2021 Managed Care Compliance Conference

  1. The Auditors Are Coming: Is Your Medicaid Managed Care Health Plan Ready?

    2021 Managed Care Compliance Conference  | Presenter(s): Holly Dolgaard, Scott Banken, Chris Babcock  | February 03, 2021 

    • The Medicaid Managed Care Final Rule requires state Medicaid agencies to complete an independent audit of the accuracy, truthfulness, and completeness of the encounter and financial data submitted by each MCO every 3 years

    • Learn key financial concepts that drive rate setting, risk adjustment, and medical loss ratio processes and their connection to financial and encounter data. Review tools and resources that encounter data validation auditors utilize

    • The COVID-19 pandemic response included special procedure codes, diagnoses, and modifiers for testing, treatment, and other healthcare impacted by COVID-19. Learn steps to ensure your encounters accurately reflect the impact of COVID-19

  2. The Risks of Risk Adjustment Reviews: Enforcement Trends and Litigation Involving Medicare Advantage Risk Adjustment Practices

    2021 Managed Care Compliance Conference  | Presenter(s): Rachel Alexander, Brandon Moss  | February 03, 2021 

    • In the last year, DOJ has proclaimed Medicare Advantage to be a prime enforcement target

    • While DOJ has suffered setbacks, they are primed to attack Medicare Advantage providers' practices with respect to auditing or reviewing risk adjustment scoring -- both civilly and criminally

    • This panel will discuss recent enforcement trends, 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

  3. Building an Audit-Ready Pharmacy Compliance Program

    2021 Managed Care Compliance Conference  | Presenter(s): Katherine Tarvestad, Niki Jo Kurtis  | February 03, 2021 

    • How can business owners and Compliance partner to achieve greater outcomes?

    • Practical tips for assessing key Compliance risks in your Pharmacy program

    • Building a Regulatory Audit Readiness Strategy

  4. CMS Universes: Using Regulatory Data Sets to Provide Monitoring and Oversight to Inform Decision Making

    2021 Managed Care Compliance Conference  | Presenter(s): Melissa Hecht, Adam Zeldin  | February 03, 2021 

    • Implement a universe monitoring program to identify key risks related to operational inefficiencies (e.g. lack of provider outreach) and adjust staffing and processes to meet compliance and operational needs

    • Proactively improve operational and compliance performance to save cost

    • Leverage data quality monitoring program to identify third-party vendors with quality and process gaps needing remedial actions

  5. Federal and State-Based Exchanges: Risk Reduction Strategies

    2021 Managed Care Compliance Conference  | Presenter(s): Steve Bunde, Stephanie Moscetti  | February 03, 2021 

    • Understand key compliance requirements for exchange-based products

    • Identify key risks areas for your exchange-based products

    • Develop a risk assessment and proactive monitoring plans to reduce compliance risks

  6. Compliance Organizational Design

    2021 Managed Care Compliance Conference  | Presenter(s): Veronica Moore, James Rose  | February 03, 2021 

    • What considerations should be made for organization design of the compliance program?

    • How does my organizations internal audit, enterprise risk management, privacy, cyber security, ethics, human resources areas impact the compliance organization design?

    • What is organizational design and how it is important to compliance program effectiveness?

  7. Compliant Coding Review Project Management: From Project Concept to Analyzing Review Results and Everything In Between!

    2021 Managed Care Compliance Conference  | Presenter(s): Dott Campo, Dana Brown  | February 03, 2021 

    • Project Management is key in overall success of a Coding Review Project. This presentation will review the key steps one should take to ensure the review performed will garner useful information once completed

    • Compliance is a necessity in performance of any coding review. Risk Adjustment poses compliance/privacy/security risks not seen in other reviews. This presentation will highlight common issues and best practices

    • Staff, Talent and Tools are critical to any project success. This presentation will address best advice and practices in these areas

