Kay Larsen
Revenue Integrity Specialist
Adventist Health
Kay Larsen
Revenue Integrity Specialist
Adventist Health
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
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.
Healthcare Fraud Shield
Website: www.hcfraudshield.com
Healthcare Fraud Shield (HCFS) is a leading provider of fraud, waste, abuse, and error (FWAE) detection and payment integrity solutions for healthcare payers nationwide. Our platform stops improper claims before payment and detects issues after payment using advanced analytics, AI, and shared intelligence from a broad client network. With over 14 years of exclusive focus on FWAE and payment integrity, HCFS was built by industry experts to deliver measurable results. Clients typically achieve an average up to 10:1, and higher when leveraging HCFS Services.
Why HCFS:
- Enterprise-wide SaaS solution – Used by health plan teams across SIU/FWA, Payment Integrity, Risk, UM, Claims, Legal, Operations, and Finance
- 2,100+ FWAE rules – The largest FWAE rule library in the industry
- AI + Human-in-the-Loop – 11 AI models (FWA360Leads, AIShield, RecordPlus), all expert-validated
- Shared Analytics – Insights from 95M+ members across plans to uncover new, high-value cases beyond internal data
- 85+ external data sources – Enrich claims data for more precise detection
- Trusted by 70+ clients, including 7 of the 10 top commercial payers and 3 of the 5 of the top national payers
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
- In healthcare to optimize skills, understanding, and expertise used to improve the value of products, it is essential to remove clinical and financial silos. Collaborating and aligning revenue teams with value analysis teams provide a platform to tell the entire business story in healthcare, decrease cost, and increase revenue.
- Relationships in this arena generate opportunities to find billing and charging errors, and implement best practices into workflow, procedures, and buying trends. Collaboration benefits the teams by offering vital evidence that helps providers make judicious choices about the products they may want to bring into facilities. A revenue cycle analyst can aid in the discovery of problems with processes or old ways of how and where procedures are performed. Using dashboards, reports, and charging and reimbursement data can be seamlessly be integrated into existing value analysis processes making it easy to collaborate on the best ways to achieve your revenue targets.
Lori Jensen
Director of Value Analysis
University of Utah Health
- Importance of accurate and complete clinical documentation
- Addressing common coding challenges and complexities faced by providers
- Driving revenue integrity with a robust CDI program
Stacy Reck
Director of Clinical Documentation Improvement and Utilization Review
Avera Health
Stacy Reck
Director of Clinical Documentation Improvement and Utilization Review
Avera Health