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2ND ANNUAL HEALTHCARE PAYMENT AND REVENUE INTEGRITY EAST | MAY 22-23

Delivering scalable and flexible solutions which ensure accuracy and integrity
of claims, nurture payer-provider relationships and support the transition to
value-based payments

THANK YOU TO EVERYONE THAT JOINED US IN BOSTON

The Healthcare Payment and Revenue Integrity Congress connects leading figures
in PI and RI/RCM to encourage information sharing, discuss the latest solutions
being leveraged to ensure the integrity of claims, nurture payer-providers
relationships and support the transition to value-based payments.

Health plans use this forum to strengthen, redefine, or establish their own
payment integrity strategies by analyzing case studies from industry peers and
joining interactive discussions that span the entire claims continuum.

It also empowers providers to make revenue cycle decisions with confidence by
leveraging intelligent automation, optimizing RCM based on value, and
effectively communicating concerns around emerging payment initiatives.

PHOTO GALLERY

VIEW ALL PHOTOS HERE

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210.1 HPRI WELCOME VIDEO (1)

Video of 210.1 HPRI Welcome Video (1)

OUR COMMUNITY OF PAYERS

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WOULD YOU LIKE TO PRESENT AT THE UPCOMING EVENT?

Showcase your work to our audience of 150+ payment integrity leaders.

If you would be interested in learning about the speaking opportunities
available, please email Matthew.Oxley@kisacoresearch.com

PAYERS PROVIDERS

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> It's a unique forum that brings together providers, payors, vendors and
> regulators for collaboration, education and information sharing.

UnitedHealth

> It was a seamless process and the intimate meeting space was ideal to allow
> for more collaboration

Health Care Services Corporation

> The quality of the event, sessions, speakers and Health Plan attendees scored
> high

Performant Corp

> Great job putting on your inaugural show. I'm certain that the show will
> continue to grow and get even better in the future.

MedReview

> I think the conference has good potential going forward. It fits a niche in
> the industry.

ClaimLogiq

> This conference filled the much needed gap in focusing on Payment Integrity
> issues and initiatives

Blue Cross and Blue Shield of North Carolina

> We finally have a PI conference!

EXL

> This PI conference was wonderful. We’d rank it 10/10 with representation from
> all across the industry

Carelon

> This was the most meaningful industry event of the year for Payment Integrity
> professionals

Advanced Medical Solutions

It was a great opportunity to hear from many subject matter experts over a wide
topic of subjects specific to Payment/Revenue Integrity

Devoted Health

HOW TO GET INVOLVED

PARTNER WITH US

Partner with us to elevate your brand, and make valuable new connections.
Subject to availability, we offer opportunities for thought leadership,
branding, and facilitated networking.

Please contact our Partnerships Director, Harry Ludbrook, for more info.

GET IN TOUCH

PAYERS AND PROVIDERS ATTEND FOR FREE

Step into interactive discussions and engaging presentations on the key
challenges and opportunities presented by payment companies.

To deliver maximum value for our community, all payers and providers are
eligible for complimentary passes.

CLAIM YOUR FREE PASS

OUR COMMUNITY

FEATURED SPEAKERS

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program
Integrity

Full bio

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program
Integrity

In her role as the Director of the Audits and Vulnerabilities Group, Ms. Dupee
identifies and develops comprehensive mitigation strategies addressing program
integrity risks for all of CMS' programs, provides oversight of Medicare Part C
and Part D plans and the Federally Facilitated Exchanges, and implements CMS’
Comprehensive Medicaid Integrity Plan. Prior to her current role at CPI, Ms.
Dupee worked on such initiatives as the improper payment rate measurement for
the Medicare fee-for-service program, Open Payments, and the Healthcare Fraud
Prevention Partnership. Ms. Dupee also completed a Congressional detail with the
House Committee on Ways and Means, responsible for a portfolio of Medicare
fee-for-service and program integrity issues. Ms. Dupee has a Bachelor of
Science Degree in Nursing from the University of Wisconsin, a Master of Science
in Nursing and a Master of Business Administration from Johns Hopkins
University, and a Juris Doctor Degree with a Health Law Certificate from the
University of Maryland.

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

Monique is a Strategic Executive Healthcare Leader with proven ability to
develop solutions and maximize the benefits of Payment Integrity programs. She
is known for having excellent domain knowledge and being driven, high
performing, and having a deep dedication to recruiting and developing top
talent.

Full bio

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

Monique started her Payment Integrity career at Oxford HealthPlans in the COB
and Subrogation Department after spending time in Payment Policy. When United
Healthcare acquired many health plans in the early 2000s like Oxford, Monique
was tagged as part of the Optum team to integrate the processes and people into
the COB systems that she had built at Oxford. She led systems development,
quality, reporting, operations, vendor management and was responsible for
creating innovative proactive programs that more than doubled savings to $1.4B
in three years.

Monique developed a successful program that reduced interest expense on late
claims for UHC, assisted a communication company to develop COB tools and
assisted in strategic system projects before joining SCIO Health Analytics in
2014 to develop new products - specifically prepayment programs.

