Payment Integrity, Take It To the Next Level with Clinical Validation
MedReview to present “Payment Integrity, Take It To the Next Level with Clinical Validation” at the Healthcare Payments and Revenue Integrity Congress
NEW YORK, N.Y. (PRNewswire)– February 1, 2023 – Dr. Michael Menen, Chief Medical Officer at MedReview, Inc. – a leading provider of payment integrity, utilization management and quality surveillance services – will present “Payment Integrity, Take It To the Next Level with Clinical Validation” at this year’s Healthcare Payments and Revenue Integrity Congress in Orlando, Florida. The talk will be held on February 8 at 11:50 a.m.
Dr. Menen will explain why physician-led DRG clinical validation is a “must have” proactive element within every payor’s payment integrity solution. He will explore the DRG system, the refinements made over time, how those refinements are being abused to game the system, and what payors can do now to expose these practices. Dr. Menen will discuss how the power of experienced physician clinical judgment, coupled with artificial intelligence and machine learning technologies, can be used to minimize waste and maximize savings.
“Identifying instances of ‘upcoding’ within an inpatient claim is a complex process that potentially exposes thousands of dollars in waste. Clinical validation, using physician expertise and judgment, is essential to determine if a claim is accurately coded compared to the medical record and the resources that were utilized,” Menen says.
As CMO at MedReview, Dr. Menen provides clinical direction on behalf of the organization. In addition to the development of innovative programs and strategic partnerships, he is ultimately responsible for ensuring programs are compliant, clinically accurate, and support both patients and clients. Prior to joining MedReview, Dr. Menen was the CMO at Optum Health and United Healthcare, where he was charged with improving health outcomes through the integration of quality, innovation, research, and care delivery optimization.
MedReview offers healthcare payors innovative, physician-led payment integrity solutions to help fight healthcare fraud, waste and abuse. The company’s clinically driven approach to DRG claim review has resulted in a total of $351 million in savings back to payer clients last year.
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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.