Past Agenda

 

 

 

Tuesday - June 07, 2022

9:00 AM 10:45 AM

8:00 AM 9:45 AM

7:00 AM 8:45 AM

6:00 AM 7:45 AM

Pre-Conference Workshop: Appeals and Grievances 101: Learn the tools to help you thrive- not just survive

• 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

Break

11:00 AM 11:10 AM

10:00 AM 10:10 AM

9:00 AM 9:10 AM

8:00 AM 8:10 AM

Chairperson Welcome Remarks

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

CMS Regulatory Update

• 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

Break

12:10 PM 12:55 PM

11:10 AM 11:55 AM

10:10 AM 10:55 AM

9:10 AM 9:55 AM

Appeals and Grievances in the Post-Pandemic Era: Acknowledging the Uncertainty is the New Normal

• 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

Lunch Break

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

10:30 AM 11:15 AM

Campfire Session: Rethinking Retention and Reining in the Great Resignation

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.

  • Understanding the challenges of employee retention and turnover in appeals and grievances
  • Hear peer best practices for tackling volume with your internal workforce
  • Evaluate cost advantages to outsourcing appeals and grievances
  • Learn how to prepare an action plan for efficient workflow when short staffed

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

Break

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

Trend and Root Cause Analysis: The Data is in Your Hands

• 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

Break

3:30 PM 4:15 PM

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

The Competition for New Members: Innovative Supplemental Benefits

• 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

Break

4:30 PM 5:15 PM

3:30 PM 4:15 PM

2:30 PM 3:15 PM

1:30 PM 2:15 PM

Case Study: Transformation of an Appeals and Grievances Department

• 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

Chairperson Closing Remarks

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

Close of Conference

Wednesday - June 8, 2022

9:00 AM 10:45 AM

8:00 AM 9:45 AM

7:00 AM 8:45 AM

6:00 AM 7:45 AM

Pre-Conference Workshop: Best Practices for Identifying and Classifying Appeals and Grievances

• 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

Chairperson Welcome & Takeaways from Day One

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

Keynote Presentation: Timeliness vs. Remote Work: Tackling Ethical Issues

• 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

Break

12:10 PM 12:55 PM

11:10 AM 11:55 AM

10:10 AM 10:55 AM

9:10 AM 9:55 AM

ODAG and CDAG New Audit Protocols

• 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

Lunch Break

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

10:30 AM 11:15 AM

Engagement letters are out. Are you ready for a CMS audit?

• 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

Break

2:30 PM 3:15 PM

1:30 PM 2:15 PM

12:30 PM 1:15 PM

11:30 AM 12:15 PM

Oversight Delegated Entities and Vendor Relationships

• 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

Break

3:30 PM 4:00 PM

2:30 PM 3:00 PM

1:30 PM 2:00 PM

12:30 PM 1:00 PM

Appeals and Grievances Operations and Organizational Benchmark

• 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

Chairperson Closing Remarks

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

Close of Conference