February 13, 2012
7:00 am – 6:30 pm | Registration
7:30 – 8:15 am | Continental Breakfast
8:15 – 9:00 am
General Session: MA and Part D Compliance Programs: Implementing Compliance Plans to Ensure a Culture of Accountability
Judith A. Geisler, R.Ph., CHC, Director, Division of Formulary and Benefit Operations, Centers for Medicare & Medicaid Services
Jerry Mulcahy, Acting Director, Program Compliance and Oversight Group
Philip Sherfey, Health Insurance Specialist, Program Compliance and Oversight Group
presentation 1, presentation 2, evaluation
9:00 – 9:45 am
General Session: Sales and Marketing, Broker Oversight
Susan Anderson, Associate General Counsel, United Healthcare
presentation, evaluation
- Challenges of broker oversight
- Tools to help with broker oversight
- Lessons learned with broker oversight
9:45 – 10:15 am | Break: EXHIBIT HALL
10:15 – 11:15 am Breakout Sessions
101 Best Practices in Training the Board of Directors
Sharon Fahlberg, CCP, Senior Manager, Corporate Compliance, Health Care Service Corporation
Mark Hill, Esq., Compliance Officer, Wellmark Blue Cross and Blue Shield
Deborah Ziegler, CCEP, Director, Corporate Compliance, Capital BlueCross
presentation 1, presentation 2, presentation 3, evaluation
- The various methods we use to conduct Board training
- Pros and cons, and lessons learned, of utilizing computer based training
102 The Internal Process to Prepare for a Government Audit
James Cottos, Corporate Responsibility Officer, St. Joseph Medical Center
presentation, evaluation
- Specific steps to prepare for a government audit
- Itemized list of required documents to have available
- How to demonstrate your compliance program's effectiveness
103 What's Your Best Guesstimate: Making Decision Frameworks for Subjective Standards in Medicare Advantage and Medicare Part D
Dorothy Deangelis, Sr. Managing Director, FTI
presentation, evaluation
- Tips for developing a risk assessment strategy
- Using CMS policy statements to glean insight into the Agency's expectations
- Case studies of creating objective standards from subjective requirements
11:15 am – 12:00 pm | Networking Lunch
12:15 – 1:15 pm | Breakout Sessions
201 HIPAA/HITECH for Health Plans: Sifting Through New Requirements to Achieve Compliance
Erika Bol, Privacy Officer, State of CO Dept of Health Care Policy & Financing
presentation, evaluation
- What to do now to get compliant with the new regulations
- Make sure you’re headed towards effective compliance
- Tools and templates to make the journey easier
202 Draft CMS Compliance Program Guidelines for Medicare Advantage Organizations and Prescription Drug Plans - Highlights and Discussion
Elizabeth Lippincott, Managing Member, Lippincott Law Firm PLLC
presentation, evaluation
203 Managing Medicare Advantage HCCs Through Auditing and Education
Gloryanne Bryant, Managing Director HIM Rev Cycle, Kaiser Permanente Rev Cycle NCAL
presentation, evaluation
- Gain knowledge of a hospital HCC auditing process
- Learn how to provide quality education on HCC compliance
- Understanding the documentation and coding issues and learn some best practices
- Computer Assisted Coding (CAC) technology for retrospective hospital auditing
- Benefits of CAC to gain accuracy and compliance
- Documentation improvement and revenue opportunities
1:15 – 1:45 pm Break: | EXHIBIT HALL
1:45 – 2:45 pm | Breakout Sessions
301 Practical Tips for Assessing a Payor Compliance Program: Approach, Preparations, and Strategies for Remediation.
Tom Bixby, Thomas D. Bixby Law Office LLC
Sheila Herringdon, Director Audit/Compliance, Blue Cross and Blue Shield of Alabama
presentation, handout 1, handout 2, evaluation
302 Managing, Planning and Mitigating Breaches
Sharon A. Anolik, Global Privacy Risk and Strategy Leader, McKesson
Deborah Ziegler, Director, Compliance & Ethics Compliance and Ethics Department, Capital Blue Cross
presentation, evaluation
303 Eat, Drink, & Pray — Reflections from a "Seasoned" Medicare C & D Compliance Officer
Anne Crawford, Medicare C & D Compliance Officer, Highmark Inc.
presentation, evaluation
- Lessons learned from recent CMS performance audit
- Ways to improve compliance monitoring & auditing strategies
- Maintaining balance as internal and external demands continue to rise
3:00 – 4:00 pm | Breakout Sessions
401 Beyond RADV: Does Your Plan's Risk Adjustment Strategy Run Afoul of the False Claims
Mary A. Inman, Partner, Phillips & Cohen LLP
Tim McCormack, Phillips & Cohen LLP
presentation, evaluation
- Understand recent trends in federal enforcement of risk adjustment fraud
- Discuss the False Claims Act and how it applies to risk adjustment
- Examine the problematic approaches to risk adjustment and how to avoid them
402 Internal Investigations
Gabriel Imperato, CHC, Managing Partner, Broad & Cassel
presentation, evaluation
- Determining scope and roles of those overseeing and conducting an investigation
- When and how to apply attorney-client and other privileges during an internal investigation
- Investigation methodology, including interview techniques, document review, organizational cooperation
403 Building Effective, Collaborative Relationships between the Medicare Compliance
D. Derek Jones, CHC, The Health Care Investigations Group, Practice Management Alternatives, LLC
Holly Robinson, Regulations Compliance Advisor
presentation, evaluation
- Tips on aligning the lingo and goals of the Medicare Compliance Program and the FWA Program/SIU
- Different approaches to use with different FWA Program/SIU organizational configurations
- Share best practices on communication tools and collaborative approaches
4:00 – 4:30 pm | Break: EXHIBIT HALL
4:30 – 5:30 pm | Breakout Sessions
501 Building an Effective FDR Oversight Program
Sandra Kimmel, Senior Compliance Analyst, BlueCross BlueShield South Carolina
presentation, evaluation
- Understanding regulatory expectations for an effective FDR oversight program
- Identifying FDR oversight deficiencies
- Creating and supporting an effective, sustainable FDR oversight program
502 Office of Inspector General: An Overview of Recent Work on Managed Care
Russell Hereford, Deputy Regional Inspector General for Evaluation and Inspections, US Department of Health and Human Services
presentation, evaluation
- Overview of the Office of Inspector General
- Discussion of OIG report on “Medicaid Managed Care: Fraud And Abuse Concerns Remain Despite Safeguards” (Dec 2011)
- Discussion of OIG report on “Medicare Prescription Drug Sponsors’ Training To Prevent Fraud, Waste, and Abuse” (Jul2011)
503
Maximizing and Measuring the Effectiveness of Medicare Advantage and Part D Compliance Training
Elizabeth Lippincott, Managing Member, Lippincott Law Firm PLLC
Holly Robinson, Regulations Compliance Advisor
presentation, evaluation
- Integrating operational procedures into specialized compliance training
- Ensuring that compliance training is in line not only with CMS requirements, but also with principles of adult learning
- Evaluating the effectiveness of training as part of the overall compliance program
5:30 – 6:30 pm
Networking Reception: Exhibit Hall
|