  8. Getting to Effective: What is Your Compliance Value Proposition?

    2021 Managed Care Compliance Conference  | Presenter(s): Jenny O'Brien  | February 03, 2021 

    • Guiding Program Principles

    • Compliance Value Proposition

    • Moving the Meteor

  9. Cyber Risk = Disruptive Business Risk

    2021 Managed Care Compliance Conference  | Presenter(s): Uday Ali Pabrai  | February 03, 2021 

    • Examine how to establish an audit-ready compliance program

    • Analyze critical areas to address in an enterprise security plan

    • Check ransomware, phishing, Dos, DDoS that can seriously disrupt business processes and priorities

  10. Implementing Regulatory Changes: A "How-To Guide" for Any Organization of Any Size

    2021 Managed Care Compliance Conference  | Presenter(s): Jessica VanderZanden, Angela Keenan  | February 03, 2021 

    • In a world of constantly changing regulations, learn best practices regarding interpretation, breaking down and facilitating required actions

    • Discuss tips, tricks, and tools for partnering with business areas on regulatory changes while keeping on track with complicated regulations that span long periods of time

    • Once changes are implemented, explore ways of ensuring continued compliance and effectiveness with the changes

  11. Managed Care: OIG Priorities and Identified Risk Areas

    2021 Managed Care Compliance Conference  | Presenter(s): Megan Tinker  | February 03, 2021 

    • Risks areas and enforcement trends

    • OIG priorities and up-coming work in managed care

    • Flexibilities and changes because of COVID-19

  12. Rewards and Incentives Programs: How to Stay on Top of Innovation and the Regulatory Landscape

    2021 Managed Care Compliance Conference  | Presenter(s): Vincent Naccarato, Tricia Beckmann, Tracy Tracy  | February 02, 2021 

    • Understand the evolution of rewards and incentives programs in managed care, with a focus on Medicare Advantage and Part D programs and regulatory landscape

    • Gain insights into common and innovative approaches to rewards and incentives offerings in practice today, including CMS demonstration projects

    • Identify how to spot and resolve potential compliance risks before and during implementation through practical tips and best practices

  13. Virtual Health Care: Oversight and Opportunities in This New World

    2021 Managed Care Compliance Conference  | Presenter(s): Anne Crawford, Jennifer Del Villar, Annie Shieh  | February 02, 2021 

    • Emerging regulatory landscape and impact on health plan operations and compliance

    • Risks and rewards from health plan, member, and provider perspectives

    • Strategies for effective due diligence

  14. Social Determinants of Health: Minimizing Compliance Challenges While Implementing a Data-Driven and Collaborative Approach to Improve Community Health

    2021 Managed Care Compliance Conference  | Presenter(s): Mareen Hydok, Marcie Rohleder  | February 02, 2021 

    • Understand Social Determinants of Health (SDoH) and how addressing these factors can improve health/wellness and reduce medical costs

    • Learn how organizations/communities are working together to positively impact overall community and population health with collaborative SDoH solutions

    • Recognize regulatory and compliance challenges when leveraging SDoH data in your strategy

  15. Successful Regulatory Relationships Post-COVID-19 with Sponsors and FDRs

    2021 Managed Care Compliance Conference  | Presenter(s): Robert Alfano, Kenneth Nunez  | February 02, 2021 

    • Changes from COVID-19 on the regulatory relationship: More virtual, government has less resources, more expectations on Health Plans to comply and step up, more regulator sensitivity to CTMs due to beneficiary financial issues

    • Changes to Health Plan workforce: More remote- how to reach, teach, and enforce compliance in virtual settings, privacy issues, and security of data/workspaces in the "new normal"

    • Impacts to daily work and operations: FDRs impacted by shifting supply chain dynamics, applicability of COVID-19 additional and evolving regulations, and how to operationalize them in this new dynamic

  16. What You Don't Know Will Hurt You: Managed Care Enforcement Trends and Key Risk Areas

    2021 Managed Care Compliance Conference  | Presenter(s): John Kelly, Benjamin Singer, Megan Tinker  | February 02, 2021 

    • The panel will review in detail and discuss lessons learned from past cases and current enforcement trends against Medicare and Medicaid Managed Care organizations and providers

