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Vital Information to Guide Your Compliance Team Successfully Through a CMS Audit

BALTIMORE, MARYLAND October 29-30, 2018 | Pier 5 Hotel

V2 DW 7.13.18

RISE HEALTH PRESENTS

Compliance PALOOZA

INNOVATIVE TECHNIQUES AND STRATEGIES FOR CMS PROGRAM AUDIT PROFICIENCY & IMPROVING FDR OVERSIGHT An overview of the new CMS Audit Protocols and Data RequestsKeep operations engaged by sharing best practices to accommodate ongoing compliance updates Evaluate your existing FDR oversight program to increase efficiency in preparation for an audit Discover innovative strategies to improve operations in your appeals and grievances department

Learn from experts that have experienced a CMS Audit in the past 12 months on how they were successful, & which preparations they wish they had made in advance Leave equipped to effectively conduct mock audits and present your findings in preparation for the real thing

Hear an overview of the new CMS audit protocols and data requests to determine how to keep operations engaged related to ongoing compliance updates.


ARE YOU PREPARED TO CONQUER A CMS AUDIT? CMS Program Audits are a complex, resource-intense dive into your plan’s compliance program. Avoid damaging enforcement actions and civil monetary penalties by assembling your compliance toolkit with effective monitoring and oversight of departments and data that will affect protocol results. Get specific guidelines and resource suggestions for managing your FDRs compliance. With sessions designed to share best practices from recently audited plans, this conference will prepare you and your plan for your next CMS Program Audit. Hear from an esteemed line-up of industry leaders candidly sharing valuable best practices and experiences for CMS Audits from around the country.

WHO SHOULD ATTEND? With a wide variety of topics that focus on the CMS Audit, compliance program effectiveness, FDR oversight, and data management, the conference will attract specialists and leaders from all functions of compliance and delegate oversight. Conference participants will have the opportunity to network with professionals including:

• Directors of Compliance Operations • Directors of Vendor Performance and Oversight • Medicare Advantage Compliance Officers • Directors of Government Programs and Compliance • Directors of Appeals and Grievances • Medicare Pharmacy Compliance Officers • Directors of External Audit and Compliance


TOP REASONS TO ATTEND

1 2 3 4 5 6 7 8 9 10

Hear success stories from industry leaders who have recently been audited

Maximize your mock audits with innovative ideas

Evaluate your FDR oversight program and identify areas of improvement Enhance your Compliance Program Effectiveness role identification Tools to eliminate misclassification in your appeals and grievances department Examine the new CMS Audit Protocols in preparation for change

Protect your plan from malicious cyber threats

Strategies to improve your compliance culture within your plan Master the statewide audits in preparation for the CMS audit Network with experienced leaders and your peers from across the nation


OUR EXPERT SPEAKING FACULTY Michele Rice-Span, Senior Manager, Quality Improvement, Government Programs, Clinical Operation

Megan Grifa, Manager, Medicare Compliance

BLUE CROSS BLUE SHIELD OF ILLINOIS

MEDICAL MUTUAL OF OHIO

Denise Parker, Project Manager Delegate Oversight

Michelle Fogg, Manager Medicare Operation Compliance

BLUECROSS BLUESHIELD OF TENNESSEE

Ambria Moore, Project Manager Delegate Oversight BLUECROSS BLUESHIELD OF TENNESSEE

Annie Hsu Shieh, Senior Compliance Council

CENTRAL HEALTH PLAN OF CALIFORNIA

Charmaine Gee, Director of Appeals and Grievances AMERIHEALTH CARITAS VIP PLANS

Gloria Yu, Compliance Officer AMERIHEALTH CARITAS VIP PLANS

Ana Handshuh, Vice President, Managed Care Programs ULTIMATE HEALTH PLANS

Anne DeLomba, Manager of FDR/ Delegation Oversight

NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND

Elizabeth Robinson, MBA, Manager, Compliance-Monitoring Delegation Oversight

MEMORIAL HERMANN HEALTH PLAN

HEALTH PARTNER PLANS

Angela Lloyd, Director of Medicare Audit and Corrective Action HEALTH PARTNER PLANS

Sarah Peix, Director of Compliance CHENMED

Heather Metz, Manager of Government Compliance GATEWAY HEALTH PLAN

Bridget Williams, Manager of Divisional Compliance and Business Security BLUECROSS BLUESHIELD OF NORTH CAROLINA

Babette Edgar, Principal BLUEPEAK ADVISORS

JoAnn McDaniel-Chinn, Chief Compliance Officer COMMUNITY CARE PLAN

Beth Socoski, Former Compliance Officer


VENUE DETAILS

PIER 5 HOTEL

711 Eastern Ave Baltimore, MD 21202 (410) 539 2000

Detailed with panoramic harbor views and artistic designs, Pier 5 Hotel, a Curio Collection property, was designed with the guest in mind. Stunning waterfront views surround your exploration of shops, venues, and attractions. Fresh cuisine is at your fingertips and premier customer service makes your travel spotless.