In 2015 she became the product owner of SCIOMine, the company’s internal audit
application and managed the roadmap. Monique also owned

strategic direction for operational metrics and reporting including executive
scorecards. Monique was promoted to VP of Business Opportunities and Client
Engagement where she improved Audit Recovery TAT by 39% and reduced client
implementations TAT by 11% and the Level of Effort by 18% while increasing the
count of implementation projects by 126%.

In 2020 Monique joined Devoted Health, a startup company with the goal of
building the first ever integrated Payment Integrity Program. The company has
one system, great data, and a great mission; to change health care by treating
every member as if they are family.

In her spare time, Monique volunteers her time in the community on the Board of
Directors of SCARE NH and works in her family business LARP Portal with her
husband Rick.

PHILLIP CHURCHILL

Assistant General Counsel
Blue Cross Blue Shield of Michigan

PHILLIP CHURCHILL

Assistant General Counsel
Blue Cross Blue Shield of Michigan

PHILLIP CHURCHILL

Assistant General Counsel
Blue Cross Blue Shield of Michigan

DAVE CARDELLE

Chief Strategy Officer
AMS

DAVE CARDELLE

Chief Strategy Officer
AMS

DAVE CARDELLE

Chief Strategy Officer
AMS

CONOR MCCAULEY

Director, Payment Integrity Clinical Capabilites
Highmark Health

My name is Conor McCauley. I am the Director of Payment Integrity Clinical
Capabilities at Highmark. Being a Critical Care nurse, it is easy to see there
are issues surrounding healthcare funding. Inserting clinical insights into
reimbursement methodologies can lead to affordability and improved patient
outcomes. Clinicians are well positioned to make a difference here. My passion
is developing an engaged team, effective processes, and surrounding clinicians
with the right technology, data, and market insights so they can work at the top
of their licensure.

Full bio

CONOR MCCAULEY

Director, Payment Integrity Clinical Capabilites
Highmark Health

CONOR MCCAULEY

Director, Payment Integrity Clinical Capabilites
Highmark Health

ANDREA BEATRICE

Director of Payment Integrity and FWA
Health New England

ANDREA BEATRICE

Director of Payment Integrity and FWA
Health New England

ANDREA BEATRICE

Director of Payment Integrity and FWA
Health New England
View all speakers

AGENDA HIGHLIGHTS

--------------------------------------------------------------------------------

Printable version

CMS CENTER FOR PROGRAM INTEGRITY (CPI) UPDATES

- This session will be focused on providing an insider’s view of CPI and CPI’s
2023 priorities
- We will cover the use of the Government Accountability Office Fraud Risk
Management Framework to develop anti-fraud strategies and react to emerging
threats, updates on our Marketplace fraud work, and opportunities for
private-public collaboration.

AUTHOR:

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program
Integrity

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program
Integrity

DEVELOPING A PAYMENT INTEGRITY PROGRAM FROM THE GROUND UP

* Developing a Payment Integrity Program from the ground up for a brand new
Medicare Advantage Health Plan
* Covering both the opportunities and the challenges of building and
effectively managing PI programs that prevent, avoid, or recover billing
errors, payment errors and other party liability errors
* Listing of suggestions/ advice from our success, and lessons learned

AUTHOR:

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

In 2015 she became the product owner of SCIOMine, the company’s internal audit
application and managed the roadmap. Monique also owned

In her spare time, Monique volunteers her time in the community on the Board of
Directors of SCARE NH and works in her family business LARP Portal with her
husband Rick.

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

In 2015 she became the product owner of SCIOMine, the company’s internal audit
application and managed the roadmap. Monique also owned

In her spare time, Monique volunteers her time in the community on the Board of
Directors of SCARE NH and works in her family business LARP Portal with her
husband Rick.

CLAIMS AUDIT – THE INDIANA JONES OF PAYMENT INTEGRITY?

- How does Claim Audit fit into the overall savings goals from PI?
- Archaeology amongst savings drivers? High $ treasures?
- Claim Audit Digs & Research – driving process improvement, not just savings.
- Do underpayments matter?
- How to keep finding treasure:
- Partnering with other departments as a true “Partner” not an “Auditor.”
- It will all be in a museum (creating reference materials).

AUTHOR:

TOM MARTIN

AVP, Payment Integrity
Molina Healthcare

TOM MARTIN

AVP, Payment Integrity
Molina Healthcare

2023 PARTNERS

HEADLINE PARTNER

PLATINUM PARTNER

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GOLD PARTNERS

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View all partners

OUR COMMUNITY

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Step into interactive discussions and engaging presentations on the key
challenges and opportunities presented by payment companies today:

OUR PARTNERS

2
Main Event Days
35+
Industry Leading Speakers
180+
Industry Experts
15+
Dedicated Networking Hours

OUR SELECTION COMITTEE

AUTHOR:

BRANNON MORISOLI

Director
SWK Holdings

Mr. Morisoli joined SWK Holdings as a Senior Analyst in March 2016. Prior to
joining SWK, he was an Investment Analyst and Portfolio Manager for a family
office that invested in equities, fixed income, real estate, and alternative
investments. Prior to that, he was an Investment Analyst for Presidium Group, a
real estate private equity firm, where he played an integral role in closing
over $100mm in transactions. Mr. Morisoli began his career at Neurografix, a
startup medical technology company in Santa Monica, CA that was doing
groundbreaking work in the MRI imaging of peripheral nerves. While with
Neurografix, he was published in two leading neurology journals. Brannon
graduated from UCLA with a B.S., was awarded a fellowship and graduated from the
University of Notre Dame with an M.B.A, and was awarded a Samson Fellowship from
the University of Wisconsin Law School, where he graduated with a J.D. Mr.
Morisoli is an inactive member of the State Bar of Wisconsin

