#P03

P03: The A to Zs of FDR, Delegate, and Subcontractor Oversight Steve Bunde, VP Integrity & Compliance & Internal Audit, HealthPartners Laurena Lockner, Director Monitoring & Compliance, HealthPartners Rebecca Fuller, Corporate Compliance Officer, PrimeWest Health View Description

• Prevent: Learn about CMS and state requirements for FDR, delegate, and subcontractor oversight and areas of audit focus
• Detect: Understand due diligence, contracting, risk assessment, and auditing and monitoring strategies - including key partnerships
• Correct: Discover what to do when issues are identified and how to incorporate those into the correct CMS Program Audit Universe

General Compliance

#P04

P04: Compliance 2020: Compliance and Business Roles in Today’s Complex Regulatory Environment James Taylor, Manager, PricewaterhouseCoopers Christopher Schroeder, Director, PricewaterhouseCoopers Taline Avakian, Director of Compliance and Medicare Compliance Officer, Harvard Pilgrim Health Care View Description

• Key developments and trends across the healthcare industry related to the evolving role of compliance and the role of business units
• How compliance has helped define the role of meeting regulatory requirements
• An understanding of embedded compliance support and/or performance/program support teams/units, and how risk ownership is driving the role of business units

General Compliance

#P05

P05: Effectively Managing Internal Investigations and Regulatory Disclosures Anne Crawford, Director, ATTAC Consulting Group LLC Annie Shieh, Sr Compliance Counsel, Central Health Plan of California Lori Benso, Member, Strategic Health Law View Description

• Methods to determine if communication infrastructure supports prompt identification of potential issues
• Strategies for initiating timely investigations that determine beneficiary and organizational impacts
• Common themes and regulatory disclosure approaches when deciding whether self-reporting to regulators is required or advisable
• Attorney-client privilege and litigation risk-management strategies

General Compliance

#P06

P06: Compliance Goals in Risk Adjustment Coding Dana Brown, President, Reimbursement Management Consultants, Inc. Dott Campo, Manager, Risk Adjustment Division, Reimbursement Mgmt Consultants, Inc. Rebecca Welling, Senior Director- Coding Compliance, Providence Health Plan Rebecca Welling, Senior Director- Coding Compliance, Providence Health Plan View Description

• Overview of Risk Adjustment reimbursement in the MA and ACA models
• Review of Risk Adjustment coding, HCC code capture accuracy, review of coding guidelines, rules & regulations
• In-depth review of most common compliance issues in coding in an RA environment, isolating the issues and giving tools to analyze them and make good compliant decisions

General Compliance

#P07

P07: Special Supplemental Benefits and the FDRs that Provide Them - Unique Monitoring Challenges They Pose Jennifer Del Villar, Dir Gov Pgms Compliance, Cambia Health Solutions, Inc. Gail Blacklock, Compliance Officer , Inter Valley Health Plan View Description

• Unique monitoring challenges with unique FDRs
• Monitoring the member match - right member to the right supplemental benefit
• Tracking & monitoring health outcomes

General Compliance

#P08

P08: Establishing a Best-Practice Approach for Your Compliance, Privacy, and Security Programs Bret Bissey, Vice President, Chief Compliance Officer, Gateway Health Kelly McLendon, Managing Partner, CompliancePro Solutions View Description

• Learn how to utilize, in detail, the elements of the DHHS OIG Model Compliance Program(s) to develop a best practice for your compliance efforts
• Learn how to utilize the HIPAA Privacy and Security regulations and conduct a program assessment to create a best practice standard in your organization.
• Learn how best to formulate security, privacy, and compliance education programs in your organization, including a focus on being compliant at the top of the organization, by utilizing market knowledge to stimulate learning.

General Compliance