2019 Agenda

June 16th, 2019

12:00 pm
Pre-Conference Workshop Registration
12:50 PM
Chairperson Welcome
Ana Handshuh, Principal CAT 5
Ultimate Health Plans 

1:00 pm

Pre-Conference Interactive Workshop A- Customer Service Call Categorization

• Evaluate multiple real-life customer service calls and their classifications
• Examine what CMS is looking for when categorizing calls
• Discuss common pitfalls when classifying a grievance
• Identify educational tools to advance your customer service team classification    accuracy.

Babette Edgar, Principal
BluePeak Advisors
Michelle D. Rigby, CFE, CHC, Director, Client Services
BluePeak Advisors
3:00 pm
Afternoon Networking Break

3:15 pm

Pre-Conference Interactive Workshop B- 2018-2020 Hot Topic Forum

 

  • Identify strategies to evaluate your current performance levels and Identify areas for improvement
  • Discuss the Addiction and Recovery Act and how to navigate through it
  • Strategies to manage the preclusion list
  • Examine Universe Production changes for Part C & D
 
Deborah Marine, JD, CHC, Compliance Officer
SUMMACARE
 
JoAnn McDaniel-Chinn, Chief Compliance Officer
Community Care Plan
5:15 pm
Networking Reception

June 17th, 2019

8:00 am
Registration & Networking Breakfast

Sponsored by: 

MHK 

9:00 am
Chairperson’s Opening Remarks
Ana Handshuh, Principal CAT 5
Ultimate Health Plans

9:10 am

Examining the Impact of the CMS Program Audit Process Updates

  • Identify changes needed to your current operations to adapt to the CMS Program Audit process updates
  • Discuss best practices to implement streamline changes throughout your department with minimal disruption
  • Describe education needed to inform your team of the impending changes
  • Discuss the impact of the data/items no longer required to submit to CMS for audits and the importance of still monitoring the data
 
Babette Edgar, Principal
BluePeak Advisors

10:00 pm

Successful Implementations and Supporting Analytics

  • Strategies and tips for engaging during the development of workflows and configurations
  • Evaluating key decision points during the migration
  • Running Analytics across multiple data sets
  • Ways we improved tracking issues and tickets, as well as training and nesting

Jessica Sieger, Product Specialist (VAM – Appeals & Grievances)

Beacon Healthcare Systems 

10:45
Morning Networking Break

Sponsored by: kiriworks

11:00

Methods to Improve Stars Measures Through Appeals and Grievances

  • Strategies to ensure that timeliness measures are met on appeals decisions  
  • Best practices for documenting the review of an appeal decision made by the plan 
  • Tools to educate staff members on the impact appeals can have on a plan’s Stars rating 
  • Evaluate the reliability and accuracy of appeals Independent Review data 
  • Best practices for dealing with Complaints Tracking Module (CTM) 

 

Caroline Spencer, STARS Program Manager/A&G Manager 

Memorial Hermann Health Plan 

Mariah EmerichSupervisor 

Moda Health 

11:45 pm

Uncover Strategies to Build a Successful Mock Audit Team

  • Learn effective strategies to gain buy in from senior administrators and delegated entities
  • Identify which personnel and skillsets are needed to build effective teams within administrative budgets
  • Evaluate and leverage technology to enhance audit effectiveness 
  • Leverage mock audit programs to improve compliance program effectiveness
  • Discuss best practices for creating standard procedures, meaningful reporting, issue tracking, and work flow in preparation to build your team
  • Identify compliant clinical documentation and decision making 
  • Discuss the elements required for a compliant denial rationale 
 
David Reid, Sr Director, Operational Performance & Regulatory Support,
Florida Blue
 
Delores Stewart, Senior Manager, Operational Performance & Regulatory Support
Florida Blue
 
Sherry Goble, RN- Clinical Accreditation & Regulatory Consultant
Florida Blue
12:30
Networking Luncheon

Sponsored by: Bluepeak Advisors

1:30 pm

Monitoring Call Logs and Providing Education for the Call Team and FDR’s

  • Examine what CMS is looking for when accessing call logs
  • Best practices in providing education for your team and FDR’s
  • Strategies to implement a monthly oversight monitoring program running ODAG and CDAG samples   through all audit measures
  • Identify which members of your team are involved
  • Best practices in creating reports of your findings
  • Create a plan of action to find the root cause and correct issues
  • Angela Lloyd, Director Medicare Audit & Corrective Action
  • Health Partners Plans
 
Michelle Fogg, Manager Medicare Operational Compliance
Health Partners Plan

2:15 pm

Root Cause Analysis Trending in Remediation

  • Identify a process for finding the root cause of a grievance
  • Best practices in documentation of the root cause process to CMS standards
  • Explore actions to reduce or eliminate grievances identified through root cause analysis
  • Examine which vendors can help your plan manage member grievances
  • Enhance collaboration with internal business partners for RCA and remediation of identified trends
  • Identify a process for finding the root cause of appeals
  • Explore actions to reduce or eliminate appeals identified through root cause analysis
 
Jason M. Kaylor, Director of Appeals, Grievance, and Customer Solutions
MHK
 
Heather Metz, Manager of Government Compliance
GATEWAY HEALTH PLAN
3:00 PM
Afternoon Networking Break

