Death by a Thousand Cuts: How Payers Are Increasingly Undercutting your Contract Revenue


 

Webinar Series: Death by a Thousand Cuts Webinar Series Overview

Recordings for all four webinars available in the Versalus Health Resource Center

Some define the idiom Death by a Thousand Cuts as “a large number of seemingly small harmless actions that, taking place over months, cause the same damage as a single devastating act but without the same level of shock and visibility.” The idiom seems appropriate to describe Private Payers’1 behavior of constantly changing tactics to reduce providers’ reimbursement.

To provide health systems with the best tools for understanding the growing payer tactics, Versalus is hosting a four-part Private Payer webinar series to provide you with the information your organization needs to adopt an effective strategic payer-specific approach.

These 60-minute webinars will help you:

  • Learn how to measure payer performance
  • Identify and quantify egregious payer tactics and what you can do about them to eliminate inappropriate contract revenue leakage
  • Discover payer specific strategies and how to combat them. We’ll cover issues such as plan-sponsored physician groups, delegated entities, and how payers train your own UM staff to self-deny.

Past Webinars

PART 1: How Payers Are Increasingly Undercutting your Contract Revenue and What to Do About It

Recording available in the Versalus Health Resource Center

You just negotiated a 5% rate increase with your second largest payer. Now what? Prepare for a “death by a thousand cuts.” This payer will deploy new and evolving tactics to erode your contract value in a way that is often invisible to your contracting professionals – usually in the form of small issues across many different cases. Join this session to learn the first step in addressing evolving payer behavior: a data-driven approach to measure true payer contractual performance. Learn how to identify where revenue loss is occurring, how to establish internal processes to prevent this loss and what the Office of Inspector General is saying about Medicare Advantage Payment Denials.

PART 2: UnitedHealthcare: Delegated Entities & Other Tactics 

Recording available in the Versalus Health Resource Center
UnitedHealthcare (UHC) tactics continue to shift. This year alone they announced the EDC Analyzer to review ED claims, a new process to request peer-to-peer (P2P) appeals, and the adoption of “Sepsis-3” definition in their DRG Integrity audits. Just keeping up with the announcements is challenging… However, beyond the published issues, UHC is working with affiliated or delegated physician groups. And without you knowing it, many of these physicians may have incentives that are contrary to your hospital’s interests. Learn about the visible and invisible tactics UHC is deploying to undermine your revenue and how to identify them and adjust your operational process and contracts to defend against these tactics.

PART 3: Humana: DRG Validation Audits & Other Tactics

Recording available in the Versalus Health Resource Center
Humana’s tactics continue to shift. Join this webinar to learn about the visible and invisible tactics Humana is deploying to undermine your reimbursement and how to identify them and adjust your operational process and contracts to defend against these tactics and protect your revenue.

PART 4: Aetna: Denials Without Denying & Other Tactics

Recording available in the Versalus Health Resource Center
Aetna continues to increase its market presence. From 2017 to 2018, Medicare Advantage membership grew by 18.9%. And, the company just announced its largest Medicare Advantage expansion for 2019 adding plans in 358 new counties in 46 states. So, what does this expansion means to providers? While expanding its membership, Aetna is also working to reduce providers expected contract revenue by deploying line item denials and applying a proprietary DRG grouper. And like other payers, Aetna is deploying ED denials and relying on third-party contractors to review medical records and deny provider payment. Learn more about these tactics, so you can identify them and discover tools you have to combat Aetna’s behavior.

1 We define private payers as Managed Care Organizations and Commercial Payers.

Questions?

Call us: 484.766.1617 or Email us: info@versalushealth.com

Meet the Speakers

 

Robert Corrato


Robert R. Corrato, MD, MBA

Chief Executive Officer

Dr. Robert R. Corrato is Founder and Chief Executive Officer of Versalus Health. Before Versalus, Dr. Corrato was Founder and Managing Partner of Devon Hill Capital Partners (DHCP), a diversified healthcare investment firm. Prior to founding DHCP, Dr. Corrato was the Founder, Chairman and President & CEO of Executive Health Resources (EHR). In his roles at EHR, Dr. Corrato was responsible for driving the vision and strategy for corporate growth to best serve the healthcare compliance industry, growing EHR into the leading national provider of medical necessity compliance solutions that served the needs of over 2,000 hospitals, performed concurrent reviews on millions of Medicare short-stay cases, overturned thousands of Medicare denials and successfully defended scores of hospitals under investigation by the Office of the Inspector General (OIG) and Department of Justice (DOJ). Prior to founding EHR, Dr. Corrato held the post of deputy director of the Office of Health Policy and Clinical Outcomes at Thomas Jefferson University in Philadelphia.

