2019 Managed Care Compliance Conference

26. Lessons Learned on the Frontlines of Network Compliance Enforcement

    2019 Managed Care Compliance Conference  | Presenter(s): Deborah Schreiber, Niki Jo Kurtis  | January 27, 2019 

    • Regulatory requirements and expectations for provider and pharmacy networks

    • Lessons learned from current regulatory auditing, monitoring, and reporting requirements for provider networks

    • Why regulators consider network directory data accuracy issues to be a potential access issue and an important beneficiary/consumer protection focus area — and how to apply lessons learned to pharmacy networks

27. Build a Managed Care Compliance Audit and Remediation Plan

    2019 Managed Care Compliance Conference  | Presenter(s): Nicole Huff, Deborah Johnson  | January 27, 2019 

    • Best practices on how to review and audit risk adjustments

    • How to correlate compliance risk assessments and ongoing audit work

    • Tracer summaries, including internal controls, remediation activity, documented outcomes, and remediation effectiveness for a compliance scenario

28. Building an SIU That's Nimble, Effective, and Audit Ready!

    2019 Managed Care Compliance Conference  | Presenter(s): Marita Janiga, Tamara Neiman, Mark Horowitz  | January 27, 2019 

    • The key components of building and leading an effective SIU

    • A “best practice” process for responding to CMS memos and issuances

    • The steps to take in preparing for a CMS Compliance Program Effectiveness Audit

29. Compliance 101 (2019 Managed Care Compliance)

    2019 Managed Care Compliance Conference  | Presenter(s): Shawn DeGroot, Jenny O'Brien  | January 27, 2019 

    • Factors to consider when developing and implementing a compliance program

    • The elements and keys to maintain an effective compliance program

    • Introduction of tools and techniques

30. Let's Talk Shop: Changes in MA and Part D Compliance Requirements for 2019

    2019 Managed Care Compliance Conference  | Presenter(s): Kate McDonald, Annie Hsu Shieh, John Tanner  | January 27, 2019 

    • Understand and prepare for CMS’s encounter data monitoring efforts

    • Reconsider your approach to FDR training in light of CMS changes

    • Implement best practices for preclusion list screenings, new MLR reporting requirements, and other compliance-related changes in 2019

31. Compliance, Privacy, and Security Program Assessment Best Practices

    2019 Managed Care Compliance Conference  | Presenter(s): Bret Bissey, Kelly McLendon  | January 27, 2019 

    • Ideas for conducting a compliance program review to ultimately reduce overall organizational compliance risk

    • How to utilize the elements of the DHHS OIG Model Compliance Program(s) to develop a work plan to perform this assessment

    • The content of — and tips for performing — HIPAA privacy and security assessments in order to impress OCR and facilitate a high level of compliance which ultimately reduces organizational risk

32. I Can Hear You -?But Am I Listening?

    2019 Managed Care Compliance Conference  | Presenter(s): Jennifer Del Villar, Gail M. Blacklock  | January 27, 2019 

    • When our members call, are we fulfilling all their needs? Appeals, determinations, grievances, and inquiries

    • CMS call log universes —  the who, where, what, why, and how

    • Monitoring and auditing using call logs universes — both the business area and compliance

33. Understanding the Varying Perspectives of Counsel, Compliance Officer, and Prosecutor to Improve Your Internal Investigation Process

    2019 Managed Care Compliance Conference  | Presenter(s): Heather Fields, Lisa Estrada, James Sheehan  | January 27, 2019 

    • Yates/Sessions focus on individual liability in DOJ corporate investigations — how attorney ethical duties, compliance officer ethical guidelines, and Yates cooperation credit requirements impact interviews and investigation process and documentation

    • Different planning approaches of compliance officer, legal counsel, and prosecutor/regulator to compliance reviews, investigations, and reporting — through case studies and interaction

    • Practical strategies to address investigation challenges and optimize your organization’s ability to achieve the best possible outcome in government investigations or litigation