Healthcare Payment & Revenue Integrity Congress (HPRI) 2025

Healthcare Payment & Revenue Integrity Congress (HPRI) 2025

About the Event

Join MedReview in Nashville Feb. 5-7th at the 7th Annual Healthcare Payment & Revenue Integrity Congress

Visit us at our booth at B11!

MedReview is heading to the heart of country music to address payor payment integrity challenges, including shifting the complex claims review process to pre-pay, enhancing the provider experience, and discussing how the right mix of clinical expertise and technology makes all the difference in achieving your goals.

The good news is that, with our physician-approved pre-pay and post-pay solutions, we’re ready to partner with you to tackle these challenges with custom solutions tailored to your needs. Visit us at our booth on the show floor to learn more!

On February 5th, don’t miss Ellen Catania’s in-depth look at the FDA approval process for medical implants and biologics, especially the 510(k) pathway, and its impact on provider and payor policy coverage. They will also learn strategies for improving payer policies and managing risk in implant and biologics coverage.

Presentation: Navigating the FDA Medical Implant Approval Process
Date/Time: Wednesday, February 5, 2025–12:30 p.m. CST
Presenter: Ellen Catania, RN, Sr. Director of Review Operations, MedReview

Synopsis:
Medical implants and biologics are a critical part of modern healthcare, but the FDA approval process for these devices often creates provider and payor policy coverage confusion. Many implants are approved through the 510(k) pathway, which allows new devices to be cleared based on similarity to existing products and real-world evidence data, rather than requiring clinical trials to demonstrate safety and efficacy.

This presentation will provide an in-depth look at the issues with the current FDA approval framework for implantable devices and biologics. We will examine case studies of problematic implants that have led to patient complications and discuss the lack of reliable evidence required for many products. Attendees will learn about the criteria for reliable evidence that health plans should utilize to create coverage policies.

The session will address considerations for payors to protect members and ensure appropriate care, highlighting the role of payment integrity teams in identifying and validating implant and biologics charges.

By the end of this session, attendees will have a comprehensive understanding of the systemic issues with medical implant and biologics regulation, and practical approaches their organizations can implement to ensure appropriate utilization.

Audience Takeaways:

  • Understand the disconnect between the real-world evidence required by the FDA versus reliable evidence necessary for approval.
  • Explore the role of payment integrity in identifying overpayment related to these issues.
  • Develop strategies to enhance payer policies and review processes to mitigate risks and manage biologics and implant coverage effectively

 

Event Details:

February 5-7, 2025

9:00AM

Millennium Maxwell House, Booth B11

Nashville, TN