The 8th annual virtual event for compliance specialists will take place June 6-7. Here’s what’s on this year’s agenda.
RISE’s Optimizing Appeals & Grievance Summit returns as a virtual event June 6-7 for compliance specialists looking to improve ODAG and CDAG outcomes.
The conference is designed for Medicare Advantage and Part D plan executives and managers who are responsible for appeals and grievance operations, customer or member services, quality improvement, Medicare compliance, audits and delegate oversight, clinical services and medical management, and call center operations.
Look at the planned sessions for the main conference:
Two-part preconference workshop
The first morning will kick off with a two-part preconference workshop. The first session will focus on maximizing the potential of your internal compliance systems. You’ll learn how to improve your collaborative network within your organization, best practices for managing reconsideration processes, and how to implement creating staffing models. Part two will concentrate on maximizing efficiencies in your toot cause analysis. You’ll learn how to use data effectively to identify the root cause of grievances, interact with other organizations to better understand how they approach their root cause processes, and the steps to approach a root cause analysis based on the type of grievance.
CMS highlights on ODAG and CDAG
We’ll kick off the main conference with a session that dives into the operational implications of the Centers for Medicare & Medicaid Services’ (CMS) proposed rules. Attendees will learn how to define considerations, such as cultural awareness of your communities. Speakers will also discuss how to update your playbook of strategies to meet new expectations.
Addressing gaps in your FDR’s and reviewing operations
Speakers Beth Socoski, medical compliance director, Longevity Health Plan, and JoAnn McDaniel-Chinn, Medicaid compliance officer, Simply Healthcare Plans, will offer strategies to identify how to improve communication between first tier, downstream or related entities (FDR) and health plans. They will also highlight the value of monitoring cases to identify potential pitfalls in your systems and discuss the risks and liabilities associated with your FDRs.
Classifying appeals and grievances: How to ensure better patient outcomes
Join Mark Dwinnells, CHC director, Commonwealth Care Alliance, and Michelle Fogg, manager, operational compliance, Heath Partners Plan, for a discussion on best practices for categorizing complex cases. The speakers will outline the impacts of having an effective review system in place and explore the challenges related to balancing member satisfaction with accurate and timely classifications.
Defining strategies for integrating health equity in grievance processing
Learn how to effectively make use of resources to improve outcomes, how to streamline processes that affect patient loyalty, and optimize strategies for addressing quality-of-care grievances.
Forming an audit playbook: Implementing strategies for a successful examination
This session focuses on best practices for assigning protocols to your departments. Learn how to effectively communicate and share new tools and resources with your teams so that they are better prepared. Speakers Joy Enright, director, CVS health client audit, CVS Health, and Angela Lloyd, associate compliance officer, Health Partners Plans, will also discuss how to perform a mock audit and measure the results.
Tracking the impacts of providers on appeals and grievances
This session will help attendees define strategies for effective collaboration with providers, identify how to mitigate negative member experiences, and discuss the value of working with patient continuity advocates.
Re-examining interdepartmental engagement in a work-from-home environment
Speakers will help you identify how to engage your teams while working from home. They’ll discuss protocols related to privacy and sensitive data and how to make the best use of available resources. Speakers include Beth Socoski, medical compliance director, Longevity Health Plan; Melissa Rusk, vice president of operations, SummaCare; and JoAnn McDaniel-Chinn, Medicaid compliance officer, Simply Healthcare.
Best practices for compliance officers in the ODAG and CDAG space
During this session, attendees will learn policies and procedures for adopting an effective line of communication. Speakers will outline strategies for addressing challenges related to scalability as your health plan grows. Attendees will also discover how to implement training related to how plans can better manage timeliness.
The do’s and don’ts of customer services
This session will help you understand how factors, such as tone and active listening, can play a role in member satisfaction. Attendees will learn how to determine the viability of training programs on strategic communications and review examples of successful partnerships between health plans and FDRs.
Adaptability and beyond: Maximizing the potential of your internal compliance systems
Join this session to better understand how to improve your collaborative network within your organization. Speakers will discuss best practices for managing reconsideration processes and explain how you can implement creative staffing models.
Essentials of collaborating with providers to better serve your communities
The final session will focus on collaboration. Learn the benefits of working with a language services provider, understand the needs of your member through the lens of a multi-cultural setting, and identify available resources to address challenges, such as language and technical barriers.
The 8th annual Optimizing Appeals & Grievance Summit will take place as a virtual event June 6-7. Click here for more information, including the full agenda, roster of speakers, and how to register.