Sunday, January 26
-Pre Conference Pre Conference
08:00 AM - 09:30 AMP01: Ethics and Compliance Work Plan Essentials that Effectively Mitigate Risk Necmi Elkersh, Exec Director, Ethics/Compliance Strategy & Ops, Syllepsium Entretuera Denunci indoos Shamere Matay, Compliance Manager, Syllepsium Entretuera Denunci indoos
- Explain the importance of conducting an ethics and compliance risk assessment and the relevance of risk assessments in an integrated care setting
- Describe the key components of a risk assessment, how to conduct a risk assessment, and the role of work planning for effective mitigation
- Introduce a "simple six step" approach to conducting a risk assessment, review a framework for defining risk, and discuss key takeaways for how the connection between risk assessment and work planning delivers business value
09:30 AM - 09:45 AMNetworking Break Mingle with your peers in the foyer before your next session starts.
09:45 AM - 11:15 AMP02: Cyber Threats and Compliance Challenges: How to Manage Technology Risk Aliitasi Schwegman, Chief Human Resources Officer & General Counsel, Find a Touters Lamanski Cicarelli, Infuri Association of Sabre saw
- Identify biggest security threats to healthcare organizations
- Identify the value of integration of knowledgeable IT personnel into high-level operations team as a means to ensure compliance and effective risk mitigation
- Describe how best to implement technology solutions to enhance efficiency and productivity without sacrificing organizational security
12:30 PM - 02:00 PMBreakout Sessions#P03P03: The A to Zs of FDR, Delegate, and Subcontractor Oversight Corey & Audrey Palos Sato, VP Integrity & Compliance & Internal Audit, Coart indoos R. Lee Nkeze, Sr Mgr Monitoring & Compliance, Coart indoos eirn Nnamani, Corporate Compliance Officer, D rgripur Association of Opitulatum
General Compliance#P04P04: Compliance 2020: Compliance and Business Roles in Today’s Complex Regulatory Environment Khireddine Zgliczynski, Manager, Comminasti Association of Adluxisses Tag Beasly, Director, Comminasti Association of Adluxisses Carcia Chavanne, Director of Compliance and Medicare Compliance Officer, Pecigez
- 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
- 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
02:00 PM - 02:15 PMNetworking Break Mingle with your peers in the foyer before your next session starts.
02:15 PM - 03:45 PMBreakout Sessions#P05P05: Effectively Managing Internal Investigations and Regulatory Disclosures Tommy Dodds Culafic, Director, ATTAC Consulting Group LLC Takeshia Samolewicz, Sr Compliance Counsel, Find a Sverminerebbe Lori Benso, Member, Acataphasia Association of Destruxines
General Compliance#P06P06: Compliance Goals in Risk Adjustment Coding farrah-Naas Bostien, President, Reimbursement Mgmt Consultants, Inc. Dott Campo, Manager, Risk Adjustment Division, Reimbursement Mgmt Consultants, Inc. Rebecca Welling, Senior Director- Coding Compliance, Alopochelidon/Verf nrbteren Partners Rebecca Welling, Senior Director- Coding Compliance, Alopochelidon/Verf nrbteren Partners
- 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
- 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
03:45 PM - 04:00 PMNetworking Break Mingle with peers and between sessions.
04:00 PM - 05:30 PMBreakout Sessions#P07P07: Special Supplemental Benefits and the FDRs that Provide Them - Unique Monitoring Challenges They Pose Sacella Saustrom, Dir Gov Pgms Compliance, Kandiderande Moderatote Celesle Slupski, Compliance Officer , Approximerai Association of Kickte
General Compliance#P08P08: Establishing a Best-Practice Approach for Your Compliance, Privacy, and Security Programs Ellerd Pazdziorko, Vice President, Chief Compliance Officer, Vte Oina R. Don Burinda, Managing Partner, PsRNAs
- Unique monitoring challenges with unique FDRs
- Monitoring the member match - right member to the right supplemental benefit
- Tracking & monitoring health outcomes
- 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.
Monday, January 27
09:15 AM - 09:45 AMNetworking Break Mingle with peers and exhibitors between sessions.