BRANNON MORISOLI

Director
SWK Holdings

AUTHOR:

THOMAS BUSBY

Vice President
Outcome Capital

Thomas Busby is a Vice President and has been with Outcome Capital since 2015.
He focuses on medical technology, digital health and life science services
segments with particular interest in innovative life science companies that
deliver patient impact by leveraging novel approaches. Thomas is driven by the
desire to identify disruptive technologies and services that require unique
strategic thought and assistance to realize their full market potential. Thomas
has been published in leading life science journals Life Science
Leader and The Pharma Letter, and also serves on the board of HealthTech Build,
a Boston-based digital health innovation group.

Prior to his career in life-science investment banking, Thomas pursued his
passion for the public service and non-profit sectors working in a variety of
leadership and management positions, and at one time held a Massachusetts
teaching license.

Thomas completed his MBA at Suffolk University’s Sawyer Business School on full
academic scholarship where he was President of the school’s Graduate Business
Association and class speaker at graduation. Prior, he completed a BS in
Philosophy with Honors from Suffolk’s College of Arts & Sciences. Committed to
giving back, Thomas is currently the President of the College of Arts & Sciences
Alumni Board of Directors. Thomas is a FINRA Registered Securities
Representative holding his Series 79 and 63.

THOMAS BUSBY

Vice President
Outcome Capital

AUTHOR:

ROBERT CROUSORE

Managing Partner
Health Frontier Ventures

Robert has 28 years of experience in the health care products and
services industry. Crousore is a serial entrepreneur with multiple
successful product and services company exits. His experience spans
the entire business enterprise including Sales, Marketing, Operations,
Product Innovation and, most recently M & A.

Highlights Include:

* Has successfully managed a global commercial organization in the wound care
business.
* Has a number of patent credits for products in the wound care industry.
* Sits on multiple boards of healthcare technology companies.
* His passion is creating meaningful changes in patient care by combining great
products with great teams that are focused on empowering improved clinical
and financial outcomes.

ROBERT CROUSORE

Managing Partner
Health Frontier Ventures

Highlights Include:

AUTHOR:

BRANNON MORISOLI

Director
SWK Holdings

BRANNON MORISOLI

Director
SWK Holdings

AUTHOR:

THOMAS BUSBY

Vice President
Outcome Capital

THOMAS BUSBY

Vice President
Outcome Capital

AUTHOR:

ROBERT CROUSORE

Managing Partner
Health Frontier Ventures

Highlights Include:

ROBERT CROUSORE

Managing Partner
Health Frontier Ventures

Highlights Include:

SPEAKERS

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program
Integrity

Full bio

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program
Integrity

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

Full bio

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

In 2015 she became the product owner of SCIOMine, the company’s internal audit
application and managed the roadmap. Monique also owned

In her spare time, Monique volunteers her time in the community on the Board of
Directors of SCARE NH and works in her family business LARP Portal with her
husband Rick.

PHILLIP CHURCHILL

Assistant General Counsel
Blue Cross Blue Shield of Michigan

Full bio

PHILLIP CHURCHILL

Assistant General Counsel
Blue Cross Blue Shield of Michigan

PHILLIP CHURCHILL

Assistant General Counsel
Blue Cross Blue Shield of Michigan

DAVE CARDELLE

Chief Strategy Officer
AMS

Full bio

DAVE CARDELLE

Chief Strategy Officer
AMS

DAVE CARDELLE

Chief Strategy Officer
AMS

CONOR MCCAULEY

Director, Payment Integrity Clinical Capabilites
Highmark Health

Full bio

CONOR MCCAULEY

Director, Payment Integrity Clinical Capabilites
Highmark Health

CONOR MCCAULEY

Director, Payment Integrity Clinical Capabilites
Highmark Health

ANDREA BEATRICE

Director of Payment Integrity and FWA
Health New England

Full bio

ANDREA BEATRICE

Director of Payment Integrity and FWA
Health New England

ANDREA BEATRICE

Director of Payment Integrity and FWA
Health New England

MAHI RAYASAM

PhD., Partner
McKinsey

Mahi Rayasam is a Partner in McKinsey’s Healthcare practice and leads a large
analytics team focused on Healthcare Affordability, Quality and Outcomes. Mahi
serves payers, healthcare technology & services companies and private equity
institutions on topics related to transformations, operations and innovation.
Specifically, Mahi has extensive experience in serving payers across 30 states
on topics including Payment Integrity, FW&A, Medical Management and
Out-of-Network cost management.

Full bio

MAHI RAYASAM

PhD., Partner
McKinsey

MAHI RAYASAM

PhD., Partner
McKinsey

POOJA SINGH

Partner
McKinsey

Pooja Singh is a Partner in McKinsey’s Healthcare practice and a leader in the
domain focused on Healthcare Affordability, Quality and Outcomes. Pooja serves
payers, healthcare technology & services companies and private equity
institutions on topics related to transformations, operations and innovation.
Specifically, Pooja has extensive experience in serving payers on topics
including Payment Integrity, FW&A, Medical Management, Care Management and
Network management.

