Medical Cost Containment
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Wednesday, 10 Sep, 202508:00am09:00am
Discover how to turn price transparency from a regulatory requirement into a strategic advantage across revenue cycle management and payment integrity. This session will explore how hospitals and health plans can leverage pricing data to drive smarter audits, reduce payment disputes, and strengthen compliance, all while improving patient trust and financial outcomes.
Learning Objectives:
- Understand how both hospitals and health plans can integrate pricing data into payment integrity processes to proactively identify discrepancies, minimize denials, and resolve disputes more efficiently.
- Learn best practices for aligning data sources, contract terms, and audit strategies between health plans and hospitals to ensure ongoing compliance with price transparency regulations and avoid penalties
Medical Cost ContainmentAMS Intelligent Analytics
Website: http://www.amspredict.com/
Advanced Medical Strategies (AMS) is the premier provider of payment integrity, risk management, and business intelligence solutions to identify and address excessive claims, prevent and recoup overpayments, and effectively manage the risks associated with high-cost claimants and group health underwriting.
09:55am10:35am11:05amIn payment integrity, the real question isn’t just are you saving money?—it’s are you saving the right amount, efficiently? Without clear benchmarks, measuring true performance remains challenging. In this session, the MCC Benchmarking Report’s working groups will share how they have defined key metrics like savings per member per month (PMPM) , and how these benchmarks can help organizations evaluate effectiveness, identify gaps, and optimize strategies for sustainable savings and stronger returns.
Learning Objectives:- Explore how standardized metrics like savings per member per month can provide a clearer, apples-to-apples view of payment integrity effectiveness across organizations.
- Discover how to use these metrics not just for performance reporting, but as tools to identify inefficiencies, improve vendor strategies, and align internal teams around realistic, data-driven goals for optimal savings and sustainable returns.
Payment IntegrityDiagnosis codes and modifiers aren’t just billing details—they tell the story that determines how your claims are paid. When these elements don’t align, hospitals face denials, delays, and compliance risks. This session will break down how to accurately connect coding choices with billing practices to ensure claims reflect true clinical intent, reduce audit exposure, and secure appropriate reimbursement.
Learning Objectives:- Recognize the most common coding and modifier missteps that lead to denials and learn how to avoid them through stronger documentation and coding practices.
- Implement strategies to bridge gaps between clinical, coding, and billing teams—ensuring consistent, compliant claims that tell the right story from documentation to payment.
Revenue Cycle Management12:00pm01:30pmHospice care is meant to support patients in their final months of life, yet inappropriate or prolonged utilization continues to raise clinical, ethical, and payment integrity concerns. This session will provide critical insights into what constitutes appropriate hospice enrollment, how to identify red flags for overutilization, and strategies hospitals and health plans can use to ensure hospice services align with medical necessity.
Learning Objectives:- Understand the clinical criteria for appropriate hospice enrollment and identify common patterns of misuse that may lead to unnecessary costs and compliance risks.
- Gain tools and best practices for conducting eligibility reviews, improving documentation scrutiny, and collaborating across teams to prevent improper payments while supporting appropriate patient care.
Payment IntegrityAs value-based care continues to reshape payment models, many health systems struggle to balance financial performance with care quality goals. This session will offer practical strategies to use denial data, coding insights, and care coordination metrics to strengthen value-based outcomes—without sacrificing revenue. This discussion will highlight how to engage teams, optimize processes, and identify sustainable financial opportunities within value-based contracts.
Learning Objectives:- Learn how to use denial patterns and audit insights to improve documentation, coding accuracy, and contract performance.
- Gain strategies to foster physician buy-in and leadership collaboration, finding “win-win” solutions that support both revenue integrity and value-based care success.
Revenue Cycle Management02:25pm03:05pmPayment integrity can be challenging to navigate, especially for smaller or regional health plans new to this field. In this session, experienced leaders will share their insights on how emerging trends - such as the growing use of AI and the increasing demand for timely data exchange - are shaping the field. The panel will provide practical advice on building a strong foundation, avoiding common challenges, and improving savings for plans at any stage of their payment integrity journey.
Learning Objectives:- Learn how to evaluate vendor capabilities and build strategic alliances that scale with your needs.
- Get a framework for launching a PI strategy appropriate for your plan’s size and strategic direction.
- Understand current trends such as the merging of fraud and integrity functions and the shift toward collaborative data-sharing.
Payment IntegrityAlivia Analytics
Website: https://www.aliviaanalytics.com/
Your most expansive Payment Integrity and FWA partner for medical, pharmacy, vision, and dental claims. This features our powerful, configurable Alivia 360™ Platform that provides pre- and post-payment flexibility and considerable cost savings across the healthcare claims management process. It seamlessly transitions between FWA detection and Payment Integrity solutions including clinical and non-clinical audit scenarios, first- and second-pass claims editing, and COB/TPL. Alivia 360™ not only ensures comprehensive financial oversight but full adaptability to operational needs. Alivia integrates AI as an assistant, not a replacement, prioritizing ethical use, human oversight, and compliance with industry standards. Our solutions are offered as SaaS or tech-enabled services that build strong cases against inappropriate billing practices, identify new recoveries missed by legacy vendors, deliver actionable analytics, and offer automated corrections. Alivia enables healthcare payers to streamline vendor management, improving control and strategic decision-making. Schedule a discovery meeting and demo.
