2022 Virtual Managed Care Compliance Conference

1. The Impact of HIPAA Regulatory Changes on Managed Care Organizations

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • Define the aspects of the HIPAA regulatory changes that are applicable to managed care organizations
     

   • Understand the policy and procedure changes that may be required to remain fully compliant

   • Identify the regulatory changes that will require workforce re-training

2. Applying Principles of Continuous Quality Improvement (CQI) to Your Compliance Program Using Root Cause Analysis (RCA)

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • Continuous quality improvement (CQI) is consistent with maintaining a culture of compliance
     

   • CQI and RCA are not about individuals and blame, they're about processes and cause and effect

   • CQI and RCA can help demonstrate an effective compliance program

3. How to Improve Your Medicare Data Validation Audit Process to Enhance Oversight of FDRs and Internal Operations

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • Use the annual data validation audit to more broadly understand organizational risks

   • Build your oversight tools by learning how to internally validate vendor data and documentation

   • Use data validation to assess your performance and readiness for other CMS reviews

4. OIG Audits of Diagnosis Codes at High Risk for Being Miscoded: A Discussion of How We Identify Diagnosis Codes to Audit and What You Can Do to Enhance Your Compliance Procedures

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • The panel will talk about how the OIG combines data-mining techniques and discussions with medical professionals to identify diagnosis codes to audit

   • The panel will discuss how the OIG's audits have evolved

   • The panel will discuss how MA organizations can increase their compliance program's effectiveness when detecting and correcting inaccurate diagnosis codes
     

5. The Magic of Universes: Beyond the CMS Audit

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • Leverage universes for operational performance analysis, not merely for CMS Program Audits

   • Monitor universes regularly to proactively address and mitigate issues

   • Avoid penalties and delays by sustaining continuous compliance, not reacting to audits
     

6. A Deep Dive: Enforcement Trends and Risk Areas in Managed Care

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • The panel will discuss in detail lessons learned from past and current enforcement actions

   • The panel will identify key risk areas for Medicare managed care organizations and providers

   • The panel will discuss compliance program best practices to minimize risk in Medicare Advantage

7. The Next Big Thing! Maintaining Compliance and Managing Risk with Healthcare Startup Vendors and Providers

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • Legal risks of contracting with startup and private equity backed companies, which can help health plans stay competitive with their innovation but may also pose risks to compliance and overtax your plans legal and compliance resources

   • Handling vendor negotiations with a company that lacks expertise in the healthcare legal and regulatory environment, including anti-fraud laws, such as the Anti-Kickback Statute, that can be violated during the negotiation process

   • Practical strategies for counseling internal business clients on challenges unique to dealing with healthcare startups, including ongoing compliance monitoring of organizations with limited internal legal and compliance resources

8. Compliance Organization Design

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • What is organizational design and how it is important to compliance program effectiveness?

   • How does my organization's other governance groups impact the compliance organization design?

   • What considerations should be made for organization design of the compliance program?

9. Back to the Future: Leveraging Knowledge and Experiences to Accommodate 2022 CMS Program Audit Protocols

   2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

   • Hear how recent audit experiences combined with revised CMS program audit protocols can be leveraged

   • Key considerations when determining if 2022 protocols require modifications to monitoring activities

   • Applying best practices to ensure audit readiness

   
   

10. Creativity in Compliance: A Case Study in Developing Impactful and Action-Oriented Compliance Activities and Trainings

    2022 Virtual Managed Care Compliance Conference  | February 08, 2022 

    • Learn effective methods to develop trainings and activities utilizing internal partnerships and resources, leading to greater success of your compliance program without adding significant budget

    • Acquire techniques for getting your organization excited about compliance trainings and collaboration

    • Spend time discussing successful training metrics and collaborative efforts

    
    

11. Compliance Considerations in Mergers and Acquisitions

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • Reviewing pre-delegation and contracting requirements

    • Role in due diligence reviews

    • Integration strategies

    
    

12. Looking Around the Corner: How to Navigate the Shifting Drug Contracting Landscape

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • Prepare for the changing legal landscape of drug contracting from a regulatory and compliance standpoint

    • Understand the unique risks of purchasing drugs for Medicare Advantage/PDP programs

    • Analyze trends in federal and state regulation of PBMs, drug pricing, and reimbursement

13. Compliance Issues Under the Purview of Payment Integrity and Fraud, Waste, and Abuse

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • How to quickly identify providers and beneficiaries improperly enrolled

    • Utilizing analytics to capture providers billing multiple products for the same beneficiaries

    • Using public record data in your PI/FWA program to identify exclusions, adverse actions, and more

14. HITRUST CSF: Achieving Certification

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • Walk through how HITRUST CSF maps to and addresses CMMC, ISO 27001, HIPAA, and NIST standards

    • Evaluate establishing a compliance program on HITRUST CSF

    • Examine key steps to successfully achive HITRUST certification

15. Building an Effective Medicare Compliance Risk Assessment

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • Develop effective tools to make tracking and scoring your risks an easier task

    • How to collaborate with internal teams to fully identify Medicare risks

    • Ensuring effective processes are in place for identifying risks with delegates

16. Best Practices in Establishing a Medicare Drug Management Program to Ensure Quality and Compliance

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • Review Medicare Part D requirements for a Drug Management Program

    • Describe case review team membership and process

    • Describe how the team and processes ensure compliance with Medicare DMP requirements

17. Surprises in the No Surprises Act: New Requirements for Plans and Providers Regarding Provider Directory Information - Managed Care Conference

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • In order to improve the accuracy of provider directories, Congress passed the No Surprises Act

    • The No Surprises Act puts new requirements on new health plans and providers

    • Health plans and providers have to come into compliance with the law and new regulation

18. Effective and Compliant Hierarchical Condition Category Capture Auditing

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • Receive an overview of hierarchical condition category (HCCs) capture's importance and use

    • Learn how to use data analytics to effectively audit HCC capture for accuracy and compliance

    • Understand how to oversee a risk-based HCC capture audit as well as integrating internal controls

19. CMS Program Audit: What to Do Before and After Your Organization Receives an Audit Notice

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • Learn about steps to take before you get the announcement letter

    • Understand how to prepare CPE questionnaires, universes, and tracers

    • Identify ways to be successful in CDAG, ODAG, and FAs

20. Applying the Seven Elements of an Effective Compliance Program for Best Practices in Regulatory Audits

    2022 Virtual Managed Care Compliance Conference  | February 09, 2022 

    • Apply the seven elements into regulatory audit planning to manage toward successful results

    • Discuss key regulatory audit prep best practices using the seven elements to guide successful planning, ensure cohesiveness, and organization in audit prep

    • This presentation will present best practices from a plan, PBM, and TPA oversight perspective and discuss how this effective planning can help better organize your regulatory audits