The nuanced world of behavioral health creates a challenging environment for precision in payment integrity. Keeping up with varying diagnoses, policy changes, care delivery and treatment types can be a complex, manual process - leading to lengthy processes and missed detail. Learn from Shift and Constellation Quality Health experts on emerging behavioral health trends, use cases, AI-powered tools, and the steps taken in facing a complex, real-world case involving opioid prescriptions, abuse, and recovery.
In this webinar, attendees will learn:
- Emerging trends in behavioral health from substance abuse to recovery centers
- A case walkthrough from Robyn Winters of Constellation Quality Health resulting in over $1M in prepay savings - involving a behavioral health provider who was both prescribing opioids and running a treatment center for addiction
- A technology perspective from Shift on how investigations and other behavioral health areas can benefit from advanced analysis and artificial intelligence tools
Certainly! Here's a summary of the webinar transcript organized by chapters:
Chapter 1: Introduction and Welcome Al Culberson welcomes attendees from various states and introduces himself as a product marketer at Shift. He expresses gratitude for the participants' presence and sets the stage for the webinar.
Chapter 2: Overview of Shift and Constellation Health Al introduces Shift's product, Improper Payment Detection, which uses AI to enhance savings and accuracy in payment integrity. He also introduces Robin Winters from Constellation Health, which offers consultative services in quality improvement and payment integrity.
Chapter 3: Webinar Details and Agenda Al outlines the webinar's structure, including a Q&A session at the end. He provides instructions for technical issues and mentions the availability of CPE credits. The webinar is titled "From Claims to Court: Improving Payment Integrity and Behavioral Health."
Chapter 4: Behavioral Health Trends and Case Study Mark Sinsky discusses the agenda, focusing on behavioral health trends and a case study where Robin saved a million dollars through prepayment savings. The session aims to improve payment integrity processes using technology.
Chapter 5: Personal Stories and the Fentanyl Epidemic Mark shares a quote about the fentanyl epidemic's impact on youth and communities, emphasizing its widespread effects. Personal anecdotes from the speakers highlight the epidemic's personal and national significance.
Chapter 6: Case Study and Investigation Robin Winters presents a case study involving a family practice physician with suspicious billing practices. The investigation revealed improper use of evaluation management codes and led to significant findings through prepayment reviews and document analysis.
Chapter 7: Technology and AI in Payment Integrity Mark explains the role of advanced technology and AI in identifying suspicious relationships and gaps in care. Network detection and link analysis are used to uncover unknown connections and potential fraud.
Chapter 8: Conclusion and Q&A Al concludes the webinar, thanking the speakers and attendees for their participation. The session ends with a Q&A, addressing questions about the case study and the use of AI in payment integrity.
This summary provides a concise overview of each chapter's key points. Let me know if you need further details!
