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Medicaid TPL webinar

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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U.R. Regulated: Legislative Trends in Utilization Review (UR) Services

Dec. 14, 2014

This webinar discussed:

  • Key UR legislative trends
  • The impact of legislation on commercial and state UR programs
  • Expectations for what lies ahead

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Trust but Verify: Using Dependent Eligibility Audits for Compliance and Savings

Aug. 19, 2014

This webinar discussed:

  • What a dependent eligibility audit is and why organizations should consider performing one
  • Real-world ROI data from a hospital that conducted a dependent eligibility audit
  • How to leverage technology to make this type of audit a routine part of the on-boarding process
  • The benefits of system standards and how this process can shape internal culture

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