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Payment Accuracy Starts Before the Claim is Submitted

  • October 24, 2019
  • 2:00 PM – 3:00 PM ET
  • Online
about

Waste in the U.S. health care system is astronomical. Estimates range from the hundreds of billions to over a trillion dollars. Virtually all key constituents agree that improving the incredibly complex payment process – or claims processing – offers a huge opportunity to reduce waste in administrative and medical-cost savings, as well as “soft cost savings” like increased loyalty and improved satisfaction.

The payment process, however, is a virtual labyrinth involving multiple steps forward and back, including primary editing, pre-payment review, audit and recovery, and more. And of course, there are countless solutions that can improve accuracy at each individual stage of the process.

But what if there were an opportunity to drive accuracy when a claim is submitted for payment, or before it is submitted to the payer and enters the editing, adjudication, review, and even recovery processes?

Attendees will learn

  • How to create a payment accuracy strategy that starts at the point of submission, and even before the claim is submitted
  • How Highmark is improving accuracy on high-volume, low-dollar claims to drive tangible savings, and improving provider relationships through the process
  • How crystal-clear analytics and ongoing collaboration with providers can improve claims-processing accuracy
  • The results of research illustrating how organizations across the county are changing provider behavior to improve billing accuracy

Speakers


Chris Hall
Director of Operations, Payment Integrity
Change Healthcare

Chris Hall has been with Change Healthcare for over 20 years and is currently the Senior Director of Operations for Payment Integrity. In addition to serving as a subject matter expert in Change Healthcare’s product and business development efforts, Chris’ current role has him leading the operations for the Coding Advisor solution. Having worked in the payment integrity space for over 23 years, Chris has extensive experience working as a thought leader in Fraud, Waste, and Abuse. Previous roles have allowed Chris to gain valuable industry exposure in the property/casualty arena, workers compensation, disability, life, and health. Chris is a Health Care Anti-Fraud Associate, has previously served a number of years as the co-chairman for the Midwest Anti-fraud Insurance Association, and has been a frequent guest speaker at numerous regional and national health care conferences.


Andrew M. Satriano, CPA, Esq Director,
Payment Integrity
Highmark

Drew has a bachelor’s in Accounting and an MBA and has been with Highmark since graduation. Drew started as an auditor and quickly moved through the ranks to a supervisor and then manager of the department. During his tenure in audit Drew obtained his CPA license, his Certified Fraud Examiner’s certification, a Master’s Certificate in Government Contracting from George Washington University, and his Juris Doctorate from Duquense University where he was a staff member of the Duquesne Law Review and in his final year served on the Editorial Board as a Research Editor and received the Excellence for the Future Award in the Study of Federal Criminal Law.

After about 10 years in Audit, Drew joined the newly organized Health Plan Operations area as Director of Finance and Compliance which he designed and built to support approx. 3500 FTEs and a budget of $280M. Drew’s scope increased during this timeframe to include disaster recovery, security audits, vendor relationship management, operations quality and managed the reporting and analytics teams on two separate occasions. Drew was responsible for managing efforts related to a reduction of administrative costs of $50M over 30 months.

In 2014, Drew transitioned over to Payment Integrity to build out the vision for Highmark. Since forming the Payment Integrity organization Drew has managed to grow Payment Integrity savings at Highmark by over 250% since then mainly through strategic partnerships with vendors with a primary focus on pre payment.