2020 Managed Care Compliance Conference

26. A Compliance Program Facelift: Sculpting a Program from Good to Great

    2020 Managed Care Compliance Conference  | Presenter(s): Nicole S. Huff, Deborah M. Johnson  | January 27, 2020 

    • Address increasing state and federal regulatory requirements and enforcement activities

    • Discuss strategies to move your compliance program from “Good to Great” with limited resources

    • Case scenarios describing how to build partnerships and influence positive outcomes

27. Adjusting the Risk for Medicare Advantage: Recent Enforcement Trends and Litigation Involving Medicare Advantage Risk Adjustment Practices

    2020 Managed Care Compliance Conference  | Presenter(s): Brandon J. Moss, Rachel A. Alexander  | January 27, 2020 

    • Attacks on Medicare Advantage plans’ practices with respect to auditing or reviewing risk adjustment scoring are growing both more complex and popular

    • While the government has been handed some serious setbacks in the last year, cases involving risk adjustment continue to be brought (both civilly and criminally)

    • Recent trends in civil and criminal enforcement actions, where courts are lining up on interpreting key regulations, and what all this means for Medicare Advantage providers looking to navigate this high-stakes and ever-changing landscape

28. Compliance Goals in Risk Adjustment Coding

    2020 Managed Care Compliance Conference  | Presenter(s): Dana Brown, Dott Campo, Rebecca Welling  | January 26, 2020 

    • Overview of Risk Adjustment reimbursement in the MA and ACA models

    • Review of Risk Adjustment coding, HCC code capture accuracy, review of coding guidelines, rules & regulations

    • In-depth review of most common compliance issues in coding in an RA environment, isolating the issues and giving tools to analyze them and make good compliant decisions

29. Compliance and Business Roles in Today's Complex Regulatory Environment

    2020 Managed Care Compliance Conference  | Presenter(s): James Taylor, Chris Schroeder, Taline Avakian  | January 26, 2020 

    • Key developments and trends across the healthcare industry related to the evolving role of compliance and the role of business units

    • How compliance has helped define the role of meeting regulatory requirements

    • An understanding of embedded compliance support and/or performance/program support teams/units, and how risk ownership is driving the role of business units

30. Cyber Threats and Compliance Challenges: How to Manage Technology Risk

    2020 Managed Care Compliance Conference  | Presenter(s): Jennifer Griveas, Michael Gray  | January 26, 2020 

    • The biggest security threats to healthcare organizations

    • The value of integration of knowledgeable IT personnel into high-level operations team as a means to ensure compliance and effective risk mitigation

    • How best to implement technology solutions to enhance efficiency and productivity without sacrificing organizational security

31. Effectively Managing Internal Investigations and Regulatory Disclosures

    2020 Managed Care Compliance Conference  | Presenter(s): Anne Crawford, Annie Hsu-Shieh, Lori Benso  | January 26, 2020 

    • Methods to determine if communication infrastructure supports prompt identification of potential issues

    • Strategies for initiating timely investigations that determine beneficiary and organizational impacts

    • Common themes and regulatory disclosure approaches when deciding whether self-reporting to regulators is required or advisable

    • Attorney-client privilege and litigation risk-management strategies

32. Establishing a Best-Practice Approach for Your Compliance, Privacy, and Secrity Programs

    2020 Managed Care Compliance Conference  | Presenter(s): Bret S. Bissey, Kelly McLendon  | January 26, 2020 

    • How to utilize, in detail, the elements of the DHHS OIG Model Compliance Program(s) to develop a best practice for your compliance efforts

    • How to utilize the HIPAA Privacy and Security regulations and conduct a program assessment to create a best practice standard in your organization

    • How best to formulate security, privacy, and compliance education programs in your organization, including a focus on being compliant at the top of the organization, by utilizing market knowledge to stimulate learning

33. Ethics and Compliance Work Plan Essentials that Effectively Mitigate Risk

    2020 Managed Care Compliance Conference  | Presenter(s): Andrea Share, Chanelle Gamble  | January 26, 2020 

    • The importance of conducting an ethics and compliance risk assessment and the relevance of risk assessments in an integrated care setting

    • The key components of a risk assessment, how to conduct a risk assessment, and the role of work planning for effective mitigation

    • A “simple six step” approach to conducting a risk assessment, a framework for defining risk, and key takeaways for how the connection between risk assessment and work planning delivers business value

34. Special Supplemental Benefits and the FDRs that Provide Them - Unique Monitoring Challenges They Pose

    2020 Managed Care Compliance Conference  | Presenter(s): Jennifer (Jen) Del Villar, Gail Blacklock  | January 26, 2020 

    • Unique monitoring challenges with unique FDRs

    • Monitoring the member match: Right member to the right supplemental benefit

    • Tracking and monitoring health outcomes

35. The A to Zs of FDR, Delegate, and Subcontractor Oversight

    2020 Managed Care Compliance Conference  | Presenter(s): Steve Bunde, Laurena Lockner, Rebecca Fuller  | January 26, 2020 

    • Prevent: Learn about CMS and state requirements for FDR, delegate, and subcontractor oversight and areas of audit focus

    • Detect: Understand due diligence, contracting, risk assessment, and auditing and monitoring strategies - including key partnerships

    • Correct: Discover what to do when issues are identified and how to incorporate those into the correct CMS Program Audit Universe