Recovering Overpayments from Implantable Devices and High Cost Drugs

  • June 01, 2017
  • 1:00 PM – 2:00 PM ET
  • Online
about

Implantable devices and high cost drugs (“HCDs”) are a rapidly growing expense for payers. The fact is that implantables and HCDs were never intended to be a profit center for hospitals and yet that’s exactly what they’ve become. According to a recent market research report, the U.S. implantable medical devices market is expected to be worth $73.9 billion by 2018. As a result, a process is needed to combat overpayments and recover money wherever possible.

OmniClaim has pioneered auditing in this space and amassed enough experience and data to demonstrate that, for every HCD $1 audited, it will find 36-cents in overpayments and savings, and for every Implantable $1 audited, it recovers 29-cents.

This webinar will discuss strategies, advice and best practices for ensuring accurate payments and recovering of overpayments associated with implantable devices and HCDs.

What will attendees learn by participating:

  • The contract language and terms essential to avoiding overpaying for implantable devices and HCDs;
  • The importance of pre-screening claims for audit selection and the most effective methods for doing so;
  • Best practices for scheduling an audit in a timely fashion and advice for working with facilities to create the most efficient and effective processes;
  • The skillset and experience needed to conduct an efficient and effective review;
  • Common billing errors made by providers that result in overpayment;
  • How to properly finalize the audit process and the importance of obtaining sign-off acknowledging overpaid items.

Who should attend: Payer personnel engaged in cost containment and claims payment integrity


Speakers:


david-odonnelDavid F. O’Donnell, MBA, Chairman and Chief Executive Officer
Mr. O’Donnell has more than 35 years of senior-level healthcare management experience. Prior to founding OmniClaim, Mr. O’Donnell spent 25 years as Senior Vice President of Blue Cross Blue Shield of Massachusetts. At Blue Cross, Mr. O’Donnell administered the Medicare programs in Massachusetts, Maine, New Hampshire, and Vermont where he oversaw more than $2.5 billion in annual claims revenue. Mr. O’Donnell also headed up Planning and Development, and Administration. Mr. O’Donnell was a founding member and Director of two HMOs, Medical East and Medical West, now HMO Blue, one of the largest HMOs in the country.

Mr. O’Donnell has served on the boards of directors for numerous corporate and civic boards, including Advantage Health, which grew from a single site to more than 150 and was subsequently acquired by HealthSouth. Mr. O’Donnell has also served as President of The New England Institute for Health Care Research, a healthcare think tank.

 

tim-odonnelTimothy S. O’Donnell, J.D., President and Chief Operating Officer, OmniClaim
Mr. O’Donnell has over 25 years of senior-level healthcare management experience. Prior to co-founding OmniClaim, Mr. O’Donnell served as co-founder and COO of Apex Health, a physician practice management company. Mr. O’Donnell was responsible for the acquisition, management, and managed care contracting efforts for Apex’s 250 acquired and affiliated physicians. Under Mr. O’Donnell’s direction, same-clinic revenue of affiliated physician practices grew by 22% annually, more than double the national average. Previously, Mr. O’Donnell was a founder and principal of EMG, a healthcare consulting company serving hospitals and physician groups around the country. Mr. O’Donnell also founded and managed EMG Billing, a medical billing company.

Mr. O’Donnell graduated from Colby College where he majored in Classics and received a JD from Suffolk University. Mr. O’Donnell is a Trustee of Boston College High School.