Last Year's Agenda

 

 

 

TUESDAY - June 29, 2021

9:00AM – 10:45AM EST

Pre-Conference Workshop: The Do’s and Don’ts to Build a Rapport with External Auditors

Join us for an interactive workshop designed to replicate a mock audit. Engage with experienced industry experts to learn the Do’s and Don’ts when preparing for an external audit.

• Learn tips and strategies to not overcommunicate but answer the question at hand
• Select the right person to manage the audit
• Discuss proven strategies to practice and prepare in advance of an audit

David Reid, Senior Director, Operational Performance & Regulatory Support
Florida Blue

Delores Stewart Senior Manager, Senior Manager, Medicare Operations Optimization
Florida Blue

Sherry Goble, RN, Clinical Accreditation & Regulatory Consultant
Florida Blue

Sarah Simmerson, Consultant, Business Support
Florida Blue

10:45AM-11:00AM EST
Break

11:00AM-11:10AM EST

Chairperson Welcome Remarks

David Reid, Senior Director, Operational Performance & Regulatory Support
Florida Blue

11:10AM-11:55AM EST

Deep Dive: ODAG and CDAG Protocols & Trends for 2021 and Beyond

• Explore the latest regulatory and sub-regulatory CMS guidance around appeals and grievances to receive clarity and prepare for the new audit cycle
• Dissect the changes in Part C and Part D reporting and learn how to effectively adapt your universes and data collection
• Discuss emerging trends in A&G and discuss the potential impact related to the new administration

Deborah Marine, JD, CHC, Compliance Officer
SummaCare

11:55AM-12:10PM EST
Break

12:10PM – 12:55PM EST

The Impact of COVID-19 on Appeals & Grievances

  • Discuss restrictions related to the pandemic that have impacted operations and coverage decisions and how to manage appeals and grievances with copay waiver flexibilities
  • Explore the complexity of telehealth appeals and how payers will manage the influx of these appeals and denials
  • Manage internal processes to effectively address and communicate changes to members

Linda Gates, Director, Compliance
Ascension

12:55PM – 1:30PM EST

Lunch & Virtual Networking Lobby

Turn on your camera and join us in the Virtual Lobby for that face-to-face networking experience we’ve all been missing. Connecting with your peers and vendors has never been easier - click on an open seat, say hello to familiar faces, and take part in discussions on industry hot topics.  We’ll see you in the lobby!

1:30PM – 2:15PM EST

Panel Discussion: Pro Tips & Strategies for Remote Audit Preparation

• Hear from recently audited health plans on best practices and lessons learned for remote audit preparation and which tools have been most effective
• Understand the data validation auditor perspective to ensure you are appropriately prepared for CMS
• Evaluate various approaches for mock audits to determine the best approach for successful audit preparation

Moderator:

Melissa Rusk, CLSSBB, CPC, Director Claims and BPO Operations
SummaCare

Panelists:

Ashley Cabrera, CHC, Senior Vice President Strategy and Chief Compliance Officer
MHK

Christie Fluery, Director Quality Improvement, Accreditation & Regulatory Programs
Tufts Health Plan

Megan Allison, Director, Audit and Oversight
Aetna, a CVS Health Company

2:15PM-2:30PM EST
Break

2:30PM – 3:15PM EST

Panel Discussion: Drive Star Ratings and Metrics through Excellent Customer Service and Complaint Prevention

• Discuss proven direct partnership strategies between customer service and complaint teams to improve member satisfaction and exceed expectations
• Learn innovative approaches to complaint prevention to drive STAR Ratings and promote excellence in your organization
• Assess CTM and Customer Service strategies to provide World Class Service

Moderator:
Pamela Cleveland, LSW, JD, CHC, Chief Compliance Officer
Sidecar Health

Panelists:
Nicole Henderson, MBA, Manager, Operations Quality & Compliance - Regulatory Complaints
Blue Cross and Blue Shield of North Carolina

Teneshia Harris, Manager of Service Operations
Blue Cross and Blue Shield of North Carolina

Hannah LeMere, Director, Special Projects
Cody Consulting

3:15PM – 3:30PM EST
Break

3:30PM – 4:15PM EST

Panel Discussion: Approaching Regulatory Audits with Confidence

  • Learn best-practice activities to ensure a permanent state of audit readiness
  • Discover how successful plans develop and maintain a step-by-step audit play book
  • Prepare for an audit with a well-equipped tool box 

Moderator:

David Reid, Senior Director, Operational Performance & Regulatory Support
Florida Blue

Panelists:

