2020 Managed Care Compliance Conference

  1. Telehealth - What's New: Staying On Top of Innovation!

    2020 Managed Care Compliance Conference  | Presenter(s): Ann Greenberg, Deborah Schreiber, Tricia Beckmann  | January 28, 2020 

    • What is new with how CMS is looking at telehealth—new definitions

    • Innovations driven by technology—curing rural access issues, member and patient expectations, billing, and compliance considerations

    • Reaching members and patients—it’s all about convenience

  2. Mental Health Parity: Are You Compliant?

    2020 Managed Care Compliance Conference  | Presenter(s): Leigh Anne Hodge, Rhea E. Garrett, Scott Burnett Smith  | January 28, 2020 

    • Overview of the Mental Health Parity and Addition Equity Act (the “MHPAEA”)

    • Requirements of the MHPAEA, application of parity laws and rules under the MHPAEA, state parity laws, and state report cards

    • Agency auditing activity and the types of violations that are garnering attention from regulators

    • Recent trends in MHPAEA litigation, with a focus on wilderness therapy and Applied Behavioral Analysis (“ABA”) cases.

  3. FWA Oversight for a Small-to Mid-Size Plan

    2020 Managed Care Compliance Conference  | Presenter(s): Alexander Henrichs, Lisa Coyle Gallagher  | January 28, 2020 

    • Helping small- to mid-size plans build and maintain an effective FWA program

    • How to utilize delegates to provide assistance in an FWA program

    • How to prep for a CMS program audit and demonstrate an effective FWA program

  4. Compliance Effectiveness through Channels of Communication and Investigations

    2020 Managed Care Compliance Conference  | Presenter(s): Andrew Finkelstein  | January 28, 2020 

    • Learn effective strategies, best practices, and challenges when establishing communication procedures and investigatory practices

    • Identify key metrics for your compliance program to measure the effectiveness of organizational communication and oversight

    • Case studies: A look at the compliance framework in action after issues are reported to compliance and acted upon

  5. Compliance in the New Age of Expanded Supplemental Benefits

    2020 Managed Care Compliance Conference  | Presenter(s): Regan Pennypacker, Elizabeth Browning  | January 28, 2020 

    • CMS has finalized a plan to expand the supplemental benefits that chronically ill Medicare Advantage members can access

    • The expansion of benefits, such as meals beyond a limited basis, non-medical transportation, and home environment services, will give way to new vendors like community agencies looking to partner with plans

    • This session will provide you tips on effectively working with agencies new to Medicare Advantage to ensure compliance program requirements are considered prior to implementation

  6. Driving Compliance: How to Manage Compliant Activities Without Authority

    2020 Managed Care Compliance Conference  | Presenter(s): Michelle D. Rigby, Angela Muncy  | January 28, 2020 

    • Tips, tools, and best practices to manage, communicate, and motivate business owners to drive compliance

    • How to prioritize issues and work with areas that are already overwhelmed to drive progress

    • When and how to escalate issues internally and externally to get back on track

  7. Fraud, Waste, and Abuse Program Audits are Coming to an SIU Near You - Are You Ready?

    2020 Managed Care Compliance Conference  | Presenter(s): Jala Attia, Jessica Gay  | January 28, 2020 

    • Assess your Special Investigations Unit’s compliance against fraud prevention, detection, and recovery requirements by understanding key areas reviewed during typical program audits

    • Identify and discuss critical compliance and reporting elements as well as common pitfalls that arise during the audit process

    • Leverage best practices and proactive measures to maintain ongoing fraud, waste, and abuse compliance within your Special Investigations Unit

  8. GENERAL SESSION: Managed Care Plan Network Adequacy and Accuracy Methods of Review - An Industry Comparative Analysis

    2020 Managed Care Compliance Conference  | Presenter(s): Deb Schreiber, Michael Adelberg  | January 28, 2020 

    • Review and discuss results of a critical/comparative analysis of multiple regulator reviews and research studies from 2013 to present

    • Assess effectiveness of methods used and potential issues with review methodologies

    • Recommend best practices and emerging trends

  9. GENERAL SESSION: Managed Care Risk Areas: Government Oversight and Enforcement Trends

    2020 Managed Care Compliance Conference  | Presenter(s): Megan Tinker  | January 28, 2020 

    • The government is increasingly innovative in its oversight of its managed care programs

