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The New Medicaid Managed Care Rule: Practical Guidance From Multiple Viewpoints

Sept. 27, 2016

Join panelists James Golden of Centers for Medicare and Medicaid Services (CMS), Michael McCoy of New Jersey State Comptroller Office, and Alexander Shekhdar of Medicaid Health Plans of America as they share their expertise and viewpoints related to the recent federal Medicare managed care rule regulation and how it might influence practices and approaches on program integrity.

Moderated by Penny Thompson, former deputy director of CMS’ Centers for Medicaid and CHIP Services and a current commissioner of the Medicaid and CHIP Payment and Access Commission (MACPAC), this 50-minute HMS-sponsored webinar is a recording of an original presentation to attendees at the 32nd annual National Association for Medicaid Program Integrity (NAMPI) Conference in Baltimore, Md.

The goals of this session include:

  • Provide overview of the rule’s provisions concerning program and financial integrity
  • Promote understanding of what the federal government hopes to accomplish
  • Provide insight on how states and plans view the regulations and steps to respond
  • Generate discussion and thoughts on how these provisions will affect you
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Curing Employee Benefits Blues: Solutions That Work

Mar. 10, 2016
When employee benefits costs weigh you down, lighten your load!

Join David Hines, benefits director of Metropolitan Nashville Public Schools; and Alison Walker, HMS® sales manager, as they highlight real-world benefits-saving applications for superintendents, human resources professionals, and other school stakeholders.

The webinar shows how AASA School Solutions partner HMS has helped hundreds of districts recognize significant employee benefits savings through two key solutions:

  • Dependent Eligibility Verification
  • Medical Plan Audit

Find out how these mainstream approaches save money without changing the level of benefits offered.

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The Painful Side-effects of Opioid Fraud: Fighting the Phantom with Proactive Approaches to Analytics, Investigations, and Partnerships

Mar. 3, 2016

Do opioid abuse investigations leave you with a headache? You’re not alone. During this webinar, Ed Hewitt, HMS® program integrity solution consultant, discusses:

  • A more proactive approach to analytics, investigations, and partnerships
  • New geospatial analytics, fresh methods to curb doctor shopping, and preemptive relationships with pharmacies and other partners to deliver outsized results
  • Practical ways to fight opioid fraud — and to help those suffering from addiction
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Demystifying Oral and Maxillofacial Surgery: Extractions, Impactions, Anesthesia, Sleep Apnea Appliances, and Billing

Dec. 14, 2015

Grinding your teeth over dental fraud? HMS® Consultant Dr. David Rubin has the cure in this webinar. A Diplomate of the American Board of Oral and Maxillofacial Surgery, Dr. Rubin dives into the review process, sharing his passion for better patient care.

This presentation shares how to identify some tell-tale signs of dental fraud including:

  • Upcoding of surgical extraction versus simple extraction
  • Differences between soft tissue, partial boney, and complete boney impactions
  • Clinical and radiographic documentation needed to support various extractions
  • Items needed to correctly bill for each type of anesthesia
  • Components of a true sleep apnea appliance, and when it is appropriate to bill medical vs. dental

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Future Fraud Busters: How Integrated Platforms and New Models Will Change Behavioral Health

Oct. 28, 2015

As healthcare dollars grow tighter, payers must make major technological advancements to contain fraud – a $70 billion a year problem. This presentation addresses two of the latest ways to respond:

  • Shift cost-containment efforts from recovery to prepay. By recently combining a prepay audit platform with a postpay clinical platform, HMS® shares best practices that payers can use to stop erroneous payments before they happen.
  • Apply new predictive models to behavioral health claims. The application of fresh variables based on linear regression to existing systems promise to increase recovery rates by up to 30%. Investigators will learn about the key variables to help reduce false positives – and target the most significant fraudulent claims.
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Dependent Audits: Saving Healthcare Dollars in an Era of New Fees and Requirements

Apr. 2, 2015

This webinar for state employee benefit plans, municipalities, commercial plans, and other employers discussed:

  • Recent changes to federal and state laws as a motivator for healthcare cost containment
  • The rise of transitional reinsurance fees and likely future increases
  • How a dependent eligibility audit can help cover these new costs
  • Key considerations for choosing a dependent audit vendor

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