#H01

V1 - The Impact of HIPAA Regulatory Changes on Managed Care Organizations Elizabeth Kastner, Attorney At Law, Epstein, Becker & Green Chris Bennington, Member of the Firm, Epstein Becker & Green PC View Description

• Define the aspects of the HIPAA regulatory changes that are applicable to managed care organizations
• Understand the policy and procedure changes that may be required to remain fully compliant
• Identify the regulatory changes that will require workforce re-training

Intermediate

#H02

V2 - Applying Principles of Continuous Quality Improvement (CQI) to Your Compliance Program Using Root Cause Analysis (RCA) Maggie Perritt, Compliance Officer View Description

• Continuous quality improvement (CQI) is consistent with maintaining a culture of compliance
• CQI and RCA are not about individuals and blame, they're about processes and cause and effect
• CQI and RCA can help demonstrate an effective compliance program

Basic

#H03

V3 - How to Improve Your Medicare Data Validation Audit Process to Enhance Oversight of FDRs and Internal Operations Derek Frye, Vice President, The Burchfield Group, an Aon Company Kathryn Patterson, Audit Manager, Commonwealth Care Alliance Jason Hoyme, Audit and Compliance Manager, The Burchfield Group, an Aon Company View Description

• Use the annual data validation audit to more broadly understand organizational risks
• Build your oversight tools by learning how to internally validate vendor data and documentation
• Use data validation to assess your performance and readiness for other CMS reviews

Intermediate

#H04

V4 - OIG Audits of Diagnosis Codes at High Risk for Being Miscoded: A Discussion of How We Identify Diagnosis Codes to Audit and What You Can Do to Enhance Your Compliance Procedures Chris Bresette, Director, Medicare Part C Audits, Dept. of HHS, OIG, Office of Audit Services Nicole Hackenmiller, Sr Auditor, Dept. of HHS, OIG, Office of Audit Services View Description

• The panel will talk about how the OIG combines data-mining techniques and discussions with medical professionals to identify diagnosis codes to audit
• The panel will discuss how the OIG's audits have evolved
• The panel will discuss how MA organizations can increase their compliance program’s effectiveness when detecting and correcting inaccurate diagnosis codes

Intermediate

#H05

V5 - The Magic of Universes: Beyond the CMS Audit Gabriel Viola, SVP Customer Relationship, Inovaare Corporation Brenda Wade, Chief Compliance Officer, Inovaare Judi Mason, Director - Compliance, Inovaare View Description

• Leverage universes for operational performance analysis, not merely for CMS Program Audits reports
• Monitor universes regularly to proactively address and mitigate issues
• Avoid penalties and delays by sustaining continuous compliance, not reacting to audits

Intermediate

#H06

V6 - A Deep Dive: Enforcement Trends and Risk Areas in Managed Care Megan Tinker, Assistant Inspector General, HHS-OIG Benjamin Singer, Partner, O’Melveny & Myers LLP John Kelly, Member, Bass, Berry & Sims PLC View Description

• The panel will discuss in detail lessons learned from past and current enforcement actions
• The panel will identify key risk areas for Medicare managed care organizations and providers
• The panel will discuss compliance program best practices to minimize risk in Medicare Advantage

Advanced

#H07

V7 - The Next Big Thing! Maintaining Compliance and Managing Risk with Healthcare Startup Vendors and Providers Sandra Durkin, Member Attorney, Strategic Health law Elizabeth Lippincott, Managing Member, Strategic Health Law View Description

• Legal risks of contracting with startup and private equity-backed companies, which can help health plans stay competitive with their innovation but may also pose risks to compliance and overtax your plans legal and compliance resources
• Handling vendor negotiations with a company that lacks expertise in the healthcare legal and regulatory environment, including anti-fraud laws, such as the Anti-Kickback Statute, that can be violated during the negotiation process
• Practical strategies for counseling internal business clients on challenges unique to dealing with healthcare startups, including ongoing compliance monitoring of organizations with limited internal legal and compliance resources

Intermediate

#H08

V8 – Compliance Organization Design Veronica Moore, Director, Corporate and Medicare Compliance, BCBS of AZ James Rose, Managing Director, SunHawk Consulting LLC View Description

• What is organizational design and how it is important to compliance program effectiveness?
• How does my organization's other governance groups impact the compliance organization design?
• What considerations should be made for organization design of the compliance program?

Intermediate

#H09

V9 - Back to the Future: Leveraging Knowledge and Experiences to Accommodate 2022 CMS Program Audit Protocols Philip Masser, Medicare Compliance Officer, Geisinger Health Plan Annie Hsu Shieh, Compliance Counsel, Central Health Plan of California Anne Crawford, Director, ATTAC Consulting Group LLC View Description

• Hear how recent audit experiences combined with revised CMS program audit protocols can be leveraged
• Key considerations when determining if 2022 protocols require modifications to monitoring activities
• Applying best practices to ensure audit readiness

Intermediate

#H10

V10 - Creativity in Compliance: A Case Study in Developing Impactful and Action-Oriented Compliance Activities and Trainings Jessica VanderZanden, VP, Compliance and Culture, Network Health Angela Keenan, Compliance Officer View Description

• Learn effective methods to develop trainings and activities utilizing internal partnerships and resources, leading to greater success of your compliance program without adding significant budget
• Acquire techniques for getting your organization excited about compliance trainings and collaboration
• Spend time discussing successful training metrics and collaborative efforts

Basic