Dr. Corrato earned his master of business administration degree from the Wharton School of Business at the University of Pennsylvania and received his medical degree from the Medical College of Pennsylvania.

Joseph Zebrowitz


Joseph R. Zebrowitz, MD

President

Dr. Joseph R. Zebrowitz is Founder and President of Versalus Health and has led the team in the development of an innovative approach to Two-Midnight Rule compliance. Prior to Versalus, he was Managing Partner of Devon Hill Capital Partners (DHCP), where he led the investment in several successful healthcare startups. Prior to DHCP, Dr. 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. Dr. Zebrowitz’s career focus has been on assisting hospitals in gaining a true picture of their compliance profiles through analysis and audit and advancing lasting solutions to provide enduring compliance and visibility. Prior to joining EHR, Dr. Zebrowitz founded Concuity, Inc. (formerly eHealthContracts), now part of the Advisory Board Company and served as its Vice President of Strategic Alliances.

Dr. Zebrowitz received his medical degree from Temple University School of Medicine and a bachelor’s degree in psychology from the University of Pennsylvania. He attended the Wharton School of Business at the University of Pennsylvania.

Thomas McCarter


Thomas McCarter, MD, FACP, FCPP

Executive Vice President & Chief Medical Officer

Dr. Thomas McCarter serves as Executive Vice President and Chief Medical Officer at Versalus Health. Prior to joining Versalus, Dr. McCarter was Chief Clinical Officer of Executive Health Resources (EHR) where he was responsible for clinical research, physician education, regulatory policy and the rules used to adjudicate over 10 million medical necessity reviews for over 2,000 hospitals across the United States to achieve Medicare regulatory compliance and clinical appropriateness.

Dr. McCarter has served as Senior Vice President of Medical Affairs and Chief Medical Officer of Main Line Health System in Philadelphia, and as Vice President of Medical Affairs for Tenet Health System’s Pennsylvania Region. He served faculty positions at the University of Pennsylvania, Hahnemann University, Medical College of Pennsylvania, Geisinger Medical Center, and Drexel University School of Medicine. Dr. McCarter has extensive experience defending hospitals and health systems when under scrutiny by the Office of the Inspector General (OIG) and Department of Justice (DOJ).

Dr. McCarter received his medical degree from Hahnemann University School of Medicine and bachelor’s degrees in biology and chemistry from The University of North Carolina at Chapel Hill.

Troy Williams
Troy Williams

Executive Vice President
Mr. Troy Williams is Founder and Executive Vice President for Versalus Health. Mr. Williams has over 20 years of experience in healthcare consulting, technology, revenue cycle, and analytics. He excels at understanding hospital/health system’s needs and creating products and services to address tactical execution and performance. Mr. Williams also serves as Founder and Managing Partner of Devon Hill Capital Partners (DHCP), a diversified healthcare investment firm. Mr. Williams is also President of the Troy and Sherri Williams Foundation for Education, which provides educational grants, mentoring, and internship experience to college students nationwide.

Before founding Versalus and DHCP, Mr. Williams served as Vice President of Corporate Development for Executive Health Resources (EHR) and served as a member of its board of directors. Prior to EHR, Mr. Williams co-founded Concuity, Inc where he led the Product Development, Client Services, and Business Development teams. Before Concuity, Mr. Williams served as Senior Associate and Healthcare Consultant at APM/CSC Healthcare where he advised the Chief Executive Officers and Chief Financial Officers of healthcare organizations regarding market strategy, operational efficiencies, and financial performance.

Mr. Williams holds a Bachelor of Science degree in Finance from Brigham Young University and attended the Wharton School of Business at the University of Pennsylvania.