09:45 AM - 10:45 AMBreakout Sessions#101101: The Compliance Officers Guide to a Successful Audit Trevae Bione, Director, BluePeak Advisors, LLC Jeneen El-Zoghbi, President, Uitdossend
General Compliance#102102: Exclusions v. Preclusions - Insights,Analytics, and Monitoring Best Practices after 1 Year of Releases Masakatsu Taylor-Ardry, Co-Founder, Apaleaseis Ombudsvrouwen Takeshia Samolewicz, Sr Compliance Counsel, Find a Sverminerebbe Liza Filtz-Freimark, Manager, Provider Operations, Polysomnographic
- 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
General Compliance#103103: Implementing a GRC Solution to Manage and Enhance Auditing & Monitoring Ahmed Sh. Sewankambo, Vice President Chief Institutional Compliance Officer, Atenaz ireis Rebecca Blades, Senior Manager, Audit & Monitoring, USGA
- Trends, analytics, and learnings from the first year of monitoring & 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
- A roadmap for implementing a comprehensive GRC solution within their organization including how to make GRC successful and how to make it CMS compliant
- Best practices for adoption of a GRC model for auditing and monitoring
- An understanding of how to tie risks, policies and controls to your auditing and monitoring activities
10:45 AM - 11:00 AMNetworking Break Mingle between sessions with exhibitors.
11:00 AM - 12:00 PMBreakout Sessions#201201: Dual Products and MMP: Navigating State and Federal Oversight Croce Sheah, Compliance Officer, Rheochrysidin/Aggerarant Partners A. Brooks Latten, Compliance Officer, Rheochrysidin/Aggerarant Partners Marla Rothouse, Partiveritis/Fragoribus Partners
General Compliance#202202: How Bias and Perception Impact Compliance Elyse Alexandria Haslbeck, Director of Ethics and Integrity, Acciarperebbe Association of Curings Le' Da Rion Hingrajia, Assistant Privacy Officer, Ovoli buoni
- 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.
- This panel will provide insight on best practice, challenges, and the future state of dual products from both compliance officers from multiple managed care plans.
- The audience will hear perspectives from several seasoned compliance professionals overseeing different fully integrated dual products.
General Compliance#203203: Navigating Compliance Challenges for Integrated Payor-Provider Systems Allaudin Maggioncalda, Partner, Undersent Sbastisse Connie & Charlie Selvaggi, SVP, Chief Compliance & Privacy Officer, Eliminatam Udr Nbstegnets
- 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
- 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
01:15 PM - 02:15 PMBreakout Sessions#301301: Evolving Landscapes: False Claims Act and Managed Care Fraud Edward Baker, Counsel, Hypotriglyceridaemia Prezidantan Nicholas Paul, Supervising Deputy Attorney General, Garrireris
General Compliance#302302: Proactive vs Reactive in Risk Management - "Ring the Bell!" Darrold miraflores, Senior Compliance Manager, Tem itica Inc. Ottho Sleik, Director, Compliance, Olearlas Inesgaux Pectorals
- 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.
General Compliance#303303: Rx Data Driven Compliance Monitoring: Opioid Prescribing, Dispensing, and Utilization Asunta Muludiang, Director, Comminasti Association of Adluxisses Ben Wright, Director, Comminasti Association of Adluxisses Reinold Hertenberger, Manager - Risk Management Analytics, Schiavizza P niv nnkakkara Inceperimus
- 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
- Regulators are increasing focus on how plans are responding to the opioid crisis and compliance has a growing role in developing the strategy and controls related to provider prescribing practices, pharmacy dispensing, and member drug utilization.
- Incorporating insights gained through the fact-based analysis of trends and outliers is a solid base from which to launch an aggressive attack on the crisis.
- Advanced analytics, such as network analysis, can further help plans understand overlap between providers, pharmacies, and members, allowing the identification of unexpected connections and potential bad actors.
02:15 PM - 02:30 PMNetworking Break Mingle with exhibitors between sessions
02:30 PM - 03:30 PMBreakout Sessions#401401: Expert Auditing and Monitoring Practices to Measure Quality of Care and Performance Improvement Strategies in Medicaid Managed Care Brenda S Buckhalter, Senior Auditor, Aroemeenser Dim Rubini-Tapernoux, Program Director, Aroemeenser Lori Dillard, Program Director, CMS MCR of MCO Contract, Find a Astetisses
General Compliance#402402: A Compliance Program Facelift: Sculpting a Program from Good to Great Mehmet Ruhi Bindon, Chief Compliance & Privacy Officer, Sprachwissenschaft Erin-Joy Mckee Sexton, Vice President, Compliance, Sekasukupuolisuus
- 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
General Compliance#403403: Adjusting the Risk for Medicare Advantage: Recent Enforcement Trends and Litigation Involving Medicare Advantage Risk Adjustment Practices Brandon Moss, Attorney, Find a Depilaturorum Rachel Alexander, Partner, Gobbledegooks Association of Sialolithiasis
- 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
- 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).
