Note From the Speaker: Get a Leg Up On Analyzing Payer Performance And Contracts

Note from the speaker: Get a leg up on analyzing payer performance and contracts | NAHRI

Note from the speaker: Get a leg up on analyzing payer performance and contracts

Wednesday, October 9, 2019

by Joseph Zebrowitz, MD

Is your hospital having problems with private payers? I venture to say that the answer is yes. If so, join me and my colleague, Jay Ahlmer, CFA, at the 2019 Revenue Integrity Symposium (RIS), October 15–16, as we discuss how to level the playing field with Medicare Advantage and commercial payers.

Our session, “Leveling the Field: An Analytic Approach to Creating Individual Payer Strategies” on October 16 at 1:20 p.m., will focus on developing custom payer strategies to secure revenue owed. During our session, we’ll show how payers force organizations into significant contract underperformance with little to no resistance, how departmental metrics play against hospital performance, and how a payer-specific strategy is required to win at this zero-sum-game. Our presentation will demonstrate how hospitals can leverage their data to benchmark payer performance, identify the tactics each payer is using, and create plans to address them while minimizing revenue erosion in their contracts.

RIS is a great venue to share information. Revenue integrity professionals and their respective organizations, no matter where they operate in the country, all face similar obstacles in ensuring they are providing the best care while getting appropriate reimbursement. In my experience, every time you come back from one of these events, you leave with a refreshing perspective on how to put your organization in a position to succeed. RIS is a great opportunity for revenue integrity professionals to gain from the combined human capital within the halls of the Renaissance Orlando during this year’s RIS. I think everyone can agree that this event is one not to miss.

Glancing through the agenda, there is one session that really stood out to me: “Background and History of the 2-Midnight Rule and the Importance of Patient Status Issues.” This session, led by Marc Hartstein, MA, who was responsible for drafting the 2-midnight rule, covers a topic that still causes significant confusion. I’m interested in learning what CMS was thinking while developing the rule. In my opinion, the implementation of the 2-midnight rule represents one of the most impactful healthcare industry changes I have observed in recent years. With CMS changing the criteria used to evaluate Medicare inpatient and outpatient billing status, a significant opportunity to streamline and simplify processes was born. I am excited to attend and encourage all other attendees to do so as well.

Editor’s note: Zebrowitz is founder and co-executive officer of Versalus Health where he has led the Versalus team in the development of an innovative approach to 2-midnight rule compliance and managed care performance. Before Versalus, Zebrowitz founded and was managing partner of Devon Hill Capital Partners. At DHCP, Zebrowitz identified and led investments in several successful healthcare startups. Before DHCP, Zebrowitz spent 12 years as executive vice president and senior medical director of Executive Health Resources (EHR), where he led the development of EHR’s compliance and revenue integrity products endorsed by the AHA as “Best in Class.” Prior to joining EHR, Zebrowitz was a founder and vice president of Strategic Alliances at eHealthContracts, now Concuity, Inc. Before Concuity, Zebrowitz was a practicing obstetrician/gynecologist at Abington Memorial Hospital in Pennsylvania.

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