Laurie Delgado, Vice President, Appeals & Grievances
Beacon Healthcare Systems

Tracy Jones, Senior Compliance Coordinator
SummaCare

4:15PM – 4:30PM EST
Break

4:30PM – 5:15PM EST

Business Continuity Plans During the Pandemic

  • Hear lessons learned and best practices for business continuity from health plans as they dealt with the disruption of COVID-19.
  • Gain tips to engage and excel in a virtual work environment
  • Build a bulletproof disaster recovery plan

Michelle O’Neill, Vice President, Corporate Compliance & Privacy
Summit Medical Group

Tracy Jones, Senior Compliance Coordinator
SummaCare

5:15PM – 5:25PM EST

Chairperson Closing Remarks

David Reid, Senior Director, Operational Performance & Regulatory Support
Florida Blue

WEDNESDAY - June 30, 2021

9:00AM – 10:45AM EST

Pre-Conference Workshop: Master Grievance Classification

Join us for an interactive workshop by evaluating customer scenarios with industry experts to advance your grievance classification accuracy.

• Evaluate real-life customer grievance examples for both Part C & D to critique documentation and practice classifying properly
• Learn best practices and common pitfalls when classifying a grievance to avoid inaccuracies
• Understand CMS measurement standards and explore training tips for safeguarding classification outsourcing

Ana Handshuh, Principal
CAT5 Strategies
Chair
RISE Revenue & Quality Community

Angela Muncy, Director, Medicare Advantage Compliance
Blue Cross and Blue Shield of Kansas City

10:45AM-11:00AM EST
Break

11:00AM-11:10AM EST

Chairperson Welcome & Takeaways from Day One

Ana Handshuh, Principal
CAT5 Strategies
Chair
RISE Revenue & Quality Community

11:10AM-11:55AM EST

The Role of the Provider and Appeals & Grievances

• Understand the impact of the provider on appeals and grievances and use education to foster positive relationships between health plans and providers
• Learn how provider incentives impact relationships with members and determine your approach
• Ensure top-notch customer service for appeals and grievances using effective partnership strategies


Linda Gates, Director, Compliance
Ascension

Beth Socoski, Chief Strategy Officer
Socoski Design Consulting

11:55AM-12:10PM EST
Break

12:10PM – 12:55PM EST

The Art of Quality-of-Care Grievances

• Discuss best practices and systems to address quality of care grievances
• Master proven techniques and special documentation to write an excellent grievance resolution letter
• Collaborate effectively with quality improvement organizations

Ana Handshuh, Principal
CAT5 Strategies
Chair
RISE Revenue & Quality Community

 

12:55PM – 1:30PM EST

Lunch & Virtual Networking Lobby

Turn on your camera and join us in the Virtual Lobby for that face-to-face networking experience we’ve all been missing. Connecting with your peers and vendors has never been easier - click on an open seat, say hello to familiar faces, and take part in discussions on industry hot topics.  We’ll see you in the lobby!

1:30PM – 2:15PM EST

Improve A&G Leader Effectiveness through Business Intelligence

  • Learn best-in-class approaches to deliver data to CMS and empower A&G leadership.
  • Discuss innovative approaches to slice and dice data to catch discrepancies early and avoid future challenges.
  • Discover best practices for ensuring quality data.

Craig Giangregorio, Vice President of Product Management
Inovaare

Robert Beck, Director, Appeals & Grievances and Provider Support Services
SummaCare

Deborah Marine, JD, CHC, Compliance Officer
SummaCare

2:15PM - 2:30PM EST
Break

2:30PM – 3:15PM EST

Panel Discussion: Working with FDR’s 101

• Create well-defined contracts to effectively manage expectations, set goals, perform audits and avoid CMS penalties
• Develop a plan to effectively select, onboard and manage vendors
• Learn best practices for FDR reporting

 

Moderator:
Jon Swisher, Vice President, Sales & Product
Kiriworks, LLC

Panelists:
Angela Lloyd, Director of Compliance
Health Partners Plans

Michelle Fogg, Compliance Manager,
Health Partners Plans

3:15PM – 3:30PM EST
Break

3:30PM – 4:15PM EST

Optimize Compliance with Workflows

• Hear from highly rated compliant health plans on workflow best practices
• Secure your compliance strategy with innovative approaches and proven systems
• Collaborate like a pro with other departments to increase your compliance success

Moderator:
Margaret Crowley, Lead Consultant
Inspire Innovations

Panelists:
JoAnn McDaniel-Chinn, Medicaid Compliance Officer
Simply Healthcare Plans

Mark Dwinnells, CHC, Compliance Manager
Commonwealth Care Alliance

Cortney Resto, AVP, Grievance & Appeals
EmblemHealth

 

4:15PM – 4:25PM EST
Chairperson Closing Remarks

Ana Handshuh, Principal
CAT5 Strategies
Chair
RISE Revenue & Quality Community