P18: What Do Carnegie Hall and Good Security Incident Response Plans Have In Common: To Get There You Must Practice, Practice, Practice!  


Jared Krawczyk, Mathematician, Nektar Analytics

Andrei M. Costantino, VP of Integrity & Compliance, Trinity Health

  • Discuss the critical elements needed in building a risk-based audit process from scratch.
  • Outline and demonstrate how to conduct the needed benchmarking analytics that will support a comprehensive provider risk scorecard. (Above and beyond just a generic E/M bell-curve)
  • Explore strategies to interpret and incorporate the outlier analysis results in a functional day-to-day internal audit process. Discuss current and future risk areas related to professional service billing including the use of Advanced Practice Providers, Hierarchal Condition Categories, and the Electronic Health Record

Presentation & handouts

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