Sponsored by: Ankura Consulting Group

3:15 PM

Deep Dive: A Close Observation of Changes Associated with the Consolidation of Chapters 13 and 18

  • Analyze the impact of the changes made to the Medicare Program Integrity Manual (PIM)
  • Identify what changes will influence the Local Coverage Determinations (LCD) Process 
  • Evaluate immediate adaptations that need to be made in your current operational procedures

 

Lydia Wardi, Senior Regulatory Affairs Analyst
GATEWAY HEALTH PLAN
 
Deborah Marine, JD, CHC, Compliance Officer
SUMMACARE

 

4:00 pm

Panel Discussion: 2018 CMS Program Audit- Evaluating our Experience

  • Panel members included have experienced a CMS Audit in the past 12 months
  • Evaluate the position they were in prior to the audit and what they would change
  • Identify which areas CMS focused on specifically in the audit
  • Examine the steps that were taken post audit, including corrective action plans and independent validation audits
 
Caroline Spencer, STARS Program Manager/A&G Manager
Memorial Hermann Health Plan
 
Heather Metz, Manager of Government Compliance
GATEWAY HEALTH PLAN

4:45 pm

Enhancing Relationships and Training Within Customer Service Team to Achieve Optimal Operational Outcomes

  • Identify educational tools to improve customer service representatives experience with members
  • Best practices to create consistency with classification of request
  • Tools to create a compliant culture within your customer service team
  • Training strategies to generate a team with a strong culture and leadership 
 
JoAnn McDaniel-Chinn, Chief Compliance Officer
Community Care Plan
 
Mariah Emerich, Supervisor
Moda Health
5:30 pm
Networking Reception

June 18th, 2019

8:00 am
Networking Breakfast   

Sponsored by: MedHok

8:45 am
Chairperson’s Recap of Day One
Ana Handshuh, Principal CAT 5
Ultimate Health Plans

9:00 am

Maximizing Effective Communication Between All Departments

  • Identifying appropriate resources for communicating issues / problem solving
  • Strategies to improve communication flow between all departments impacted by A & G
  • Develop an understanding of the impact of one departments role on the other departments
  • Best practices in building a team-oriented work place between departments
  • Identify universal communication strategies that coincide with and promote the corporate culture
  • Develop effective strategies for successful communication among remote workers and teams
Debbie Hill, MSN, RN, Senior Director, UM and A&G Product Applications
Medecision 
Angela Lloyd, Director Medicare Audit & Corrective Action
Health Partners Plans
 
Michelle Fogg, Manager Medicare Operational Compliance
Health Partners Plans

9:45 am

Explore the Key Points and Solutions of the OIG Medicare Advantage Appeals Report

  • Describe the background and importance of the Office of the Inspector General (OIG) report on Medicare Advantage Appeals
  • Discuss CMS annual audit report and key findings regarding Medicare Appeals
  • Discuss top trends and common issues with Medicare Appeals in five key areas: 
  • Organizational and departmental structure
  • Transparency
  • Effective controls and operations
  • Data analytics
  • Systems
  • Discuss and summarize solutions for common issues
 
Diane Ramey, Senior Director
Ankura
 
Nancy Waltermire, Senior Director
Ankura
 
10:30 am
Morning Networking Break

10:45 am

Practice Makes Perfect: Best Practices for Audit Preparedness

  • Examine the CMS requirements for ODAG and CDAG universes that must be pulled  
  • Identify issues in pulled universes and creating a plan of action to correct them 
  • Strategies to recreate the experience of a CMS Audit in real life 
  • Utilize recent audit experiences from other plans to recreate a mock audit 
  • Examine technological solutions that can assist your team in the audit process 

 

Jon Swisher, Director of Solution Development
Kiriworks 

Melissa Rusk, Director Claims and BPO Operations
SummaCare

 

 

11:30 am

Mastering the Art of Building Precise Universes

  • Analyze the CMS requirements for accurate ODAG and CDAG universes and tables
  • Strategies to implement regular universe and data accuracy checks
  • Identify problematic areas that can cause universe disparities and solutions to correct the issues 
 
David Reid, Sr Director, Operational Performance & Regulatory Support,
Florida Blue
 
Delores Stewart, Senior Manager, Operational Performance & Regulatory Support
Florida Blue
12:15 pm
Networking Luncheon

Sponsored by: Beacon Healthcare Systems 

1:15 pm

Evaluate the Role of FDR’s In Appeals and Grievances and Program Audits

  • Evaluate the resources, the FDR’s need to prepare documents needed for an audit
  • Understand the perspective of the FDR
  • Learn strategies to improve communication and expectations with FDRs
  • Understand the work load balance of FDRs managing multiple audits
 
Hayley Ellington-Buckles, Chief Compliance Office
Versant Health
Melissa Rusk, Director Claims and BPO Operations
SummaCare

2:00 pm

Develop Future Leaders Within your Current Team

  • Identify personnel within your organization with leadership abilities
  • Implement educational practices to develop their skills
  • Maximize your current leadership to foster growth and development
  • Transfer knowledge and experience between the ranks
  • Identify which skills will be needed for leaders of future generations

 

Denise Stasik, Vice President Credentialing and Advocacy
MVP Health Care
 
2:45 pm
Chairperson’s Conference Recap
Ana Handshuh, Principal CAT 5
Ultimate Health Plans
3:00 pm
Conference Adjourns