Panels and Presentations Addressing Key Challenges of Payment Integrity

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.

Engage in focused, small-group discussions where payers and providers connect over specific topics, share perspectives, and explore solutions from both sides—offering a balanced, holistic view of key challenges and opportunities.

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.

Payment 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.

As 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.

Hospice 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.