February 1 - 3, 2021
2021 Managed Care Compliance Conference
Virtual , Central Standard Time (CST)Agenda
All session times listed are in Central Standard Time (CST)
Monday, February 1
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09:30 AM - 11:00 AMBreakout Sessions#P01Building and Evolving Your Program Integrity Compliance Program Rick Munson, Program Integrity Chief Compliance Officer & VP Investigations, United Healthcare Michael Jurmu, Director, Compliance, UnitedHealthcare Matthew Berls, Sr. Director of Investigations, UnitedHealthcare
- Program Framework – Aligning Payment Integrity, SIU, relationships with Government Agencies and Program Integrity Efforts
- Program Governance - Prevention, Detection and Correction Strategies
- Program Value Proposition - Innovation and Use of Data
Intermediate#P02Covid-19 and Lessons Learned for Flexible Care Management Approaches Rob Parker, Director, PricewaterhouseCoopers Valerie DeBoe, Vice President, Ethics & Compliance, Centene Gretchen Wagner, Risk Management Director, Humana Rohit Gupta, V.P. - Compliance & Medicare Compliance Officer, Molina Healthcare, Inc- A panel discussion on lessons learned from the Coronavirus pandemic and how health plans redeployed staff, adjusted processes, prioritized member outreach, and lessons learned for future emergencies and disruptions.
- How were plans able to successfully deploy employees, including FDR staff, to provide remote care management services while proactively providing accommodations to high risk members?
- What processes and organizational responses will your organization retain for future national or local emergencies (e.g., natural disasters)? What areas of improvement have been highlighted throughout this experience?
Intermediate -
11:00 AM - 11:15 AMCoffee Break
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11:15 AM - 12:45 PMBreakout Sessions#P03Building a Cybersecurity Auditing and Monitoring Plan Jennifer Griveas, Chief Human Resources Officer & General Counsel, Eliza Jennings Senior Care Network Michael Gray, Vice President of IT and Compliance Officer, Eliza Jennings
- Upon completion, participants will be able to understand the biggest security threats to health care organizations and highlight most vulnerable systems and populations.
- Learn to assess compliance risk related to common technologies and equipment, with focus on developing an auditing and monitoring plan for meeting the mandates of the HIPAA Security Rule and other applicable substantive cybersecurity requirements.
- Speakers will review how to take results of auditing and monitoring activity to build a strong work plan to mitigate risks associated with technology.
Basic#P04How to Build a CPE Tracer: Best Practices to Focus on Prevention, Detection, and Correction Using Misclassified Grievances Michelle Larson, Consultant Milly Koranteng, Vice President & Compliance Officer, Medica Health Hannah LaMere, Director, Special Projects, Cody Consulting Group- Prevention: Apply prevention methods to avoid misclassified grievances, identify training needs, review of regulations, guidance and audit protocols, updating policies and procedures.
- Detection: Provide suggestions on how to add rigor to compliance staff oversight of call routing and classification of inquiries, grievances, organization determinations, coverage determinations.
- Correction: Learn the critical questions to consider when building Corrective Action Plans. A template will be reviewed.
Intermediate -
12:45 PM - 01:10 PMMid-Conference Break Activity - Trivia Join fellow attendees in a quick game of trivia! This live, interactive game will test your knowledge and provide a fun activity during the break. See live player rankings and win prizes!
Sponsored by: ProviderTrust -
12:45 PM - 01:30 PMMid-Conference Break
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01:30 PM - 03:00 PMBreakout Sessions#P05Risks and Audit Readiness for Non-Quantitative Treatment Limits (NQTLs) of the Mental Health Parity Addiction Equity Act (MHPAEA) Jon Swanson, Senior Compliance Practice Leader, Kaiser Permanente Maggie Russillo, Director, Commercial Health Plan Compliance, Kaiser Permanente
- Understand the unique health plan challenges posed by MHPAEA non-quantitative treatment limits (NQTLs) in order to facilitate operational engagement
- Address regulator, purchaser, and member expectations of NQTLs
- Learn to build a toolkit to complete meaningful assessments and evaluate compliance for audit readiness
Intermediate#P06Corrective Action Plans & Root Causes: Why It’s Important to Get Both Right Alexander Fields, Aon- Best Practices and Unique Perspectives on Root Causes and Developing Corrective Action Plans
- Why CAPS rely so heavily on Root Causes, and how to help ensure, as Compliance, that you get it right the first time through
- After the CAP: Measuring and Monitoring results to ensure the Corrective Action is truly Corrective
Intermediate -
03:00 PM - 03:15 PMCoffee Break
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03:15 PM - 04:45 PMBreakout Sessions#P07Another Look at Building a DSNP Compliance Program Kimulet Winzer, Director Nicole Larson, Chief Compliance Officer, Health Choice Arizona Thomas Tutaj, Asst VP - Medicare Compliance Officer, Farm Bureau Health Plans
- How to move from building to implementing a DSNP Compliance program?-?compliance professionals will share pitfalls and best practices
- Components and concepts to create an effective program
- How compliance professionals engage stakeholders as partners in building and creating an effective DSNP program
Intermediate#P08The Ever-Evolving Landscape of Privacy and Security Compliance Jonathan Friesen, Chief Privacy Officer, Geisinger Health System Adam Greene, Partner, Davis Wright Tremaine, LLP- Update on recent changes to health information privacy laws
- Recent privacy and security enforcement trends
- Third party risk assessment
Intermediate
Tuesday, February 2
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08:00 AM - 08:45 AMNetwork & Discussion Groups
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08:50 AM - 09:00 AMOpening Remarks
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09:00 AM - 10:00 AMGENERAL SESSION Medicaid Fraud Trends & Best Practices for Reporting and Partnering with State Medicaid Regulators Gary Cantrell, Deputy Inspector General for Investigations, OIG HHS Marita Janiga, Vice President, Investigations, Kaiser Permanente
- 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
Basic -
10:00 AM - 10:15 AMCoffee Break
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10:15 AM - 11:15 AMBreakout Sessions#101101 Integrated Appeals and Grievances: A Roadmap for D-SNPs Sarah Swank, Counsel, Nixon Peabody LLP Justin Frazer, Director, Healthcare Consulting, Mazars USA LLP
- 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.
