How Managed Care and AI Changed Who Wins – and Who Pays: The New Economics of Payment Integrity

Join Holland & Knight and BDO for a webcast exploring how managed care and artificial intelligence (AI) are redefining healthcare payment risk. This session will examine the structural and economic forces driving payment adjudication, the expanding role of AI in utilization management and coverage decisions, and why traditional revenue cycle strategies are no longer sufficient.

Attendees will gain practical insights into how leading organizations are using analytics, escalation strategies, and legal and regulatory avenues to address payment integrity challenges in today's evolving reimbursement environment.

Key Objectives:

• identify shifts in managed care models
• explain how AI-driven utilization management affects reimbursement
• evaluate traditional vs. automated revenue cycle workflows
• describe current legal and regulatory developments affecting AI-driven coverage and payment decisions
• determine when escalation strategies – including payer dispute processes, regulatory engagement, arbitration or litigation – may be appropriate

Speakers:

Melissa Scott | Managing Director, Healthcare Forensics, BDO USA
Sandra L. Heller | Partner, Holland & Knight

Continuing Legal Education (CLE):

After completion of the program, Holland & Knight (and its CLE administration partner, CEU Institute) will apply for CLE credit based on attendee requests. Some programs may not be awarded CLE credits because of content or jurisdictional restrictions. Please be aware that the CLE approval process can be lengthy in some jurisdictions. For New York attorneys, this program's format qualifies for CLE for transitional (newly admitted) and experienced attorneys.