9:00 AM 10:45 AM
8:00 AM 9:45 AM
7:00 AM 8:45 AM
6:00 AM 7:45 AM
• Understand the rules and the critical importance of timeliness and preparedness
• Learn about how appeals and grievances impact a health plan’s performance
• Discover how to improve member satisfaction and avoid harmful mistakes
Deborah Marine, Chief Compliance Officer, Health Plan Operations
SummaCare
Catlin Scheppler MBA, BSN, RN, Manager, Business Operations Recovery Audit and Appeals Department
Ascension Wisconsin
Dana Renicker, Senior Medicare Education Specialist
SummaCare
10:45 AM 11:00 AM
9:45 AM 10:00 AM
8:45 AM 9:00 AM
7:45 AM 8:00 AM
11:00 AM 11:10 AM
10:00 AM 10:10 AM
9:00 AM 9:10 AM
8:00 AM 8:10 AM
Ana Handshuh, Principal
CAT5 Strategies
11:10 AM 11:55 AM
10:10 AM 10:55 AM
9:10 AM 9:55 AM
8:10 AM 8:55 AM
• Gain familiarity with current CMS priorities and initiatives
• Understand key policy changes for Calendar Year 2022, including those related to Telehealth
• Identify key elements of the CMS COVID-19 Pandemic Response, current vaccine recommendations and regulations
Ashby Wolfe, MD, MPP, MPH, Regional Chief Medical Officer CMS San Francisco, Denver and Seattle Offices
Centers for Medicare & Medicaid Service
11:55 AM 12:10 PM
10:55 AM 11:10 AM
9:55 AM 10:10 AM
8:55 AM 9:10 AM
12:10 PM 12:55 PM
11:10 AM 11:55 AM
10:10 AM 10:55 AM
9:10 AM 9:55 AM
• Learn how the new public health emergency rules and flexibilities are impacting appeals and grievances
• Discuss emerging trends concerning Covid testing and vaccine booster coverage
• Discover best practices for member-facing representatives to deal with member complaints and behavioral issues
Osato F. Chitou, Esq., MPH, Principal
NMOC Healthcare Compliance Consulting, LLC d/b/a Compli by Osato
JoAnn McDaniel-Chinn, Medicaid Compliance Officer
Simply Healthcare Plans
Joe DiBiase, Director, Medicare Operations- Call Center and UM
Magellan Health
12:55 PM 1:30 PM
11:55 AM 12:30 PM
10:55 AM 11:30 AM
9:55 AM 10:30 AM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
11:30 AM 12:15 PM
10:30 AM 11:15 AM
Turn on your camera and join us in the Virtual Campfire Session: Bring your comments, insights, and questions to an intimate conversation and be part of a group discussion and peer-to-peer learning.
Facilitator :
Ian Wayton, Account Executive
Kiriworks
2:15 PM 2:30 PM
1:15 PM 1:30 PM
12:15 PM 12:30 PM
11:15 AM 11:30 AM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
11:30 AM 12:15 PM
• Analyze your current data to identify top drivers of appeals and grievances and how to make up front changes to your process
• Identify broken processes or delegated vendors that are driving volume
• Explore actions to manage unnecessary volume, and proactive remediation
• Create a plan that includes business partners collaboration
Celeste Ivey, Director II, Government Business Division Grievances and Appeals
Anthem
Amber Duenas, Appeals and Grievances Leader
Brown & Toland Physicians
Tracy Jones, Senior Compliance Coordinator
SummaCare
Laurie Delgado, VP Appeals & Grievances
Beacon Healthcare Systems
3:15 PM 3:30 PM
2:15 PM 2:30 PM
1:15 PM 1:30 PM
12:15 PM 12:30 PM
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
• Learn how to provide non-medical services under a medical plan
• Analyze how supplemental benefits impact appeals and grievances
• Explore innovative practices when designing strategy, benefit limits, and a communication plan for your members
Ana Handshuh, Principal
CAT5 Strategies
Mark Dwinnells, Compliance Manager
Commonwealth Care Alliance
Beth Socoski, Medicare Compliance Director
Longevity Health Plan
4:15 PM 4:25 PM
3:15 PM 3:25 PM
2:15 PM 2:25 PM
1:15 PM 1:25 PM
4:30 PM 5:15 PM
3:30 PM 4:15 PM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
• Explore the journey from a broken to successful appeals and grievances department
• Evaluate processes, roles, and technology in your AG department
• Discover how processes can be improved by observing and analyzing the workflow
Alicia Gray, Director Appeals and Grievances
Delta Dental
Brittany Lione, Grievance and Appeal Optimization Manager
Delta Dental
5:15 PM 5:30 PM
4:15 PM 4:30 PM
3:15 PM 3:30 PM
2:15 PM 2:30 PM
Ana Handshuh, Principal