Intermediate#102What You Don’t Know Will Hurt You: Managed Care Enforcement Trends and Key Risk Areas John Kelly, Partner, Barnes & Thornburg LLP Benjamin Singer, Partner, O’Melveny & Myers LLP Megan Tinker, Assistant Inspector General, HHS-OIG- 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.
Intermediate#103SESSION CANCELLED: The Workplace of the Future Is Now Suzanne Adnams, Gartner- 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
Intermediate -
11:15 AM - 11:30 AMCoffee Break
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11:30 AM - 12:30 PMBreakout Sessions#201Rewards and Incentives Programs: How to Stay on Top of Innovation and the Regulatory Landscape Vincent Naccarato, Director, Compliance and Counsel, Centene Inc. Tricia Beckmann, Director, Faegre Drinker Tracy Tracy, VP- Compliance and Legal, CCPO, Icario
- 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
Intermediate#202Successful Regulatory Relationships Post-COVID-19 with Sponsors and FDRs Robert Alfano, U.S. Regulatory Lead, Babylon Kenneth Nunez, Chief Compliance Officer, Provider Partners Health Plans- 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
Advanced#203Digital Transformation Strategies: Risk & Compliance Considerations Jaime Pego, Managing Director, KPMG LLP Joe Ravas, Director, KPMG- 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
Intermediate -
12:30 PM - 12:55 PMMid-Conference Break Activity - Trivia Join fellow attendees in a quick game of trivia! This live, interactive game will test your knowledge and provide a fun activity during the break. See live player rankings and win prizes!
Sponsored by: ProviderTrust -
12:30 PM - 01:15 PMMid-Conference Break
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01:15 PM - 02:15 PMBreakout Sessions#301Preparing for the Era of Provider Network Transparency John Weis, President and Co-Founder, Quest Analytics Michael Adelberg, Principal, Faegre Drinker Consulting
- Across health care there is a growing need to measure, manage, and improve provider directories?—?a need driven by regulators and market driven innovations
- Find out how regulators and members depend on provider directories, why directories are frequently inaccurate, and what new tools and approaches exist to improve their accuracy
- Gain an understanding of why provider directories are increasingly used to measure network adequacy in real time and for determining network capacity and stability
Intermediate#302Preparing Effective Corrective Action Plans: Get to the Root! Thomas Wilson, Sr Dir Medicare Compliance Ofcr, KS Plan Administrators LLC Tammy Hall, Senior Compliance Manager, Care N' Care of North Carolina- 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
Basic#303Best Practices in Board, Compliance Committee, and CEO Reporting Laurena Lockner, Director Monitoring & Compliance, HealthPartners Steve Bunde, VP Integrity & Compliance & Internal Audit, HealthPartners- Learn about Board and Compliance Committee Oversight Responsibilities
- Understand Best Practices in Reporting
- Develop Agendas, Tools, and Templates for Reporting
Intermediate -
02:15 PM - 02:30 PMCoffee Break
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02:30 PM - 03:30 PMBreakout Sessions#401Not for the Faint of Heart: The Path to Compliance amid Medicaid Expansion Chris Zitzer, VP, Chief Compliance & Ethics Officer, UCare Susan Anderson, Vice President Corporate Compliance Officer, CareSource
- 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
Intermediate#402Social Determinants of Health: Minimizing Compliance Challenges While Implementing a Data-Driven and Collaborative Approach to Improve Community Health Maureen Hydok, Senior Director Healthcare, Huron Consulting Group Marcie Rohleder, Director, Huron- Understand Social Determinants of Health (SDoH) & 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
Intermediate#403Virtual Health Care: Oversight and Opportunities in This New World Anne Crawford, SVP, Compliance Solutions, ATTAC Consulting Group LLC Jennifer Del Villar, Dir Gov Pgms Compliance, Cambia Health Solutions, Inc. Annie Shieh, Sr. Director of Compliance, CA Compliance Officer , Central Health Plan of California- 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
Intermediate -
03:30 PM - 03:45 PMCoffee Break
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03:45 PM - 04:45 PMGENERAL SESSION: Managed Care Compliance Hot Topics Panel Carolyn Barton, VP, Compliance & Regional Compliance Officer, Kaiser Foundation Health Plan of Washington Michelle Turano, Vice President Medicare Compliance, Anthem Pamela Cleveland, Director, Healthcare Consulting, Mazars USA, LLC Dave Nesseler-Cass, Chief Compliance Ofc and Director of Regulatory, Moda Health and Delta Dental of OR and AK