ROOM BLOCK DETAILS: We have a block of rooms reserved at a special rate of $165/night. This rate expires on October 12, 2019; although, we expect the block to sell out prior to this date. To receive a room at the negotiated rate book well before the expiration date. Mention the “Compliancepalooza Summit” when placing your room reservation by phone to receive the negotiated rate. We urge you to book your room early as we expect the block will sell out. Upon sell out of the block room rate and availability will be at the hotel’s discretion. Please call (410) 539-2000 to book your room or simply click the link: http://group.curiocollection.com/Compliancepalooza


D A Y O N E : O C T O B E R 2 9 TH, 2 0 1 8 8:00 – 9:00

Registration & Continental Breakfast for Attendees and Speakers

9:00

Conference Introduction and Kickoff

9:05

Panel Review: CMS Audit Protocols & Data Requests Effective January 2019 • Which of the changes will impact health plans the most? • How to adjust your internal audits to prepare for the new regulations? • What information do your FDR’s need? Should you adjust your agreements? • Best practices to prepare for the new audit process • Identifying training methods to prepare your team Babette Edgar, Principal BLUEPEAK ADVISORS

10:05

Exploring the Trials, Tribulations & Success Stories from Health Plans’ Recent CMS Audits Learn from health plan compliance specialists from varying size health plans, that have recently completed a CMS audit on their experiences through interactive discussions and Q & A. Items discussed will include: • The preparation involved for the audit, and what they wish they had prepared for • What was the outcome? Positives and negatives • How did your plan respond to the audit? ICAR, CAR, Validation? • What changes do you intend to make post audit? Michele Rice-Span, Senior Manager, Quality Improvement, Government Programs, Clinical Operation BLUE CROSS BLUE SHIELD OF ILLINOIS

Denise Parker, Project Manager Delegate Oversight BLUECROSS BLUESHIELD OF TENNESSEE

Ambria Moore, Project Manager Delegate Oversight BLUECROSS BLUESHIELD OF TENNESSEE

Beth Socoski, Former Compliance Officer

11:00

Morning Networking Break


11:15

Examining How to Estimate Potential Civil Monetary Penalties and Guidance from CMS • Learn how to correctly use the CMS formula to calculate potential CMPs • Identifying through mock audits what infractions are likely to be penalized • Establishing methodology to allocate necessary resources in preparation for CMP • Enabling CMP as a tool: Use findings to motivate leadership to increase action. • Using CMS guidance as an explanation for CMPs awarded Annie Hsu Shieh, Senior Compliance Counsel CENTRAL HEALTH PLAN OF CALIFORNIA

12:15

Networking Luncheon

Track A: CMS & Statewide Program Audits

Track B: FDR Oversight & Provider Monitoring 1:15 - 1:30

Introduction & Remarks

Introduction & Remarks

1:30 - 2:30 Methods to Advance Your Appeals and Grievances Operation to Enhance Ef fectiveness

Implementation of an Ef ficient FDR Monitoring Prog ram

• Adopting new techniques to improve collaboration with the compliance team • Evaluating your current systems to increase productivity and timeliness when compiling data • Discovering new methods to enhance your monitoring system and reduce misclassification • Process overview: How can you improve how your staff functions

• Tools to create an effective and accurate risk assessment process • Restructuring your existing monitoring program to increase efficiency • Creating a robust corrective action plan for FDRs • Evaluating existing procedures for FDR evaluations • FDR Risk Scores- Identifying potential weaknesses • Installing universal operational requirements between your plan and FDRs

Charmaine Gee, Director of Appeals and Grievances AMERIHEALTH CARITAS VIP PLANS

Ana Handshuh, Vice President, Managed Care Programs ULTIMATE HEALTH PLANS

Gloria Yu, Compliance Officer AMERIHEALTH CARITAS VIP PLANS

Anne DeLomba, Manager of FDR/Delegation Oversight NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND


2:30 - 3:30 Best Practices: Managing your Statewide Audits to Impact your CMS Audits

FDR Management & E xpectations: Setting the Bar Hig h

• Managing Quarterly or Bi Annual statewide audits successfully • How preparations for state audits can benefit your plan for the CMS audit • Overview of similarities between state/CMS audits • Best practices to avoid civil monetary penalties and sanctions from the state

• • • •

Effectively communicating with your FDRs Gaining willful FDR participation & accountability Innovative FDR compliance training programs Proven FDR risk management strategies

Elizabeth Robinson, MBA, Manager, Compliance-Monitoring Delegation Oversight MEMORIAL HERMANN HEALTH PLAN