CAT5 Strategies
5:30 PM 5:30 PM
4:30 PM 4:30 PM
3:30 PM 3:30 PM
2:30 PM 2:30 PM
9:00 AM 10:45 AM
8:00 AM 9:45 AM
7:00 AM 8:45 AM
6:00 AM 7:45 AM
• Discuss examples of customer complaints and compare results regarding right documentation and proper classification
• Learn new CMS requirements and common risks when classifying multiple grievances in one call to avoid inaccuracies
• Discover best practices for addressing quality of care grievances
Deborah Marine, Chief Compliance Officer, Health Plan Operations
SummaCare
Tracy Jones, Senior Compliance Coordinator
SummaCare
Dana Renicker, Senior Medicare Education Specialist
SummaCare
11:00 AM 11:10 AM
10:00 AM 10:10 AM
9:00 AM 9:10 AM
8:00 AM 8:10 AM
Ana Handshuh, Principal
CAT5 Strategies
11:10 AM 11:55 AM
10:10 AM 10:55 AM
9:10 AM 9:55 AM
8:10 AM 8:55 AM
• Understand what is behind work engagement, emotional exhaustion, and counterproductive work behavior
• Learn how organizations are engaging their employees in then new hybrid work model
• Evaluate the reality of pandemic burnout and strategies for avoiding burnout of your team members
Michael Legut, PhD, Principal Consultant
Leader Image
Mary Anne Brady PhD, Owner/Management Consultant
Sustainable Management
11:55 AM 12:10 PM
10:55 AM 11:10 AM
9:55 AM 10:10 AM
8:55 AM 9:10 AM
12:10 PM 12:55 PM
11:10 AM 11:55 AM
10:10 AM 10:55 AM
9:10 AM 9:55 AM
• Learn the challenges faced by health plans to adapt to the new universe layout
• Understanding the latest requirements in grievance classification and description / implement strategies to prepare for the next audit cycle
• Review new dismissal requirements and validate with experts’ interpretation
• Learn strategies to help you and your vendors increase consistency when collecting data for an audit-proof universe
Tracy Jones, Senior Compliance Coordinator
SummaCare
Michelle Fogg, Manager Medicare Operational Compliance
Health Partners Plans
Beth Socoski, Medicare Compliance Director
Longevity Health Plan
12:55 PM 1:30 PM
11:55 AM 12:30 PM
10:55 AM 11:30 AM
9:55 AM 10:30 AM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
11:30 AM 12:15 PM
10:30 AM 11:15 AM
• Exchange ideas with recently audited plans - hear their experiences to prepare your team for future audits
• Learn which areas are the primary focus of the CMS representatives’ audit to ensure successful outcomes
• Evaluate the importance of communication actions that prepare your team for a positive interaction during an audit
Deborah Marine, Chief Compliance Officer, Health Plan Operations
SummaCare
Joe DiBiase, Director, Medicare Operations- Call Center and UM
Magellan Health
Catlin Scheppler MBA, BSN, RN, Manager, Business Operations Recovery Audit and Appeals Department
Ascension Wisconsin
Brenda Wade, Chief Compliance Officer
Inovaare
2:15 PM 2:30 PM
1:15 PM 1:30 PM
12:15 PM 12:30 PM
11:15 AM 11:30 AM
2:30 PM 3:15 PM
1:30 PM 2:15 PM
12:30 PM 1:15 PM
11:30 AM 12:15 PM
• Create well-defined contracts to effectively manage expectations, set goals, perform audits, and avoid CMS penalties
• Create strategies to effectively select, onboard and manage vendors and providers aligned with CMS and health plans expectations.
• Understand the impact of third parties on appeals and grievances and the use of education to foster positive relationships between health plans and providers
Mark Dwinnells, Compliance Manager
Commonwealth Care Alliance
Michelle O’Neill, Vice President, Corporate Compliance & Privacy
Summit Medical Group
Amy Dubay, Director of Client Engagement
Cody Consulting
3:15 PM 3:30 PM
2:15 PM 2:30 PM
1:15 PM 1:30 PM
12:15 PM 12:30 PM
3:30 PM 4:00 PM
2:30 PM 3:00 PM
1:30 PM 2:00 PM
12:30 PM 1:00 PM
• Share and compare information concerning health plan operation by participating in a data collection
• Compare organizational structures and scope of work handled by A&G departments
• Share training methodologies
• Discuss various workflow designs, roles, and performance expectations
Laurie Delgado, VP Appeals & Grievances
Beacon Healthcare Systems
4:00 PM 4:15 PM
3:00 PM 3:15 PM
2:00 PM 2:15 PM
1:00 PM 1:15 PM
Ana Handshuh, Principal
CAT5 Strategies
4:15 PM 4:15 PM
3:15 PM 3:15 PM
2:15 PM 2:15 PM
1:15 PM 1:15 PM