Full bio

POOJA SINGH

Partner
McKinsey

POOJA SINGH

Partner
McKinsey

VLADIMIR-DUCARMEL JOSEPH

CDI Program Manager
Lahey Hospital & Medical Center

Full bio

VLADIMIR-DUCARMEL JOSEPH

CDI Program Manager
Lahey Hospital & Medical Center

VLADIMIR-DUCARMEL JOSEPH

CDI Program Manager
Lahey Hospital & Medical Center

Vladimir-Ducarmel Joseph is the CDI Program Manager at Lahey Hospital & Medical
Center, where he spearheads a dedicated team of CDI professional experts to
optimize clinical documentation best practices. With almost a decade in CDI
leadership across diverse healthcare environments, Vladimir-Ducarmel holds a
Master of Health Administration from George Washington University and is
ECFMG-certified as a foreign-trained physician. His expertise encompasses
physician leadership, team dynamics, CDI provider education, and program
management. A fervent advocate for healthcare excellence, Vladimir-Ducarmel is
adept at bridging the gap between clinical and administrative roles. He is
proficient in various healthcare-oriented analytical and business tools,
leveraging them to drive impactful CDI outcomes.

STUART EPLING

Assistant Director, Office of Program Integrity
West Virginia

STUART EPLING

Assistant Director, Office of Program Integrity
West Virginia

STUART EPLING

Assistant Director, Office of Program Integrity
West Virginia

MICHAEL TAYLOR

Senior Fraud Analyst, Medicaid Fraud Control Unit
West Virginia

MICHAEL TAYLOR

Senior Fraud Analyst, Medicaid Fraud Control Unit
West Virginia

MICHAEL TAYLOR

Senior Fraud Analyst, Medicaid Fraud Control Unit
West Virginia

DALE CARR

Director
Missouri Medicaid Audit and Compliance (MMAC)

Dale Carr currently serves as Director of the Missouri Medicaid Audit &
Compliance (MMAC) unit, which
has overall responsibility for Medicaid program integrity efforts. Dale has
worked for the State of
Missouri since 2011. Director Carr was previously a Police Officer in Fallon,
NV; an Investigator for the
U.S. Office of Special Counsel; and a Supervisory Special Agent with the Coast
Guard Investigative
Service. Dale holds a Bachelor’s degree in Administration of Criminal Justice
and is a graduate of the

158th Session of the FBI National Academy.

Full bio

DALE CARR

Director
Missouri Medicaid Audit and Compliance (MMAC)

DALE CARR

Director
Missouri Medicaid Audit and Compliance (MMAC)

158th Session of the FBI National Academy.

LACEY CROWL

Director, Claims Operations
Longevity Health Plan

Lacey Crowl is the Director of Claims Operations for Longevity Health Plan,
responsible for the accuracy of claims processing focused on Medicare members.
Lacey has experience in the Commercial, Medicare and Medicaid environments,
developing prospective and retrospective payment integrity solutions for both
clinical and claim coding reviews. She has operated within various claims
processing platforms to develop, code and implement new audit concepts while
operating within the Managed Care space.

Full bio

LACEY CROWL

Director, Claims Operations
Longevity Health Plan

LACEY CROWL

Director, Claims Operations
Longevity Health Plan

NIOBIS QUEIRO

CEO
The Queiro Group

Niobis (Nio) Queiro is the founder of The Queiro Group offering transformation,
integration, advisory and leadership development services. Nio formerly was the
SVP of Revenue Cycle Tufts Medicine, in Boston Massachusetts.

Full bio

NIOBIS QUEIRO

CEO
The Queiro Group

NIOBIS QUEIRO

CEO
The Queiro Group

She brings vast experience in both the hospital and physician revenue cycle
industry. Nio uses her expertise in Lean and Six Sigma to drive change across
diverse healthcare delivery channels, hence, bridging the chasm between finance
and clinical care. As a change agent she has been able assist health systems
transition to an integrated revenue cycle that met or exceeded HFMA KPI
standards. Nio has presented in front of Congress as an industry expert for the
digitization of the military service men medical records as the lead of a
proof-of-concept project that is now the standard healthcare data exchange for
the military. Nio was named as one of the top 25 Innovators of 2021 by Modern
Healthcare.

Niobis continues her dedication to education as an adjunct Professor with Tufts
University’s Masters in Public Health program and as a Professional Coach,
business advisor. For fun its all about family and spoiling her grandson, Cylas.

DUTCH NOSS

Chief Operating Officer
Precision GX

Dutch Noss, COO of PrecisionGx is a highly versed Operations leader with 20+
years in Payment Integrity, Revenue Cycle Management, and Product Development.
Dutch is an expert in the operational use of Artificial Intelligence, Machine
Learning, Predictive Analysis, and Gaming Theory. Dutch’s specialties span both
clinical and non-clinical audits including Contract Compliance, Duplicate
Payments, IBill & DRG Review, COB, TPL, Retro-term, FWA and RAC audits in pre
and post pay settings for Commercial, Medicare, and Medicaid payers.”

