2024 NAIRO Symposium Sessions

A Recipe for a Good Medical Review, presented by Dr. Jacqueline Cain and Dr. Mary Pascucci

Join Medical Directors, Drs. Cain and Pascucci in an interactive panel discussion of what makes, and breaks, complex medical record review as viewed through the medical directors’ lens. They explore the application of regulations across all claim types: what holds, what doesn’t, and best preparation for appeal levels. 

Maximizing Efficiency and Minimizing Disruption: Optimization of Clinical Reviews with AI, presented by Emily McMakin

Join Advent Health Partners' Director of Product and Interoperability, Emily McMakin, as she explores the application of traditional AI, cutting-edge techniques such as deep learning, and generative artificial intelligence (e.g., ChatGPT and others) in optimizing the process of medical record reviews. During this session, Emily will showcase the practical application of AI in automating error detection and enhancing efficiency, simplifying the complex and time-consuming medical record review process. Plus, discover strategies to seamlessly integrate AI within your organization, with a special focus on augmented intelligence principles where AI serves as a helpful assistant, enhancing human expertise rather than replacing it.

** Highly relevant to healthcare leaders and practitioners who aim to streamline clinical reviews using digital advancements. **

A View from the Capitol: What Governmental Changes Mean for Health Care, presented by Dr. Shawn Griffin

Join the President and CEO pf URAC, Shawn Griffin, MD, for his perspective on Federal policy and legislative activity. He'll touch on the No Surprises Act, Prior Authorization, Pharmacy, and Digital / Telehealth.

Legislation Affecting the Medical Review Industry, presented by Eric Hatfield

Eric Hatfield, counsel for Dane Street, LLC, a medical review company and their Director of Legal, Compliance, and Regulatory Affairs, identifies and discusses the most impactful legislation facing our industry.

PBM – What You’ve Always Wanted to Know, presented by Paul King and Courtney Deck

Credit for starting the PBM industry is usually given to the invention of the plastic benefit card in 1968 by Pharmaceutical Card System, Inc., or simply, PCS. However, the processing of prescription claims was entirely paper based until the 1980’s with the introduction of electronic processing via dial-up services. Even that was a far cry from the on-line processing of over 6 billion prescriptions a year in today’s environment coupled with the provision of clinical pharmacy oversight on each and every Rx processed.

To achieve the goal of reducing prescription costs while keeping drug therapy safe on over 11,000 prescriptions a minute has pushed PBMs to the forefront of innovation in technology, patient care and prescription fulfillment. Therefore, it should come as no surprise that artificial intelligence (AI) and machine learning (ML) are rapidly finding a role in this environment. However, at the same time, dispensing pharmacists on the front-line of patient care in retail pharmacies and other practice settings are concerned about “alert fatigue” and burnout. Perhaps it is time to examine a role for virtual pharmacists.

Join this exciting presentation to learn more about the potential role of AI and ML in the practice of pharmacy, the impact on injured patients and automation of the prior authorization process. In addition, an examination of the hurdles will be examined, such as the oversight provided by the various state boards of pharmacy and medicine.

Emerging Review Markets, presented by Tom Naughton

This session will discuss emerging markets for clinical review in the Federal and State Marketplaces. Emerging markets will include Medicaid MCO appeals, Federal and State disability, and Workers’ Compensation. Information will include legislative and new program updates.

Artificial Intelligence and Machine Learning in the Review Process, presented by Jenn Richards

In this session, URAC will discuss the use of AI and ML in health care, considering organizational processes, the impact to patient care, and regulatory implications. Through this discussion, we will consider URAC’s IRO and HUM programs, outlining how URAC approaches AI and ML within benefit reviews.

Learning Objectives:
1. Participants will be able to describe the benefits and limitations of AI and ML in health care.
2. Participants will be able to outline the impact of AI and ML on URAC standards within the IRO and HUM programs.
3. Participants will be able to define how URAC approaches AI and ML within benefit reviews.

The Future of Commercial Health and Work Comp - Current Pitfalls & Hurdles, presented by Tim Temple

Description coming soon!

Empowering Independent Review Organizations: AI's Transformative Role - Bridging Advanced Technology and Healthcare Expertise, presented by Madhu Reddiboina

1. A brief History of AI in Healthcare
2. Key Operational Challenges for IROs
3. Potential areas where AI could augment and benefit IROs
4.Some practical scenarios within the IROs workflows
5. What are some emerging trends
6. What are some ethical and practical considerations while considering AI for IROs

Louisiana Legislative and Regulatory Reform, presented by Wayne Fontana

The current Louisiana work comp system is one of the least efficient and highest cost systems in the nation but particularly in the southern region. Our Louisiana neighbors have reformed their systems and now it is time for us to do the same.

Keys to Identifying, Preparing For, and Responding to Opportunities, presented by Tim Mechlinski

A presentation on the critical actions and common mistakes pertaining to the capture management and proposal development phases of winning business with the Federal and State government.

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