Denial management isn’t just about fighting back—it’s about understanding why denials happen and fixing the root causes upstream. This session will focus on how hospitals and health systems can use audit findings and denial data to identify coding gaps, documentation weaknesses, and process breakdowns that lead to preventable denials. Learn how to close these gaps through stronger internal collaboration across revenue cycle, coding, and clinical teams, while also using data-driven insights to foster more productive payer relationships.
Learning Objectives:- Learn how to analyze denial patterns and audit results to uncover documentation, coding, and process issues—enabling proactive prevention rather than reactive rework.
- Discover best practices for improving internal workflows, fostering collaboration between clinical and revenue cycle teams, and ensuring that claims reflect accurate, defensible coding and clear clinical intent.
Revenue Cycle Management04:30pm -
Thursday, 11 Sep, 202508:55am09:00am
Payer-provider abrasion remains one of the biggest barriers to efficient payment, timely care, and operational success. Too often, denials, delayed payments, and prior authorization disputes stem from misaligned expectations, incomplete data, and unclear communication—not true disagreement. This session will offer a candid, solutions-focused discussion on what payers really need from providers, what providers can do upfront to reduce friction, and how both sides can work together to minimize rework, prevent avoidable denials, and create shared wins.
Learning Objectives:- Gain clear insights into how providers can proactively align documentation, coding, and authorization workflows to meet payer requirements and reduce denials and appeals.
- Learn practical approaches to improve data sharing, reduce ambiguity in clinical and billing documentation, and foster payer-provider partnerships that lead to faster resolutions and fewer administrative burdens.
- Explore strategies to move beyond transactional interactions and build trust-based partnerships between payers and providers—focusing on shared goals like timely care, accurate payment, and operational efficiency.
Medical Cost Containment09:55am10:35am11:05amAs AI use rapidly expands across health plan operations, understanding how these technologies will be governed is essential. In this session, experts will take a deeper dive into the current state of AI governance frameworks and the legislative landscape shaping their use. Health plan leaders will gain timely insights into what’s happening now—and what’s coming next—in AI oversight, helping them prepare their organizations for compliance, accountability, and responsible innovation.
Learning Objectives:- Learn how to assess, document, and monitor AI models used in claims review, fraud detection, and payment integrity to ensure they meet accountability, explainability, and compliance standards.
- Gain actionable insights into current and pending legislation on AI use in healthcare, and understand what steps your organization should take now to align with evolving regulatory expectations and avoid audit risks.
As payers increasingly deploy AI and automation to accelerate denials and reduce payments, health systems must evolve their own technology strategies to keep pace. This session will share best practices for integrating AI, automation, and machine learning into revenue cycle operations—drawing on real-world examples from leading health systems, hospitals and practices. Explore the journey of implementing automation and machine learning while navigating governance, overcoming technical hurdles, and fostering adaptability across teams.
Learning Objectives:- Understand technical and operational obstacles in adopting automation and AI tools, and learn proven strategies to overcome them effectively.
- Gain insights into building flexible governance frameworks, supporting staff education, and fostering adaptability to maximize the impact of emerging technologies in your revenue cycle.
12:00pm12:00pm02:25pm02:55pmEngage with quick, interactive demos from emerging vendors as they present new and innovative payment integrity and RCM solutions. A panel of judges will award the "Innovator of the Year" to the vendor with the most promising technology or approach. Apply here to showcase your solution or sign up here to join the judging panel.
Medical Cost Containment03:45pm04:25pm04:55pmAccurate risk adjustment coding is a cornerstone of effective payment integrity, directly impacting reimbursement accuracy and audit risk. This session will explore how health plans can strengthen HCC coding through targeted audits, technology solutions, and coder education—ensuring proper risk score capture, reducing payment errors, and supporting defensible, compliant payment practices.
Learning Objectives:
- Understand common sources of coding errors and how to use audit findings, coder education, and feedback loops to strengthen HCC coding precision and reduce payment risk.
- Explore how strong auditing practices, clear documentation standards, and focused coder training can help health plans identify gaps, improve coding accuracy, and ensure compliance across payment integrity programs.
As real-time data sharing becomes essential for care coordination, prior authorizations, and value-based care, hospitals and health systems face growing pressure to exchange sensitive information quickly—without compromising security. This session will explore how provider organizations can balance the need for timely data access with robust cybersecurity strategies. Learn practical approaches to mitigate risk, protect patient information, and build the infrastructure needed for secure, compliant data sharing across systems and partners.
Learning Objectives:- Understand key risks associated with real-time data sharing and learn strategies to safeguard PHI while supporting operational and clinical needs.
- Explore best practices for access controls, vendor oversight, encryption, and audit readiness to enable safe data sharing across health systems, payers, and partners.
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