Full bio

DUTCH NOSS

Chief Operating Officer
Precision GX

DUTCH NOSS

Chief Operating Officer
Precision GX

RITESH RAMESH

Chief Executive Officer
MDAudit

RITESH RAMESH

Chief Executive Officer
MDAudit

RITESH RAMESH

Chief Executive Officer
MDAudit

ANKUR VERMA

Vice President, Healthcare
Everest

ANKUR VERMA

Vice President, Healthcare
Everest

ANKUR VERMA

Vice President, Healthcare
Everest

AARON BROWDER

President
Carelon Subrogation

Aaron Browder is Staff Vice President, Elevance Health and President, Carelon
Subrogation, formerly Meridian Resource Company (Meridian), where he and his
team are responsible for overseeing the successful implementation and execution
of our clients’ end-to-end subrogation programs. With a nearly 20-year career in
subrogation, Aaron possesses a deep knowledge of healthcare subrogation. He has
held a wide range of management positions throughout his tenure at Meridian,
most recently serving as Staff Vice President.

Full bio

AARON BROWDER

President
Carelon Subrogation

AARON BROWDER

President
Carelon Subrogation

Aaron holds a Bachelor of Arts degree from Indiana University and a Master of
Business Administration from Butler University. He served on the Board of
Directors for the National Association of Subrogation Professionals and has been
a national presenter and author on issues related to subrogation.

KYLE PANKEY

Sales & Growth Leader
Carelon Subrogation

KYLE PANKEY

Sales & Growth Leader
Carelon Subrogation

KYLE PANKEY

Sales & Growth Leader
Carelon Subrogation

MORGAN TACKETT

Vice President Product
CAQH

Morgan Tackett is Vice President Product at CAQH. Over the last nine years, he
has worked to build the portfolio of member and provider data solutions that
CAQH offers to the industry. Prior to joining CAQH, Morgan spent 18 years at
Blue Cross and Blue Shield of North Carolina, where he led teams in Member
Service Operations, EDI Services, and Network Management. Morgan holds an MPH
from the University of North Carolina at Chapel Hill.

Full bio

MORGAN TACKETT

Vice President Product
CAQH

MORGAN TACKETT

Vice President Product
CAQH

KAREN WEINTRAUB

Executive Vice President
HEALTHCARE FRAUD SHIELD

KAREN WEINTRAUB

Executive Vice President
HEALTHCARE FRAUD SHIELD

KAREN WEINTRAUB

Executive Vice President
HEALTHCARE FRAUD SHIELD

KATHY GONZALES-BYRD

Chief Strategy Officer
MedReview

Kathy Gonzales is the Chief of Staff, collaborating with the CEO and other
senior leaders on revenue growth, process improvement and organizational
effectiveness. Kathy oversees new client implementations and operations for key
strategic accounts; manages the organization’s strategic planning process; and
oversees interdepartmental accountability processes to ensure operational
efficiency.

Full bio

KATHY GONZALES-BYRD

Chief Strategy Officer
MedReview

KATHY GONZALES-BYRD

Chief Strategy Officer
MedReview

Before joining MedReview’s senior leadership team, Kathy served as Vice
President, Payment Recovery for Cotiviti, Inc. overseeing claim audit operations
and client management for Blue Cross Blue Shield accounts. She also has a
long-standing consulting career, which include leadership roles in healthcare
revenue cycle and organization effectiveness with Accenture and Ernst & Young.

Kathy has a bachelor’s degree in psychology from West Chester University of
Pennsylvania, and a master’s degree in business administration (MBA) and Health
Care Administration and Finance from Widener University.

WILLIAM O'NEILL

Vice President – Product Management, Payment Integrity
EXL

WILLIAM O'NEILL

Vice President – Product Management, Payment Integrity
EXL

WILLIAM O'NEILL

Vice President – Product Management, Payment Integrity
EXL

SHERRI RICHARDSON

Strategy, Growth and Program Director
Carelon

SHERRI RICHARDSON

Strategy, Growth and Program Director
Carelon

SHERRI RICHARDSON

Strategy, Growth and Program Director
Carelon

TONI CASE

Vice President, National Sales
CERIS

TONI CASE

Vice President, National Sales
CERIS

TONI CASE

Vice President, National Sales
CERIS

RAJEEV RONANKI

Chief Executive Officer
Lyric

RAJEEV RONANKI

Chief Executive Officer
Lyric

RAJEEV RONANKI

Chief Executive Officer
Lyric

TIMOTHY WILSON

Senior Vice President of Population Health Management
P3 Health Partners

TIMOTHY WILSON

Senior Vice President of Population Health Management
P3 Health Partners

TIMOTHY WILSON

Senior Vice President of Population Health Management
P3 Health Partners

MICHAEL BROWN

Data Mining Expert
MedReview

MICHAEL BROWN

Data Mining Expert
MedReview

MICHAEL BROWN

Data Mining Expert
MedReview

KATREECE BAKER

VP of Clinical Operations
DRG Claims Management

KATREECE BAKER

VP of Clinical Operations
DRG Claims Management

KATREECE BAKER

VP of Clinical Operations
DRG Claims Management

BOB STARMAN

SVP Payment Integrity Solutions
Sagility

BOB STARMAN

SVP Payment Integrity Solutions
Sagility

BOB STARMAN

SVP Payment Integrity Solutions
Sagility

+ See More

AGENDA

--------------------------------------------------------------------------------

Printable version

CMS CENTER FOR PROGRAM INTEGRITY (CPI) UPDATES

AUTHOR:

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program
Integrity

JENNIFER DUPEE

Director, Audit & Vulnerabilities Group, Center for Program Integrity
CMS

Jennifer Dupee, Director. Audits & Vulnerabilities Group. Center for Program
Integrity

DEVELOPING A PAYMENT INTEGRITY PROGRAM FROM THE GROUND UP

AUTHOR:

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

In 2015 she became the product owner of SCIOMine, the company’s internal audit
application and managed the roadmap. Monique also owned

In her spare time, Monique volunteers her time in the community on the Board of
Directors of SCARE NH and works in her family business LARP Portal with her
husband Rick.

