview offers a flexible approach, supporting both complete outsourcing and supplemental enhancements to existing programs. By optimizing recoveries, preventing overpayments, and improving the provider experience, MedReview empowers payors to navigate the complexities of payment integrity with confidence and measurable success.
