The 7th annual event, live streamed June 7-8, will feature strategies to improve ODAG & CDAG outcomes, a review of the latest changes to Centers of Medicare & Medicaid Services (CMS) regulations, and strategies to improve member satisfaction.

Day one highlights

The first day of the virtual event will open with an Appeals and Grievances 101 preconference workshop. Throughout the session, participants will gain a deeper understanding of the rules and critical importance of timeliness and preparedness, how appeals and grievances impact a health plan’s performance, and how to improve member satisfaction and avoid harmful mistakes. Deborah Marine, chief compliance officer, health plan operations, SummaCare, and Catlin Scheppler MBA, BSN, RN, manager, business operations recovery audit and appeals department, Ascension Wisconsin, will lead the workshop.

The main event will kickoff with a keynote presentation about timeliness versus remote work and tackling ethical issues with Michael Legut, Ph.D., principal consultant, Leader Image, and Mary Anne Brady, Ph.D., owner/management consultant, Sustainable Management. Legut and Brady will discuss work engagement, emotional exhaustion, and counterproductive work behavior; how organizations are engaging their employees in the new hybrid work model; and the reality of pandemic burnout and strategies to avoid burnout among your teams.

Brady will return to the virtual stage later in the afternoon to facilitate an interactive campfire session on rethinking retention and reining in the great resignation. Attendees are encouraged to turn on their cameras and share comments, insights, and questions throughout the intimate conversation for peer-to-peer learning. Discussion topics will include the challenges of employee retention and turnover in appeals and grievances, best practices to tackle volume with your internal workforce, cost advantages to outsourcing appeals and grievances, and strategies to prepare an action plan for efficient workflow when short staffed.

The Optimizing Appeals and Grievances Summit

Other sessions throughout the first day of the conference will explore:

  • Appeals and grievances in the post-pandemic era and acknowledging the uncertainty as the new normal
  • Trend and root cause analysis: the data is in your hands
  • The competition for new members and innovative supplemental benefits
  • A case study on the transformation of an appeals and grievances department

Day two highlights

A second preconference workshop will start day two, offering an interactive session to share best practices for identifying and classifying appeals and grievances. Conference Chairperson Ana Handshuh, principal, CAT5 Strategies, chair, RISE Quality & Revenue Community, and Angela Muncy, director, Medicare Advantage compliance, Blue Cross and Blue Shield of Kansas City, will lead the workshop, where they’ll explore real-life customer grievance examples for both Part C & D to critique documentation and practice classifying properly; share best practices and common pitfalls when classifying a grievance to avoid inaccuracies; and discuss CMS measurement standards and training tips to safeguard classification outsourcing.

The main conference will resume with Osato F. Chitou, Esq., MPH, principal, NMOC Healthcare Compliance Consulting, LLC d/b/a Compli by Osato, and Melissa Rusk, director claims and BPO operations, SummaCare, who will explore CMS regulatory outlook. Throughout the discussion, the speakers will shed light on CMS priorities and expectations, Medicare policy changes for 2022 related to the continuation of telehealth, and the impact of the No Surprises Act and D-SNPs integration unified appeals and grievances requirements.

ODAG and CDAG new audit protocols will also be a timely session during day two. Attendees will learn about the challenges health plans face to adapt to the new universe layout, the latest requirements in grievance classification and description and strategies to prepare for the next audit cycle, new dismissal requirements, and tactics to help you and your vendors increase consistency when collecting data for an audit-proof universe. Session speakers will include Tracy Jones, senior compliance coordinator, SummaCare; Michelle Fogg, manager Medicare operational compliance, Health Partners Plans; and Beth Socoski, Medicare compliance director, Longevity Health Plan.

Other topics on the agenda for day two include:

  • Engagement letters and CMS audit readiness
  • Oversight delegated entities and vendor relationships
  • Appeals and grievances operations and organizational benchmarks

The 7th Annual Optimizing Appeals and Grievances Summit will be held as a live-streaming, virtual event June 7-8. Click here to learn more, including the full agenda and how to register for the event.