    • Improvements in data quality support the government’s oversight and protection of its programs

    • Despite some gains and successes, challenges remain

  10. How to Identify and Handle a Contracted Over-Prescriber

    2020 Managed Care Compliance Conference  | Presenter(s): Mark Horowitz, Joaquin Basauri, Carolyn Barton  | January 28, 2020 

    • How to identify an over-prescriber and internally escalate the case with the right health plan disciplines

    • How to address patient abandonment concerns and network adequacy

    • How to navigate the contract termination, external reporting, and PBM controls processes

  11. Making Sense of Risk Adjustment for Compliance and Legal Personnel: Best Practices and Pitfalls

    2020 Managed Care Compliance Conference  | Presenter(s): Julie Nielsen, Jason Christ, Teresa Mason  | January 28, 2020 

    • The basics of Medicare Advantage Risk Adjustment payment methodology

    • The current regulatory and enforcement landscape, including government areas of focus

    • How to effectively deploy compliance resources to manage risk adjustment, including internal auditing and monitoring

  12. Process Optimization, Organizational Structure, and Best Practices to Boost Appeals & Grievances Outcomes and Compliance

    2020 Managed Care Compliance Conference  | Presenter(s): Richard Merino, Nancy Waltermire  | January 28, 2020 

    • Prevention of common audit finding “pitfalls”, and industry best practices for remediation, including compliance with new regulations and updates

    • OIG Report: How best to identify high overturn rates in your appeals, identifying gaps to increase accuracy and lower overturn rates

    • Tackling an end-to-end ODAG process evaluation, developing process improvements, development of effective organization structure, workflows and monitoring workplan on your appeals and grievances.

  13. Proven Methods to Streamline & Optimize FDR Oversight

    2020 Managed Care Compliance Conference  | Presenter(s): Christopher G. Wilde, Deborah M. Johnson  | January 28, 2020 

    • Covered entities are ultimately responsible for actions delegated to FDRs

    • FDR oversight and monitoring of often overlooked functional areas

    • Pharmacy benefits manager (PBM) auditing & monitoring best practices

  14. How Bias and Perception Impact Compliance

    2020 Managed Care Compliance Conference  | Presenter(s): Ahmed Salim, Walter Johnson  | January 27, 2020 

    • Breaking down why people make bad decisions

    • Understanding how risk perception and inherent tendencies negatively impact compliance

    • Utilizing tools to identify bias to increase compliance within your organization

  15. GENERAL SESSION: Managed Care Compliance Hot Topic Panel

    2020 Managed Care Compliance Conference  | Presenter(s): Jenny O'Brien, Bret S. Bissey, Wanda Robinson, Mary Jo Flynn  | January 27, 2020 

    • Compliance officer top focus areas

    • Program strategies to support innovation and healthcare transformation

    • Influencing culture and driving to better outcomes

  16. A Compliance Program Facelift: Sculpting a Program from Good to Great

    2020 Managed Care Compliance Conference  | Presenter(s): Nicole S. Huff, Deborah M. Johnson  | January 27, 2020 

    • Address increasing state and federal regulatory requirements and enforcement activities

    • Discuss strategies to move your compliance program from “Good to Great” with limited resources

    • Case scenarios describing how to build partnerships and influence positive outcomes

  17. Adjusting the Risk for Medicare Advantage: Recent Enforcement Trends and Litigation Involving Medicare Advantage Risk Adjustment Practices

    2020 Managed Care Compliance Conference  | Presenter(s): Brandon J. Moss, Rachel A. Alexander  | January 27, 2020 

    • Attacks on Medicare Advantage plans’ practices with respect to auditing or reviewing risk adjustment scoring are growing both more complex and popular

    • While the government has been handed some serious setbacks in the last year, cases involving risk adjustment continue to be brought (both civilly and criminally)

    • Recent trends in civil and criminal enforcement actions, where courts are lining up on interpreting key regulations, and what all this means for Medicare Advantage providers looking to navigate this high-stakes and ever-changing landscape

  18. Navigating Compliance Challenges for Integrated Payor-Provider Systems

    2020 Managed Care Compliance Conference  | Presenter(s): Randi Seigel, Marianna (Annie) Miyazaki  | January 27, 2020 

    • Key regulatory considerations relevant to intercompany arrangements, patient/member consent, and other documentation

