MGMA Demo Day: Revenue Cycle Management Solutions

Craig Wiberg
Senior Manager, Digital Events, MGMA

Mark Herzog
Principal Solutions Specialist, Veradigm

Veradigm Revenue Cycle Services is a revenue cycle management (RCM) service that supports various platforms such as Epic, Nextgen, ModMed, Athena and other various platforms and offers a robust suite of solutions designed to reduce claim errors and denials.

Veradigm Coding Services is an EHR agnostic coding solution that leverages AI, identifies workflow deficiencies, optimizes the coding and claims workflow, increases first-pass claims, and expedites revenue generation.

Veradigm Predictive Scheduler simplifies scheduling with artificial intelligence patient scheduling software and predictive analytics.

Attend this 30-minute demo if you're looking for solutions for:

• Increased administrative overhead
• Staffing shortages 
• Coding complexity and compliance 
• Government and carrier requirement complexity
• Efficiency with limited resources

Leivi Staal, M.Sc.
Managing Director, RevCare Plus LLC

Recouping Underpayments to Surpass a 96% Net Collection Rate
With more than 25 years of experience in the field, Leivi serves as a RCM Turn-Around consultant to hospital administration, providing a strategic and data-driven approach to hospital revenue cycle management.  In the session Leivi will discuss vendor-agnostic methods and best practices of recouping underpayments in healthcare reimbursements, and the growing negative impact it is making in the industry.  Included in the discussion will be the use of AI, Business Intelligence, and strategies for the most effective use of human resources on the billing team.

• Step One: How to Establish Accountability for Underpayments with Your Billing Team
  • Understand the Inherent Challenges with Recouping Underpayments 
  • RevCare Plus Seamlessly Adds Decades of Leadership Experience to Your Billing Team 
• Step Two: How to Analyze and Compute the Annual Opportunity at Your Organization
  • RevCarePlus Provides the Required Human Bandwidth in Terms of:
    • Leadership
    • Data Gathering and Data Entry
  • RevCare Plus Provides the RequiredTechnological Bandwidth
    • Role and Use of AI and Business Intelligence in Recouping Underpayments
• Step Three: How to Execute the Appeal for Maximum Results
  • Role of Your Legal Team During the Appeal
  • Setting Realistic Expectations in Terms of ETA and Financial Result

Manish Jain
Vice President, Business Development, AuthParency

AuthParency simplifies prior authorization for healthcare groups by eliminating administrative burdens with an innovative, customizable solution. Whether you choose our Software as a Service (SaaS) platform or opt for our full white-glove prior authorization service, we empower healthcare organizations to save time, reduce denials, and focus on delivering exceptional patient care.

Attend this 30-minute demo if you're looking for solutions for:

• Days to treatment: Current prior authorization processes are delay prone due to high resource requirements. Our comprehensive solution is aimed at reducing those delays by decreasing the turnaround times for prior authorizations.
• Errors and Denials: Most organizations, even larger ones, are beset with errors and denials in the entire PA process. Our AI-enabled solution strives to minimize these errors and reduce the denials.
• Lack of Transparency: Real-time tracking and updates provided by AI ensure healthcare providers and patients are informed of the PA status, improving transparency and trust.
• Comprehensive Solution: Most PA solutions focus on a particular specialty or work with certain payors. We offer a comprehensive solution that is specialty or service line agnostic. 
• Cost Inefficiencies: By optimizing workflows and reducing manual intervention, our solution can cut operational costs for healthcare providers, leading to a more efficient and cost-effective system.

Alice McMahan, MBA
Revenue Cycle Advisor, Denial Management, Cognizant

Cognizant’s TriZetto® Advanced Reimbursement Manager Pro integrates real-time claim and remit data, an organization’s fee schedules, as well as government fee schedules to audit payer performance for both professional and institutional claims. With over 350 million payer rules and edits, it maintains a detailed understanding of the payer adjudication process and automates the discovery of under allowed or denied claim lines. This early identification allows for process improvements, as well as recovery opportunities for incorrectly denied or remitted claims. Additionally, it enhances efficiency by streamlining the appeals process with pre-populated redetermination letters and electronic form submissions, saving valuable time and resources, and helping healthcare providers achieve optimal financial results by leveraging key performance indicators and industry best practices.

TriZetto® Advanced Reimbursement Manager can help providers:

• Increase revenue by capturing underpaid or denied claims
• Reduce administrative costs through streamlined work queues
• Increase speed-to-payment with automated appeals

Craig Wiberg
Senior Manager, Digital Events, MGMA