MONIQUE PIERCE

Payment Integrity Leader
Devoted Health

In 2015 she became the product owner of SCIOMine, the company’s internal audit
application and managed the roadmap. Monique also owned

In her spare time, Monique volunteers her time in the community on the Board of
Directors of SCARE NH and works in her family business LARP Portal with her
husband Rick.

CLAIMS AUDIT – THE INDIANA JONES OF PAYMENT INTEGRITY?

AUTHOR:

TOM MARTIN

AVP, Payment Integrity
Molina Healthcare

TOM MARTIN

AVP, Payment Integrity
Molina Healthcare

DOWNLOAD YOUR COPY OF THE AGENDA

REGISTRATION

Monday, October 30, 2023 to Thursday, May 23, 2024
Healthcare Payers and Providers
COMPLIMENTARY PASS
+ Register Now
An organization that determine service prices, collect payments, and handle
claims
A legal entity, or sub-set of a legal entity, which may contract for the
provision of health care

Monday, October 30, 2023 to Thursday, May 23, 2024
Vendors/ Service Providers
$4,999
+ Register Now

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HEADLINE PARTNER

AMS INTELLIGENT ANALYTICS

WEBSITE: HTTPS://WWW.MDSTRAT.COM/

Please visit our website for more information.

PLATINUM PARTNER

*
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EXL

WEBSITE: HTTPS://WWW.EXLSERVICE.COM/

Please visit our website for more information.

PRECISIONGX

WEBSITE: HTTPS://PRECISION-GX.COM/

PrecisionGx is an automated claims intelligence solution designed for healthcare
payers to identify and recover millions in overpaid, incorrect, or fraudulent
payments each year.

The PrecisionGx technology advantage is our customer's business advantage.
Coupled with decades of subject matter expertise in data mining and audit, our
claims-native AI engine enables payers to reduce vendor spend and identify more
refunds earlier in the recovery lifecycle. These advantages allow us to
outperform legacy vendors in payment recoveries and create transformative,
AI-enabled prevention for the 75% of incorrect payments that existing vendors
can’t address today.

GOLD PARTNERS

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CARELON

WEBSITE: HTTPS://WWW.CARELON.COM/

Please visit our website for more information.

DRG CLAIMS

WEBSITE: HTTPS://WWW.DRGCLAIMS.COM/

Please visit our website for more information.

HEALTHCARE FRAUD SHIELD

WEBSITE: HTTPS://WWW.HCFRAUDSHIELD.COM/

Healthcare Fraud Shield specializes in fraud, waste, and abuse detection and
payment integrity for healthcare payers nationally by efficiently stopping
claims prior to payment using utilizing post-payment advanced analytics and
artificial intelligence insights. We save health plans millions annually
incremental to existing pre-payment processes using our unique and proven
approach. FWAShield™ offers the combination of targeted rules, artificial
intelligence, shared analytics across multiple payers resulting in higher ROI
(up to 20:1) compared to other vendors. FWAShield™ software platform was
developed by industry leading healthcare subject matter experts and is a
component of over 50+ clients’ including 16 Blue plans Payment Integrity/SIU
departments. Our client satisfaction rating is exceptional with a net promoter
score of 97 and client retention rate over 95%.

FWAShield™ – is a fully integrated platform consisting of PreShield™
(pre-payment), AIShield™ (AI), PostShield™ (post-payment), RxShield™ (pharmacy
analytics), Shared Analytics™, QueryShield™ (ad hoc query and reporting tool)
and CaseShield™ (case management).

LYRIC

WEBSITE: HTTPS://WWW.LYRICHEALTH.COM/

Please visit our website for more information.

MEDREVIEW

WEBSITE: HTTPS://WWW.MEDREVIEW.US/

Headquartered in the financial district of New York City and serving all U.S.
states and territories, MedReview has been a leading provider of payment
integrity, utilization management and quality surveillance services for more
than 40 years. A physician-led organization with a passion for ensuring that
health care claims fairly represent the care provided, MedReview provides timely
independent hospital billing audits and clinical validation reviews on behalf of
health plans, government agencies and Taft-Hartley organizations, saving
millions of dollars for its clients each year.

SILVER PARTNERS

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CAQH

WEBSITE: HTTPS://WWW.CAQH.ORG/

Please visit our website for more information.

CERIS HEALTH

WEBSITE: HTTPS://WWW.CERIS.COM/

Please visit our website for more information.

