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Edward Marx

Chief Executive Officer
Marx Advisory

The youngest child of Holocaust survivors, Ed moved to the United States at age 10. At 16, he served as a medical clinic janitor where he discovered his healthcare calling. Ed took successive positions as combat medic, anesthesia tech, strategic planner and technology manager. He quickly learned how the convergence of clinical, business and digital saved lives. His passion ignited, he jumped feet first into technology and operations in the C-Suite of Cleveland Clinic, NYC Health & Hospitals, Texas Health Resources and University Hospitals.

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Edward Marx

Chief Executive Officer
Marx Advisory

Edward Marx

Chief Executive Officer
Marx Advisory

The youngest child of Holocaust survivors, Ed moved to the United States at age 10. At 16, he served as a medical clinic janitor where he discovered his healthcare calling. Ed took successive positions as combat medic, anesthesia tech, strategic planner and technology manager. He quickly learned how the convergence of clinical, business and digital saved lives. His passion ignited, he jumped feet first into technology and operations in the C-Suite of Cleveland Clinic, NYC Health & Hospitals, Texas Health Resources and University Hospitals.

Intermixed, Ed served the supplier side as well. He was CEO for consulting firm Divurgent, global CDO for Tech Mahindra Health & Life Sciences and CIO of the Advisory Board. Concurrently, he served 15 years as an Army combat engineer officer and combat medic. Today, Ed is focused on his own advisory practice.

Ed does a fair amount of speaking, writing and podcasting. He authored healthcare bestsellers including “Voices of Innovation” and “Healthcare Digital Transformation”. He is currently writing a book for Mayo Clinic on “Patient Experience” and “Voices of Innovation - Payers”. His podcast “DGTL Voices” is “Top 3%” globally. His Blog, CEO Unplugged, surpassed 1M views. Ed recently started a YouTube channel to expand his audience.

Most importantly, Ed is husband to Simran who holds a Doctor of Nursing (DNP). They love to dance and climb mountains. They have 5 grown children and 4 grandchildren. To stay fit, he is captain of TeamUSA Triathlon.

For more career information you can find me:

Twitter https://twitter.com/marxtango

LinkedIn https://www.linkedin.com/in/edwardmarx/

Website https://www.marxadvisory.com/

YouTube https://www.youtube.com/@EdwardMarx

  • Gain insights into the current state of the RCM industry and understand the key challenges healthcare organizations face. 
  • Identify strategic priorities for enhancing financial performance and optimizing the revenue cycle. 
  • Explore the impact of adopting cutting-edge technologies and tools to streamline revenue cycle management processes, reduce costs, and improve overall profitability.
Revenue Cycle Management

Author:

Edward Marx

Chief Executive Officer
Marx Advisory

The youngest child of Holocaust survivors, Ed moved to the United States at age 10. At 16, he served as a medical clinic janitor where he discovered his healthcare calling. Ed took successive positions as combat medic, anesthesia tech, strategic planner and technology manager. He quickly learned how the convergence of clinical, business and digital saved lives. His passion ignited, he jumped feet first into technology and operations in the C-Suite of Cleveland Clinic, NYC Health & Hospitals, Texas Health Resources and University Hospitals.

Intermixed, Ed served the supplier side as well. He was CEO for consulting firm Divurgent, global CDO for Tech Mahindra Health & Life Sciences and CIO of the Advisory Board. Concurrently, he served 15 years as an Army combat engineer officer and combat medic. Today, Ed is focused on his own advisory practice.

Ed does a fair amount of speaking, writing and podcasting. He authored healthcare bestsellers including “Voices of Innovation” and “Healthcare Digital Transformation”. He is currently writing a book for Mayo Clinic on “Patient Experience” and “Voices of Innovation - Payers”. His podcast “DGTL Voices” is “Top 3%” globally. His Blog, CEO Unplugged, surpassed 1M views. Ed recently started a YouTube channel to expand his audience.

Most importantly, Ed is husband to Simran who holds a Doctor of Nursing (DNP). They love to dance and climb mountains. They have 5 grown children and 4 grandchildren. To stay fit, he is captain of TeamUSA Triathlon.

For more career information you can find me:

Twitter https://twitter.com/marxtango

LinkedIn https://www.linkedin.com/in/edwardmarx/

Website https://www.marxadvisory.com/

YouTube https://www.youtube.com/@EdwardMarx

... read more

Edward Marx

Chief Executive Officer
Marx Advisory

The youngest child of Holocaust survivors, Ed moved to the United States at age 10. At 16, he served as a medical clinic janitor where he discovered his healthcare calling. Ed took successive positions as combat medic, anesthesia tech, strategic planner and technology manager. He quickly learned how the convergence of clinical, business and digital saved lives. His passion ignited, he jumped feet first into technology and operations in the C-Suite of Cleveland Clinic, NYC Health & Hospitals, Texas Health Resources and University Hospitals.

Intermixed, Ed served the supplier side as well. He was CEO for consulting firm Divurgent, global CDO for Tech Mahindra Health & Life Sciences and CIO of the Advisory Board. Concurrently, he served 15 years as an Army combat engineer officer and combat medic. Today, Ed is focused on his own advisory practice.

