Payment integrity can be challenging to navigate, especially for smaller or regional health plans new to this field. In this session, experienced leaders will share their insights on how emerging trends - such as the growing use of AI and the increasing demand for timely data exchange - are shaping the field. The panel will provide practical advice on building a strong foundation, avoiding common challenges, and improving savings for plans at any stage of their payment integrity journey.

Learning Objectives:

• Learn how to evaluate vendor capabilities and build strategic alliances that scale with your needs.
• Get a framework for launching a PI strategy appropriate for your plan’s size and strategic direction.
• Understand current trends such as the merging of fraud and integrity functions and the shift toward collaborative data-sharing.

As value-based care continues to reshape payment models, many health systems struggle to balance financial performance with care quality goals. This session will offer practical strategies to use denial data, coding insights, and care coordination metrics to strengthen value-based outcomes—without sacrificing revenue. This discussion will highlight how to engage teams, optimize processes, and identify sustainable financial opportunities within value-based contracts.

Learning Objectives:

• Learn how to use denial patterns and audit insights to improve documentation, coding accuracy, and contract performance.
• Gain strategies to foster physician buy-in and leadership collaboration, finding “win-win” solutions that support both revenue integrity and value-based care success.

Hospice care is meant to support patients in their final months of life, yet inappropriate or prolonged utilization continues to raise clinical, ethical, and payment integrity concerns. This session will provide critical insights into what constitutes appropriate hospice enrollment, how to identify red flags for overutilization, and strategies hospitals and health plans can use to ensure hospice services align with medical necessity.

Learning Objectives:

• Understand the clinical criteria for appropriate hospice enrollment and identify common patterns of misuse that may lead to unnecessary costs and compliance risks.
• Gain tools and best practices for conducting eligibility reviews, improving documentation scrutiny, and collaborating across teams to prevent improper payments while supporting appropriate patient care.

Diagnosis codes and modifiers aren’t just billing details—they tell the story that determines how your claims are paid. When these elements don’t align, hospitals face denials, delays, and compliance risks. This session will break down how to accurately connect coding choices with billing practices to ensure claims reflect true clinical intent, reduce audit exposure, and secure appropriate reimbursement.

Learning Objectives:

• Recognize the most common coding and modifier missteps that lead to denials and learn how to avoid them through stronger documentation and coding practices.
• Implement strategies to bridge gaps between clinical, coding, and billing teams—ensuring consistent, compliant claims that tell the right story from documentation to payment.

In payment integrity, the real question isn’t just are you saving money?—it’s are you saving the right amount, efficiently? Without clear benchmarks, measuring true performance remains challenging. In this session, the MCC Benchmarking Report’s working groups will share how they have defined key metrics like savings per member per month (PMPM) , and how these benchmarks can help organizations evaluate effectiveness, identify gaps, and optimize strategies for sustainable savings and stronger returns.

Learning Objectives:

• Explore how standardized metrics like savings per member per month can provide a clearer, apples-to-apples view of payment integrity effectiveness across organizations.
• Discover how to use these metrics not just for performance reporting, but as tools to identify inefficiencies, improve vendor strategies, and align internal teams around realistic, data-driven goals for optimal savings and sustainable returns.

Curated meetings based on your RCM/PI painpoints and investments -30 minutes each -3 meetings per registered individual -All those not scheduled to take meetings will be encouraged to take part in interactive sessions, competitions and activities in the exhibition room.

Take a break to grab a drink, enjoy a snack, and connect with presenters after their sessions. Don’t miss the interactive sessions and competitions happening in the exhibition room during this time!

Discover how to turn price transparency from a regulatory requirement into a strategic advantage across revenue cycle management and payment integrity. This session will explore how hospitals and health plans can leverage pricing data to drive smarter audits, reduce payment disputes, and strengthen compliance, all while improving patient trust and financial outcomes.

Learning Objectives:

• Understand how both hospitals and health plans can integrate pricing data into payment integrity processes to proactively identify discrepancies, minimize denials, and resolve disputes more efficiently.
• Learn best practices for aligning data sources, contract terms, and audit strategies between health plans and hospitals to ensure ongoing compliance with price transparency regulations and avoid penalties