CLAIMLOGIQ

WEBSITE: HTTPS://WWW.CLAIMLOGIQ.COM/

While the everchanging healthcare landscape can be challenging to navigate,
ClaimLogiq’s advanced technology, streamlined processes, intelligent automation,
and improved methods for data extraction to generate actionable clinical
insights enables health plans across the country to gain control of payment
integrity and risk adjustment programs. ClaimLogiq’s proprietary platform and
scalable technology enhanced by industry-leading OCR and NLP technology are
primary drivers for the delivery of accurate and consistent cost savings,
efficient turnaround times, and coding results. The flexibility of the
healthcare technology company’s engagement models allows health plans to achieve
their goals and solve even the most complex healthcare data challenges no matter
where they are in their program journey. As a collaborative partner, ClaimLogiq
enables technology-based solutions and supplements existing resources and
program capabilities as plans insource more work around their payment integrity
and risk adjustment programs.

SAGILITY

WEBSITE: HTTPS://SAGILITYHEALTH.COM/

Please visit our website for more information.

EXHIBITORS

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6 DEGREES HEALTH

WEBSITE: HTTPS://WWW.6DEGREESHEALTH.COM/

6 Degrees Health is on a mission to reduce the cost of healthcare. We take a
service-first approach to our Clean Claim Reviews to ensure accuracy in billing
and fair payments. Using our extensive cost containment experience, clinical
expertise, and next-generation, purpose-built software, we deliver remarkable
savings for health plans. Our proprietary review process leverages CMS and other
industry standard guidelines to evaluate every line item and identify billing
errors and inconsistencies.

These pre-pay clinical reviews are completed by our team of highly trained and
experienced registered nurses to ensure each billed line item is appropriate for
reimbursement. This detailed review removes erroneous line items and verifies
billing accuracy. Our comprehensive process manages claims during the review
stage, as well as through payment and appeals resolution. Our white glove
service on appeals allows us to maintain an uphold rate of 97 %, so your savings
are secure.

ADVENT HEALTH PARTNERS

WEBSITE: HTTPS://ADVENTHP.COM/

Advent Health Partners is the leader in workflow agnostic technology
applications across the various payer and provider payment and revenue integrity
programs. Payers and providers recognize the need for Plug and Play technology
to achieve healthy financials and solve manual challenges around clinical and
coding activities. Advent Health Partners technology incorporates AI extractions
and models paired with an intuitive interface to ingest and normalize
unstructured documentation and data to drive consistent, accurate, and improved
clinical and coding determinations across numerous use cases within the payer
and provider reimbursement integrity space.

FATHOM HEALTH

WEBSITE: HTTPS://WWW.FATHOMHEALTH.COM/

Fathom is the leader in autonomous medical coding, applying cutting-edge deep
learning and natural language processing (NLP) to produce complete coding
results for patient encounters with zero human intervention. We deliver the
highest automation rates and the broadest specialty coverage. Our AI technology
reduces costs, increases accuracy, strengthens revenue capture, and shortens
turnaround times from days to minutes. We carry out a risk-free trial to
demonstrate our coding quality before your organization ever pays us a dollar.
Fathom’s clients include leading health systems, physician groups, and revenue
cycle management companies. Following our $46M Series B in November 2022, we are
backed by world-class investors including Lightspeed and Alkeon Capital as well
as leading health systems and healthcare executives including Cedars-Sinai,
Vituity's Inflect Health, and Jonathan Bush.

PENSTOCK GROUP

WEBSITE: HTTPS://WWW.PENSTOCKGROUP.COM/

Penstock is a service partner and SaaS builder for forward-thinking health plans
and providers, empowering recovery, audit and regulatory teams to get accuracy
right from the start—when it matters most. Our mission is to create lasting
systemic change that removes wasted spend from our healthcare system, returning
dollars to payers, lowering the cost of care and improving access for all.

Penstock is powered by industry veterans who are some of the most sought-after
payment integrity and regulatory experts in the industry. Our business model is
rooted in transparency and the drive to reinstate true integrity in payment
integrity—even if it defies traditional business sense.

Our audit workflow SaaS platform, ClearBridge gives health plans the tools and
insights they need to identify overpayments, correct them and implement their
own edits with ease, ensuring correct payments and mitigating future
discrepancies.

When you partner with Penstock, you reclaim time and control with an end-to-end
partnership that beautifully and seamlessly connects human and machine
intelligence—to prevent recurring issues at the source.

PHIA GROUP

WEBSITE: HTTPS://WWW.PHIAGROUP.COM/

The Phia Group, LLC is an experienced provider of healthcare cost containment
techniques offering comprehensive consulting services, legal expertise, plan
document drafting, subrogation and overpayment recovery, claim negotiation, and
plan defense designed to control costs and protect plan assets.

RIALTIC

WEBSITE: HTTPS://WWW.RIALTIC.IO/

Rialtic is a modern healthcare technology platform focused on payment accuracy.
Built by a team of seasoned industry veterans, Rialtic addresses the most
important areas of the payment process. Payment policies are highly configurable
and customizable: insurers can edit or build their own bespoke policies, while
providers can analyze potential reimbursement levels. Robust analytics features
across claims, lines of business, payments, and policies provides insightful
business intelligence to users. By continuously sourcing, ingesting, and
structuring healthcare payment policy documents and data, customers can
confidently make up-to-date decisions. Keeping security and compliance top of
mind, Rialtic empowers healthcare organizations to work off the same platform
with rigorous security controls, a standard in enterprise software.