Ed does a fair amount of speaking, writing and podcasting. He authored healthcare bestsellers including “Voices of Innovation” and “Healthcare Digital Transformation”. He is currently writing a book for Mayo Clinic on “Patient Experience” and “Voices of Innovation - Payers”. His podcast “DGTL Voices” is “Top 3%” globally. His Blog, CEO Unplugged, surpassed 1M views. Ed recently started a YouTube channel to expand his audience.

Most importantly, Ed is husband to Simran who holds a Doctor of Nursing (DNP). They love to dance and climb mountains. They have 5 grown children and 4 grandchildren. To stay fit, he is captain of TeamUSA Triathlon.

For more career information you can find me:

Twitter https://twitter.com/marxtango

LinkedIn https://www.linkedin.com/in/edwardmarx/

Website https://www.marxadvisory.com/

YouTube https://www.youtube.com/@EdwardMarx

Author:

Lisa Meredith

AVP, Revenue Cycle Management
LifePoint Health
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Lisa Meredith

AVP, Revenue Cycle Management
LifePoint Health

Medical implants and biologics are a critical part of modern healthcare, but the FDA approval process for these devices is flawed creating provider and payor policy coverage confusion. Many implants are approved through the 510(k) pathway, which allows new devices to be cleared based on similarity to existing products and real world evidence data, rather than requiring clinical trials to demonstrate safety and efficacy.

 

This presentation will provide an in-depth look at the issues with the current FDA approval framework for implantable devices. We will examine case studies of problematic implants that have led to patient complications, and discuss the lack of reliable evidence required for many products. Attendees will learn about the criteria for reliable evidence that health plans should utilize to create coverage policies.

 

The session will address considerations for payors to protect members and ensure appropriate care, highlighting the role of payment integrity teams in identifying and validating implant charges.

 

By the end of this session, attendees will have a comprehensive understanding of the systemic issues with medical implant and biologics regulation, and practical approaches their organizations can implement to ensure appropriate utilization.

 

Learning Objectives/Key Takeaways of the Session (max 50 words, 2-3 bullet points):

 

  • Understand the disconnect between the real world evidence required by the FDA versus reliable evidence necessary for approval.
  • Explore the role of payment integrity in identifying overpayment related to these issues.
  • Develop strategies to enhance payer policies and review processes to mitigate risks and manage biologics and implant coverage effectively
Payment Integrity

Author:

Ellen Catania

Sr. Director of Review Operations
MedReview

Ellen is a registered nurse with extensive experience spanning clinical care and the health insurance industry, making her an expert in payment integrity and claims review. She has served as a clinical leader and consultant for payors and payment integrity companies. She excels in auditing high-value claims for third-party administrators and stop-loss carriers, while also providing clinical support to clients and addressing claim-related inquiries.

 

At MedReview, Ellen oversees the planning and development of Medicare and Medicaid hospital bill and DRG validation reviews and is also responsible for the oversight of the foreign and domestic nurse auditor teams conducting those reviews. An authority on Medicare and Medicaid policies, Ellen’s expertise also includes quality assurance oversight, peer review programs, and health plan contract interpretation.

 

... read more

Ellen Catania

Sr. Director of Review Operations
MedReview

Ellen is a registered nurse with extensive experience spanning clinical care and the health insurance industry, making her an expert in payment integrity and claims review. She has served as a clinical leader and consultant for payors and payment integrity companies. She excels in auditing high-value claims for third-party administrators and stop-loss carriers, while also providing clinical support to clients and addressing claim-related inquiries.

 

At MedReview, Ellen oversees the planning and development of Medicare and Medicaid hospital bill and DRG validation reviews and is also responsible for the oversight of the foreign and domestic nurse auditor teams conducting those reviews. An authority on Medicare and Medicaid policies, Ellen’s expertise also includes quality assurance oversight, peer review programs, and health plan contract interpretation.

 

This presentation will delve into the latest trends and tactics employed by fraudsters, providing actionable insights to safeguard your organization. Attendees will gain a comprehensive understanding of the evolving threat landscape, learn to identify red flags and implement effective prevention strategies.

Payment Integrity

Maxillofacial surgeries and advancements with cutting edge technologies have evolved into an area of cosmetic and non-covered benefit abuse when billed to medical plans.  Venture capitalists are disrupting the dental industry by purchasing large practices, promoting unnecessary procedures and opening Wellness Centers within dental practices.  This presentation will identify the most common oral surgery procedures billed to medical plans, identify clinical schemes and misrepresentations being used to bypass edits.  Holistic dental procedures will be addressed.  This will allow medical review staff to gain an understanding into the complex language of dentistry to enhance investigations.   