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04:45 PM - 05:45 PMConference Social Event - Live Piano Show Interact and engage with your fellow attendees at this live request-driven piano show. Bring your song requests and favorite beverage for this fun musical variety show with thousands of songs to choose from spanning many decades and genres
Wednesday, February 3
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08:55 AM - 09:00 AMOpening Remarks
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09:00 AM - 10:00 AMGENERAL SESSION: Managed Care: OIG Priorities and Identified Risk Areas Megan Tinker, Assistant Inspector General, HHS-OIG
- Risks areas and enforcement trends
- OIG priorities and up-coming work in managed care
- Flexibilities and changes because of COVID-19
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10:00 AM - 10:15 AMCoffee Break
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10:15 AM - 11:15 AMBreakout Sessions#501CMS Universes: Using Regulatory Data Sets to Provide Monitoring and Oversight to Inform Decision Making Melissa Hecht, AVP, Operational Resiliency, Healthfirst Adam Zeldin, Manager, PricewaterhouseCoopers
- 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
Intermediate#502Compliance Organizational Design Veronica Moore, Director, Corporate and Medicare Compliance, BCBS of AZ James Rose, Managing Director, SunHawk Consulting LLC- 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?
Intermediate#503Federal and State-Based Exchanges: Risk Reduction Strategies Steve Bunde, VP Integrity & Compliance & Internal Audit, HealthPartners Stephanie Moscetti, Senior Manager, HealthPartners- 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
Intermediate -
11:15 AM - 11:30 AMCoffee Break
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11:30 AM - 12:30 PMBreakout Sessions#601Building an Audit-Ready Pharmacy Compliance Program Katherine Tarvestad, VP of Compliance, Medicare and Retirement, United Health Care Niki Jo Kurtis, Director, Advisory Services, Optum Insight
- 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
Intermediate#602The Risks of Risk Adjustment Reviews: Enforcement Trends and Litigation Involving Medicare Advantage Risk Adjustment Practices Rachel Alexander, Partner, Wiley Rein Brandon Moss, Partner, Wiley Rein- 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
Intermediate#603Implementing Regulatory Changes: A "How-To Guide" for Any Organization of Any Size Jessica VanderZanden, VP, Compliance and Culture, Network Health Angela Keenan, Compliance Officer, Network Health- 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
Basic -
12:30 PM - 01:15 PMCANCELLED: SpeedNetworking Due to technical difficulties, the Speed Networking event scheduled for the Mid-Conference break today, has been cancelled. We apologize for the inconvenience.
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12:30 PM - 01:30 PMMid-Conference Break
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01:30 PM - 02:30 PMBreakout Sessions#701The Auditors Are Coming: Is Your Medicaid Managed Care Health Plan Ready? Holly Dolgaard, Principal, Mercer Scott Banken, Principal, Mercer Chris Babcock, Consultant, Mercer
- 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
#702Compliant Coding Review Project Management: From Project Concept to Analyzing Review Results and Everything In Between! Dortha Campo, Manager, Risk Adjustment Division, Reimbursement Mgmt Consultants, Inc. Dana Brown, Compliance Connections, Inc.- 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
#703Cyber Risk = Disruptive Business Risk Uday Ali Pabrai, CEO, ecfirst- 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
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02:30 PM - 02:45 PMCoffee Break
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02:45 PM - 03:45 PMGENERAL SESSION: Getting to Effective: What is Your Compliance Value Proposition? Jenny O'Brien, President and Principal, Blackbridge Advisors
- Guiding Program Principles
- Compliance Value Proposition
- Moving the Meteor
All breakout sessions have a knowledge level associated with them, these levels are just guidelines and you are free to attend sessions of any level.
Basic: Program knowledge level most beneficial to Compliance Professionals new to a skill or an attribute. These individuals are often at the staff or entry level in organizations, although such programs may also benefit a seasoned professional with limited exposure to the area.
Intermediate: Program knowledge level that builds on a basic program, most appropriate for Compliance Professionals with detailed knowledge in an area. Such persons are often at a mid-level within the organization, with operational or supervisory responsibilities, or both.
Advanced: This level focuses on the development of in-depth knowledge, a variety of skills, or a broader range of applications. Advanced level programs are often appropriate for seasoned professionals within organizations, and professionals with specialized knowledge in a subject area.