ZOLL

WEBSITE: HTTPS://WWW.ZOLLDATA.COM/

Please visit our website for more information.

MEDIA PARTNERS

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HEALTHCARE IT TODAY

WEBSITE: HTTPS://WWW.HEALTHCAREITTODAY.COM/

Please visit our website for more information.

HEALTHTECH MAGAZINES

WEBSITE: HTTPS://WWW.HEALTHTECHMAGAZINES.COM/

LinkedIn: https://www.linkedin.com/company/health-tech-magazines/
Twitter: https://twitter.com/HTMagazines
Description: HealthTech Magazines is a Wilmington-based award-winning
publication that offers robust platform for healthcare technology professionals
to express their views and exchange knowledge on emerging technologies that are
transforming the healthcare industry.

MANAGED HEALTHCARE EXECUTIVE

WEBSITE: HTTPS://WWW.MANAGEDHEALTHCAREEXECUTIVE.COM/

Managed Healthcare Executive® covers the cost and delivery of healthcare. We
provide insight, information and analysis on developments in value-based care,
cost effectiveness research and programs, pharmacy benefit management and
population health. We publish a monthly print publication and maintain a
news-driven website.

PARTNER WITH US

Based on your objectives, we can create bespoke packages designed specifically
for you – from presenting your expertise on the main stage, to hosting a private
dinner. You can partner with us showcase your brand and make valuable new
connections. Opportunities predominantly lie in 3 main categories: Thought
Leadership, Branding & Networking.

To discuss your objectives and partnership opportunities please contact Harry
Ludbrook, Sales Director harry.ludbrook@kisacoresearch.com

Interested in a media partnership?
We'd love to hear from you and how we can support one another to connect with
the industry. Contact Jodie Purser, Marketing Manager,
jodie.purser@kisacoresearch.com

PARTNER WITH US

Based on your objectives, we can create bespoke packages designed specifically
for you. Opportunities predominantly lie in 3 main categories: Thought
Leadership, Branding, and Networking.

Interested in a media partnership?
We'd love to hear from you and how we can support one another to connect with
the industry. Contact max.hallmark@kisacoresearch.com.

DELIVERING SCALABLE AND FLEXIBLE SOLUTIONS WHICH ENSURE ACCURACY AND INTEGRITY
OF CLAIMS

The Healthcare Payments and Revenue Integrity Congress is the only summit
focused on addressing healthcare waste and ensuring that claims are
paid correctly, reflecting current healthcare needs. You will join key
decision-makers, within health insurers and providers, who are responsible for
payment and revenue integrity, value-based payment, and networking relations.

At a time when both payers and providers are evaluating and streamlining
internal payment and revenue integrity processes, this networking conference has
been established to breakdown silos, by promoting discussion between clinical,
coding, revenue cycle and payment departments to facilitate the development of
efficient, value-based healthcare systems.

RESOURCES

HPRI EAST 2023 POST EVENT REPORT

INTERVIEW: DALE CARR, DIRECTOR OF MISSOURI MEDICAID AUDIT & COMPLIANCE

AMS PARTNERS WITH MDAUDIT

COMMUNITY BROCHURE

DOWNLOAD RESOURCE

VENUE

THE COLONNADE BOSTON 120 HUNTINGTON AVE BOSTON, MA 02116

We're excited to welcome you to The Colonnade Boston for the Healthcare Payment
& Revenue Integrity Summit East!

To book your room at a discounted rate, please use this link here.

MEDIA KIT

For more information on webinars, roundtables, content marketing
packages, interviews and marketing solutions opportunities, download the Media
Kit.

DOWNLOAD THE MEDIA KIT

If you have any questions, please contact Harry Ludbrook, Sales
Director, harry.ludbrook@kisacoresearch.com.

ABOUT KISACO RESEARCH

Kisaco Research produces, designs and hosts B2B industry conferences,
exhibitions and communities – focused on a specialized selection of topic areas.

Meet industry peers that will help build a career-changing network for life.

Learn from the mistakes of your peers as much as their successes—ambitious
industry stalwarts who are happy to share not just what has made them successful
so far but also their plans for future proofing their companies.

Note down the inspired insight that will form the foundation for future
strategies and roadmaps, both at our events and through our online communities.

Invest both in your company growth and your own personal development by signing
up to one of our events and get started.

WE'D LOVE TO HEAR FROM YOU.

Contact us at +44 (0)20 3696 2920 and email events@kisacoresearch.com, or let us
know what subject area you're interested in below.

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KEEP IN TOUCH

Kisaco Research
Registered office address:
41a Maltby Street, London, SE1 3PA
+44 (0)20 3696 2920 | events@kisacoresearch.com
Place of registration: London, United Kingdom
Company number: 09316521

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ABOUT US

* Meet industry peers that will help build a career-changing network for life.
* Learn from the mistakes of your peers as much as their successes - ambitious
industry stalwarts who are happy to share not just what has made them
successful so far but also their plans for future proofing their companies.
* Note down the inspired insight that will form the foundation for future
strategies and roadmaps, both at our events and through our online
communities.
* Invest both in your company growth and your own personal development by
signing up to one of our events and get started.

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