Payment Integrity

Author:

Rae A. McIntee, DDS, MD, MBA, FACS, CPE

Medical Director Clinical Solutions (Supporting Payment Integrity & SIU)
Louisiana Blue
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Rae A. McIntee, DDS, MD, MBA, FACS, CPE

Medical Director Clinical Solutions (Supporting Payment Integrity & SIU)
Louisiana Blue

Artificial Intelligence (AI) and generative AI have the transformative potential to revolutionize the payment integrity industry. These advanced digital capabilities are no longer visionary concepts but live practices that empower team members to work at the top of their licenses. By employing a human-in-the-loop approach to AI, payment integrity professionals can operate beyond gathering and collating data and focus on making critical decisions while staying at the forefront of these industry-changing innovations. This session will share real-world use cases on how these technologies are enabling transformative change – and ultimately driving improved outcomes – including how to access and interpret both structured and unstructured data, automate the distillation of critical insights from data into actionable information, and expose payment integrity vulnerabilities and accelerate mitigation initiatives.

Payment Integrity

Author:

William O'Neill

Vice President – Product Management, Payment Integrity
EXL
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William O'Neill

Vice President – Product Management, Payment Integrity
EXL
Payment Integrity

Author:

Anthony Baize

Inspector General
Wisconsin Department of Health Services

Anthony J. Baize is the Inspector General for the Wisconsin Department of Health Services.  Baize took the position in early 2016 after eight years with Kentucky state government in the Kentucky Cabinet for Health and Family Services, serving as the Deputy Director of Audits and Investigations for the Office of Inspector General and the Director of Business Informatics with the Department of Behavioral Health, Developmental and Intellectual Disabilities.

Baize has served as the Region V representative for the National Association of Medicaid Program Integrity Directors and on the Advisory Board for the Centers for Medicare and Medicaid Services’ Medicaid Integrity Institute.  He regularly speaks at national conferences on topics related to Medicaid Program Integrity. 

Baize became a certified inspector general in 2022 after completing the Association of Inspectors General Institute.  He is also a member of the Internation Association of Financial Crimes Investigators.      

Baize was a civil rights consultant for nearly 20 years, serving on the Board of Directors for the National Fair Housing Alliance and the Lexington (KY) Fair Housing Council. Baize has given presentations on fair housing requirements across the United States, but especially in Kentucky, Indiana, Ohio and Tennessee.  He has a master’s degree in public administration from Indiana State University, has been married for 29 years and has two daughters. 

... read more

Anthony Baize

Inspector General
Wisconsin Department of Health Services

Anthony J. Baize is the Inspector General for the Wisconsin Department of Health Services.  Baize took the position in early 2016 after eight years with Kentucky state government in the Kentucky Cabinet for Health and Family Services, serving as the Deputy Director of Audits and Investigations for the Office of Inspector General and the Director of Business Informatics with the Department of Behavioral Health, Developmental and Intellectual Disabilities.

Baize has served as the Region V representative for the National Association of Medicaid Program Integrity Directors and on the Advisory Board for the Centers for Medicare and Medicaid Services’ Medicaid Integrity Institute.  He regularly speaks at national conferences on topics related to Medicaid Program Integrity. 

Baize became a certified inspector general in 2022 after completing the Association of Inspectors General Institute.  He is also a member of the Internation Association of Financial Crimes Investigators.      

Baize was a civil rights consultant for nearly 20 years, serving on the Board of Directors for the National Fair Housing Alliance and the Lexington (KY) Fair Housing Council. Baize has given presentations on fair housing requirements across the United States, but especially in Kentucky, Indiana, Ohio and Tennessee.  He has a master’s degree in public administration from Indiana State University, has been married for 29 years and has two daughters. 

Author:

Ray Evans

Vice President of Healthcare Sales
CoventBridge Group

Ray Evans is a dynamic business development executive with extensive experience working within, and servicing healthcare organizations. He holds the position of Vice President of Healthcare Sales at CoventBridge Group where he utilizes his experience to share with the industry CoventBridge’s unmatched FWA investigative solutions. His goal is to work with health plans in protecting their organization from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.

... read more

Ray Evans

Vice President of Healthcare Sales
CoventBridge Group

Ray Evans is a dynamic business development executive with extensive experience working within, and servicing healthcare organizations. He holds the position of Vice President of Healthcare Sales at CoventBridge Group where he utilizes his experience to share with the industry CoventBridge’s unmatched FWA investigative solutions. His goal is to work with health plans in protecting their organization from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.

Author:

Amanda Brown

Vice President - Revenue Integrity
CoventBridge Group

Amanda Brown is the Vice President of Revenue Integrity at CoventBridge Group where she provides expertise to her clients spanning Medicare Advantage, Medicare Part D, Medicaid, Marketplace, Commercial and FEHB products. She is a subject matter expert in the design and implementation of effective compliance, program integrity, risk, audit, vendor oversight, and ethics programs. Amanda has a keen ability to break down silos and bring organizational collaboration to facilitate compliance with policies, laws, regulations, and risk management.

... read more

Amanda Brown

Vice President - Revenue Integrity
CoventBridge Group

Amanda Brown is the Vice President of Revenue Integrity at CoventBridge Group where she provides expertise to her clients spanning Medicare Advantage, Medicare Part D, Medicaid, Marketplace, Commercial and FEHB products. She is a subject matter expert in the design and implementation of effective compliance, program integrity, risk, audit, vendor oversight, and ethics programs. Amanda has a keen ability to break down silos and bring organizational collaboration to facilitate compliance with policies, laws, regulations, and risk management.