Structuring a Commercial Payer Management Solution to Maximize Return (PR6)

HFMA Peer Review® Session with Executive Health Resources and St. Joseph’s/Candler Health System

Date & Time

Tuesday, November 4 — 7:00 – 8:00 a.m.

Speakers

Dee Dee Seagraves RN, MSN, MHSA, CCM, BC-NE
Director, Clinical Care Coordination
St. Joseph's/Candler Health System

Ralph Wuebker, MD
Chief Medical Officer
Executive Health Resources

Summary

Intense scrutiny by Medicare Recovery Auditors and Medicare Administrative Contractors on admission status assignment (Inpatient versus Outpatient /Observation) has prompted providers to invest significant time and resources strengthening their utilization review processes. This presentation will explore the financial implications of these trends and provide a framework for addressing the unique utilization management challenges in the commercial payer market.

After This Session, You'll Be Able To:

  • Describe new ways to evaluate commercial payer opportunities
  • Identify the factors and barriers that lead to payer and self-denials
  • Determine how to better allocate utilization management resources
  • Recognize future trends in commercial payer contracting, utilization management, and denial management