    • The panel will identify key risk areas and best practices to minimize exposure

    • The panel will discuss how compliance program deficiencies in the risk adjustment space can create enforcement risk

  17. The Workplace of the Future Is Now

    2021 Managed Care Compliance Conference  | Presenter(s): Suzanne Adnams  | February 02, 2021 

    • Learn ways to re-create a flexible work policy

    • Consider concepts to rethink functions and redefine expectations

    • Identify and manage challenges related to the new work model

  18. Digital Transformation Strategies: Risk & Compliance Considerations

    2021 Managed Care Compliance Conference  | Presenter(s): Jaime Pego, Joe Ravas  | February 02, 2021 

    • How to design a healthcare digital experience strategy

    • Where to start on a digital experience transformation

    • How to avoid potential compliance pitfalls along the way

  19. Integrated Appeals and Grievances: A Roadmap for D-SNPs

    2021 Managed Care Compliance Conference  | Presenter(s): Sarah Swank, Justin Frazer  | February 02, 2021 

    • Per CMS requirements, by 2021, D-SNPS must be prepared to deliver to its beneficiaries a fully integrated (Medicaid and Medicare) appeals and grievance model

    • At the time of this presentation, State agencies have already proposed various models of integration to CMS that D-SNPs will be required to implement, operationalize, and monitor to assure that mandated benchmarks meet the revised regulatory standards

    • Most integrated models will be similar in scope and delivery; therefore, methods and controls for D-SNPs to update their operational models, member notifications, corporate policies, member materials as well as assurances of compliance will be recommended

  20. Best Practices in Board, Compliance Committee, and CEO Reporting

    2021 Managed Care Compliance Conference  | Presenter(s): Laurena Lockner, Steve Bunde  | February 02, 2021 

    • Learn about Board and Compliance Committee Oversight Responsibilities

    • Understand Best Practices in Reporting

    • Develop Agendas, Tools, and Templates for Reporting

  21. Managed Care Compliance Hot Topics Panel

    2021 Managed Care Compliance Conference  | Presenter(s): Carolyn Barton, Michelle Turano, Pamela Cleveland, Dave Nesseler-Cass  | February 02, 2021 

    • Medicaid Fraud Trends & Best Practices for Reporting and Partnering with State Medicaid Regulators

      2021 Managed Care Compliance Conference  | Presenter(s): Gary Cantrell, Marita Janiga  | February 02, 2021 

      • Emerging Medicaid fraud risks and areas of interest to Managed Care Professionals

      • Partnering with your Medicaid fraud control teams and best practices for reporting suspected fraud

      • Preparing for Medicaid audits to achieve sucessful outcomes

    • Not for the Faint of Heart: The Path to Compliance amid Medicaid Expansion

      2021 Managed Care Compliance Conference  | Presenter(s): Chris Zitzer, Susan Anderson  | February 02, 2021 

      • From Medicaid expansion to COVID-19, expectations of state Medicaid agencies continue to evolve at a rapid pace

      • Top compliance issues facing Medicaid Compliance Officers

      • How to adjust your Medicaid Compliance Program considering the rapidly changing environment

    • Preparing Effective Corrective Action Plans: Get to the Root!

      2021 Managed Care Compliance Conference  | Presenter(s): Thomas Wilson, Tammy Mosely  | February 02, 2021 

      • CMS expects health plans to develop corrective action plans in response to noncompliance or fraud, waste, and abuse issues. Developing effective corrective action plans generally includes root cause and impact analyses. What does this really mean?

      • The presentation will cover CMS expectations - Resolve, Prevent, Monitor. Root Cause Analysis - Why? Impact Analysis - Who? Corrective Action Plan (CAP) - What do we do? *Actions Taken *Testing *Implementation *Monitoring

      • The presentation will explore the end-to-end process with an interactive case study to demonstrate critical steps. Polling questions will be used

    • Preparing for the Era of Provider Network Transparency

      2021 Managed Care Compliance Conference  | Presenter(s): John Weis, Michael Adelberg  | February 02, 2021