The three-day live-streaming event will take place Oct 2-4 with sessions to help Medicare Advantage compliance professionals successfully navigate Centers for Medicare & Medicaid Services (CMS) audits, prepare for increased Office of Inspector General (OIG) scrutiny, and evaluate the impact of the latest regulatory changes. Here’s what’s planned so far:
New: Pre-conference workshop on communications and marketing changes in the 2024 CMS Final Rule
For the first time, CompliancePalooza will offer a preconference workshop.
The afternoon workshop will begin at 1 p.m. ET, Monday, Oct. 2. The first part of the workshop will focus on the changes contained in the new communications and marketing rules. Workshop leaders Ana Handshuh, CHC, principal, CAT5 Strategies, and Shelley Segal, CEO, Segal Medicare Experts, will explain how the new provisions may change your current practices and provide tips on how to communicate the changes to your agents, brokers, and third-party marketing organizations.
Part two of the workshop will offer practical ideas on how to train internal staff and external partners about the changes; update your auditing and monitoring workplan to optimize oversight of communications, marketing, and sales staff to prevent violations; and collaborate with marketing and sales teams to find ways to foster healthy sales outcomes while staying in compliance.
Day one highlights
Planned sessions will focus on CMS rule changes, audit prep, utilization management, vendor oversight, and behavioral health:
CMS latest rule changes: Key provisions impacting your compliance program
Colleen Gianatasio, director, clinical documentation integrity and coding compliance, Capital District Physician's Health Plan, will join Handshuh to go over the massive changes in the latest codified rules that affect utilization management, marketing, Star ratings, health equity, behavioral health access, and risk adjustment.
Get a handle on new utilization management requirements
This session will offer an overview and compliance tips for CMS’ new utilization management rules, including requirements for prior authorization, coordination of care, and the creation of a utilization management committee. Presenters include Jennifer Del Villar, CHC, director of government programs compliance/Medicare compliance officer, Cambia Health Solutions, Inc.; Annie Shieh, sr. director of compliance, California compliance officer, Bright Health Group; and Gail Blacklock, CHC, compliance officer, Astiva Health.
CMS program audit prep: Best practices for surviving and thriving
Angela Kennan, compliance officer, Network Health, and Tracy Jones, interim chief compliance officer, SummaCare, will provide lessons learned from recent audits, offer tips for creating and testing your universes, and what to expect during the corrective action phase.
Vendor compliance oversight: How to monitor and lower your risk
Attendees will learn best practices for contracting and delegation agreements; learn about the reports you should get from your vendors and how to analyze them; create and implement service level metrics to avoid costly mistakes; and get tips for training internal staff and vendors to improve precision. Laura Sheriff, vice president, risk adjustment, Southwestern Health Resources, will present.
Complying with new CMS behavioral health access requirements
Tricia Beckmann, principal, Faegre Drinker, will lead a session on the new network adequacy requirements aimed at increasing access to behavioral health providers. Beckmann will help ensure your organization is following the rules for prior authorization and care coordination and will go over risk areas and enforcement trends that target behavioral health parity.
Day two highlights
Planned sessions will focus on the RADV audit, CMS program audit, how to strengthen your compliance program, and new Department of Justice (DOJ) guidance:
The RADV audit is back: Here’s what you need to know
Sheriff will return to the podium, along with Jeannine Bumford, director of coding operations, Southwestern Health Resources, to discuss the return of Risk Adjustment Data Validation audits following a hiatus during COVID. They’ll go over the importance of two-way reviews to find coding deletes and discuss the 12 high-risk diagnosis codes on the Office of Inspector General watch list.
The value of a mock CMS program audit
This session will provide an inside look at real-life experiences with a mock audit. Speakers Angela Lloyd, associate compliance officer, Jefferson Health Plans, and Carissa Lingenhag, supervisor of compliance, Network Health, will offer step-by-step details on how plans have conducted the mock audits and what you need to do to identify and correct issues before you face a real CMS audit.
Compliance program effectiveness: Build a tracer that will knock their socks off
Learn about CMS requirements for tracers, how to use tracers during a CMS audit, and tips for creating tracers that will shine a light on the strengths of your compliance program and impress auditors. Tracy Jones, interim chief compliance officer, SummaCare, will lead the session.
New DOJ guidance: Can you access plan data shared via messaging apps?
Join Tina C. Tolliver, executive ethics, compliance, risk & privacy advisor,
TCT Consulting, for a session about the DOJ’s new efforts to make sure workplace communications via messaging apps like Slack and Teams can be preserved and accessed. The session will also help you evaluate your policies for “bring your own device” and the permissible use of other mobile devices and messaging apps. Tolliver will also review the consequences of not having the appropriate policies and procedures in place regarding the use of these communication devices.
Lessons learned from the CMS audit report
Mary A. Inman, partner, Constantine Cannon, will analyze recent violations that resulted in enforcement actions, including large civil money penalties. Inman will help you understand your program’s potential weaknesses and how to strengthen those areas and provide tips on how to avoid common violations.
Elevating the compliance department’s worth to leadership
Learn how to demonstrate the compliance function’s value in this age of inflation and inevitable cuts with speakers Sarah Peix, compliance and privacy officer, ChenMed, and Jordan Muhlestein, compliance and ethics director, Intermountain Healthcare. They’ll provide tips on how to communicate with the board and other leaders, and help you understand the type of information and level of detail board members want about compliance efforts.
CompliancePalooza 2023 will take place as a virtual event October 2-4. Click here for the complete agenda, roster of speakers, and registration information.