    • Tips for balancing plan versus provider regulatory frameworks and referral source/community partner needs

    • Risks and opportunities in data sharing among affiliates under HIPAA and other privacy laws

  19. Dual Products and MMP: Navigating State and Federal Oversight

    2020 Managed Care Compliance Conference  | Presenter(s): Deanna Simonds, Anjenette Fenske, Marla Rothouse  | January 27, 2020 

    • The Bipartisan Budget Act of 2018 sets forth requirements for increased integration for Dual Special Needs Plans (DSNPs) by 2021. These unprecedented requirements will impact the landscape of duals products

    • Insight on best practice, challenges, and the future state of Dual products from compliance officers from multiple managed care plans

    • Perspectives from several seasoned compliance professionals overseeing different fully integrated Dual products

  20. Evolving Landscapes: False Claims Act and Managed Care Fraud

    2020 Managed Care Compliance Conference  | Presenter(s): Edward A. Baker, Nicholas N. Paul  | January 27, 2020 

    • Medicare Advantage plans, Medicaid MCOs, and their partners are increasingly attractive targets for FCA whistleblower lawsuits

    • The U.S. DOJ and State MFCUs face many challenges, but are gaining traction against managed care fraud, including risk adjustment and network compliance fraud

    • Having a written compliance plan is not enough; MCOs must develop and implement systems that steer clear of FCA liability

  21. The Compliance Officers Guide to a Successful Audit

    2020 Managed Care Compliance Conference  | Presenter(s): Michelle D. Rigby, Wendy Edwards  | January 27, 2020 

    • What can you do today to be prepared for an audit tomorrow?

    • What resources does a compliance officer use to help identify gaps and prioritize issues in a lean organization with competing priorities?

    • Consultants, a compliance officer’s best friend to support mitigation efforts, staffing augmentation, audit prep, and audit support

  22. Exclusions v. Preclusions - Insights, Analytics, and Monitoring Best Practices After 1 Year of Releases

    2020 Managed Care Compliance Conference  | Presenter(s): Michael Rosen, Annie Hsu-Shieh, Liza Filtz-Frelmark  | January 27, 2020 

    • Trends, analytics, and learnings from the first year of monitoring and implementation

    • Learn the crossover between the CMS Preclusion List and Federal and State Medicaid Exclusion Lists

    • Predictive insights and future considerations for your provider network operations and SIU teams

  23. Expert Auditing and Monitoring Practices to Measure Quality of Care and Performance Improvement Strategies in Medicaid Managed Care

    2020 Managed Care Compliance Conference  | Presenter(s): Michael Walsh, Jennifer Tryder, Lori Dillard  | January 27, 2020 

    • Understanding MCO performance measurement data and what is required to be produced and reported

    • Best practices on performing and selecting Medicaid audits in order to effectively measure quality of care standards and performance

    • Examples of MCO policies and procedures that assure the provisions and quality of care are actively monitored and remediated on an ongoing basis, and that the results are used to improve performance

  24. GENERAL SESSION: CMS Update (2020 Managed Care Compliance)

    2020 Managed Care Compliance Conference  | Presenter(s): Kimberly Brandt  | January 27, 2020 

    • Overview of the agency’s ongoing burden reduction efforts, including updates to Medicare Medicare Conditions of Participation (CoPs) and Conditions for Coverage (CfCs)

    • Proposal to modernize and clarify regulations for the Physician Self-Referral Law

    • CMS efforts to combat the opioid epidemic, including SUPPORT Act initiatives

    • Reforms to modernize and bring transparency to CMS program integrity efforts

  25. Proactive vs. Reactive in Risk Management - "Ring the Bell!"

    2020 Managed Care Compliance Conference  | Presenter(s): Fredy Rocha, Tiffany Lewis  | January 27, 2020 

    • Identify challenges and explore practical experiences for conducting an effective risk assessment while building a proactive monitoring and auditing plan

    • Identify proactive risk management, which consists of mitigating the risks of threat events before these might possibly occur and negatively impact the organization

    • Identify reactive risk management, which consists of responding to risk events as they occur to mitigate negative impacts to the organization