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Interview - Daniel Gysel
Interview - Matthias Greiller

In the dynamic landscape of healthcare, Payment Integrity is evolving beyond its traditional role of avoiding or recovering overpayments. This presentation explores how Payment Integrity can become the foundational driver of business intelligence within Payer organizations. Instead of perpetually avoiding or recovering overpayments, we propose harnessing the vast expertise of Payment Integrity audit professionals to identify, aggregate, and quantify key areas of continued overpayment. By working collaboratively with various stakeholders, these professionals can provide a roadmap, specific details, and root cause analysis to fix system edit issues, negotiate improved contract reimbursements, and align reimbursement and medical policies with industry benchmarks. This paradigm shift not only can significantly reduce the medical cost of care, optimizes financial performance but also, this approach and expanded role can foster a culture of continuous improvement and cost-effective healthcare.

Author:

Dave Cardelle

Chief Strategy Officer
AMS

Dave Cardelle, R.Ph., is on the executive team at AMS and serves as the Chief Strategy Officer. He leads a dedicated team of professionals focused on transforming the payment integrity (PI) industry. With a BS in Pharmacy from the Massachusetts College of Pharmacy in Boston, MA, Dave brings a unique blend of healthcare expertise and domain knowledge to his role.
As the CSO, Dave leverages years of experience in the PI industry, including working for both Payer and Provider organizations to help AMS grow through innovative product, sales, marketing, and client relationship strategies.
Throughout his career, Dave has consistently demonstrated a keen understanding of healthcare-related matters, a skill that proves invaluable in the context of payment integrity. His passion for advancing the industry and commitment to maintaining the highest standards of integrity have earned him a reputation as a true industry expert.

... read more

Dave Cardelle

Chief Strategy Officer
AMS

Dave Cardelle, R.Ph., is on the executive team at AMS and serves as the Chief Strategy Officer. He leads a dedicated team of professionals focused on transforming the payment integrity (PI) industry. With a BS in Pharmacy from the Massachusetts College of Pharmacy in Boston, MA, Dave brings a unique blend of healthcare expertise and domain knowledge to his role.
As the CSO, Dave leverages years of experience in the PI industry, including working for both Payer and Provider organizations to help AMS grow through innovative product, sales, marketing, and client relationship strategies.
Throughout his career, Dave has consistently demonstrated a keen understanding of healthcare-related matters, a skill that proves invaluable in the context of payment integrity. His passion for advancing the industry and commitment to maintaining the highest standards of integrity have earned him a reputation as a true industry expert.

 

Kay Larsen

Revenue Integrity Specialist
Adventist Health

Kay Larsen

Revenue Integrity Specialist
Adventist Health

Kay Larsen

Revenue Integrity Specialist
Adventist Health
Innovation Showcase Starter Pack

Payment integrity analytics is a critical tool for organizations of all sizes to protect themselves from fraud, waste, abuse and error. In this session, attendees will learn about how to:

  • Identify and assess common payment integrity risks
  • Use analytics to detect, investigate, and mitigate suspicious activity
  • Implement an integrated payment integrity solution to improve efficiency and effectiveness

Author:

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

... read more

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

 

Michael Devine

Director Special Investigations Unit
L.A Care

Michael Devine

Director Special Investigations Unit
L.A Care

Michael Devine

Director Special Investigations Unit
L.A Care
  • Itemized Bill Reviews (Led by Peformant, moderator TBC)
  • DRG Validations
  • The Changing World Of Payment Integrity As It Relates To VBC