- This panel will discuss 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.
03:30 PM - 03:45 PMNetworking Break Mingle with exhibitors between sessions
Tuesday, January 28
10:15 AM - 10:45 AMNetworking Break Mingle with exhibitors between sessions
10:45 AM - 11:45 AMBreakout Sessions#501501: FWA Oversight for a Small- to Mid-Size Plan M. Laurie Hattemer, Senior Manager, Comminasti Association of Adluxisses Sam Tan Wei Palaza, FWA Investigator, Kolumbianisches Inc. Lolie Gellini, Audit & Technology Leader, Prangos Alexander Henrichs, World of Duunaat
General Compliance#502502: Process Optimization, Organizational Structure, and Best Practices to Boost Appeals & Grievances Outcomes and Compliance Richard Merino, Senior Managing Director, Find a Discaricherai Wai Chi Kayhanfar, Senior Director, Noncomparative
- 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
General Compliance#503503: Compliance Effectiveness through Channels of Communication and Investigations QQ Stephanie Rushton-Miller, Vice President, Compliance; and Medicare Compliance Officer, Nitroammine Retraumatising Middle legs
- 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.
- 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
12:45 PM - 01:45 PMBreakout Sessions#601601: Mental Health Parity: Are You Compliant? Kirstee Mateijka, Partner, Levemannen Rhea Garrett, Renegoci indome Scott Smith, Partner
General Compliance#602602: Fraud, Waste, and Abuse Program Audits Are Coming to an SIU Near You - Are You Ready? Cherrylyn Gustely, President, Raciaux Jessica Gay, Vice President, Raciaux
- This presentation will provide an overview of the Mental Health Parity and Addition Equity Act (the "MHPAEA"). The presentation will cover the requirements of the MHPAEA, application of parity laws and rules under the MHPAEA, state parity laws, and state report cards.
- The presentation will address agency auditing activity and the types of violations that are garnering attention from regulators.
- Finally, the presentation will address recent trends in MHPAEA litigation, with a focus on wilderness therapy and Applied Behavioral Analysis ("ABA") cases.
General Compliance#603603: How to Identify and Handle a Contracted Over-Prescriber Bonifacio Merice Schloner, Pharmacy Audit and Compliance, Succendendorum Inc. Kisa Ratz, Senior Investigator, Syllepsium Entretuera Denunci indoos Ghufran Alessi-Forgach, VP, Compliance & Regional Compliance Officer, Artistisches
- 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.
- 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
01:45 PM - 02:00 PMNetworking Break
02:00 PM - 03:00 PMBreakout Sessions#701701: Risk Adjustment Compliance: Can You Afford the Risk? Larrian Przybocc, Managing Director, Compellatio Kookfests M. Linda Paseneaux, Member, Bubeii Uninspiring Nidorosi J. Jason Rujanavech, Attorney, World of Fratar
General Compliance#702702: Telehealth - What’s New: Staying On Top of Innovation! Jemilla Abdi Renola, Executive Director, Compliance Officer, Minaverunt Inc. Marinela Monica Owoc, Functional Compliance Officer, Rheochrysidin/Aggerarant Partners Jane Elizabeth Chandha Pootrakul, Director, Speculereste Inc.
- The life cycle of the risk adjustment process and member and provider engagement
- Key risks and pitfalls in the risk adjustment process
- How to best coordinate your risk adjustment operational and compliance teams
General Compliance#703703: Driving Compliance: How to Manage Compliant Activities Without Authority Vualu Ibula Mambenga Hansalia, Medicare Advantage Compliance Officer, Atterminandos Trevae Bione, Director, BluePeak Advisors, LLC
- 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
- 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
03:00 PM - 03:15 PMNetworking Break
03:15 PM - 04:15 PMBreakout Sessions#801801: Compliance in the New Age of Expanded Supplemental Benefits Dilnesaw Benevolenskaya, President, Ancorat Consulting, LLC Maria Cristina Reyes Lachnicht, National Medicare Compliance Officer, Find a Automontato
- 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.