Michele Rice-Span, Senior Manager, Quality Improvement, Government Programs, Clinical Operations BLUE CROSS BLUE SHIELD ILLINOIS

Megan Grifa, Manager, Medicare Compliance MEDICAL MUTUAL OF OHIO

3:30

Afternoon Networking Break

3:45 - 4:45 E xamining Ef fective Methods to Complete ICARs and CARs in a Time Constraint • Identification of testing methods to evaluate the efficiency of your corrective action plan • Creating a culture: Developing strategies to create a culture of compliance in preparation for ICARs and CARs • Evaluating your audit - how to improve in time for the next State or CMS audit Elizabeth Robinson, MBA, Manager, ComplianceMonitoring Delegation Oversight MEMORIAL HERMANN HEALTH PLAN

E xamining the FDR’s Role Within an Audit • Examining the documentation the FDR must provide • A unique view of the PBM’s role in an audit • Identifying the timeframes necessary to complete the audit efficiently • Effective methods for health plan’s inclusion in the FDR’s process Julie Billman, Vice President Operational Performance GORMAN HEALTH GROUP Michelle Fogg, Manager Medicare Operation Compliance HEALTH PARTNER PLANS

Bridget Williams, Manager of Divisional Compliance and Business Security BLUE CROSS BLUE SHIELD OF NORTH CAROLINA

4:45

Cocktail Reception


D A Y T W O : O C T O B E R 3 0 TH, 2 0 1 8 7:15

Continental Breakfast for Attendees and Speakers

8:00

Early Bird Session: Cyber Security and Privacy Data Protection - Best Practices to Protect Your Plan • Learn how to accurately assess your current security program to identify weaknesses • Best practices in screening FDRs and contractors to confirm security and privacy • Examining different response plans to a security breach to calculate the best way to respond • Implementing a testing strategy to improve efficiency of your program and response plan JoAnn McDaniel-Chinn, Chief Compliance Officer COMMUNITY CARE PLAN

9:00

Chairperson’s Recap of Day One

9:15

There is No “I” in Team! Preparing for the CMS Audit- Identifying Roles and Enhancing Collaboration • Learn how to successfully identify each person’s role within the audit process • Discover strategies to enhance collaboration in high risk areas • Implementing a timeframe for each member to meet their requirements • Discovering innovative training techniques to keep your team on their toes Denise Parker, Project Manager Delegate Oversight BLUECROSS BLUESHIELD OF TENNESSEE

Ambria Moore, Project Manager Delegate Oversight BLUECROSS BLUESHIELD OF TENNESSEE

10:15

Case Study: 2018 Overview of Special Needs Plans Audit- Unique Requirements of CMS on Model Of Care • Identifying strategies to improve the high-risk HRA including hard to reach members • Developing mock audit methods on the SNPs model of care to meet CMS requirements • Collaboration synchronization techniques with the care coordination teamcommunication tools to increase efficiency • Adjusting to changes in D SNP requirements from the Bi Partisan Budget Act Angela Lloyd, Director of Medicare Audit and Corrective Action HEALTH PARTNER PLANS

Michelle Fogg, Manager Medicare Operation Compliance HEALTH PARTNER PLANS

11:00

Morning Break


Track A: Compliance Program Effectiveness

Track B: Data Management 11:15 – 12:15

E xamining the Organization and Ef ficiency of an Ef fective Compliance Prog ram- Identification of Areas for Improvement • Establishing accurate metrics to measure the effectiveness of your compliance program • An overview of successful processes and best practices implemented by efficient health plans • Identifying strategies to keep the compliance team engaged • Evaluating the seven elements of an effective compliance program

Strategies to Improving and Maintaining Your Provider Network and Adequacy and Director y Accuracy • Preparing your Network and Health Service Delivery Table for the CMS audit • Evaluating CMS regulations for your plans provider directory • Best practices to improve accuracy within your directory • Provider and Network Oversight: Implementing a monitoring program to increase efficiency and accuracy

Sarah Peix, Director of Compliance CHENMED

12:15

Networking Luncheon

1:15 – 2:15 Innovative Techniques for Managing Universes and Compliance Organizational Structure with Limited Resources • Evaluating the structure of your compliance department to initiate a streamlined approach • Learn key techniques on how to maximize your budget through universe management • Identifying communication tools to address future audits with high level managers Megan Grifa, Manager, Medicare Compliance MEDICAL MUTUAL OF OHIO Heather Metz, Manager of Government Compliance GATEWAY HEALTH PLAN

Strategies to Accomplish a Smar t Impact Analysis to Benefit Your Plan • • • •

Evaluating CMS changes on Impact Analysis Best practices in identifying impact and evaluating scope Tools to develop an efficient impact analysis Reporting issues to CMS: The procedure and timeline

Annie Hsu Shieh, Senior Compliance Counsel CENTRAL HEALTH PLAN OF CALIFORNIA


2:15 – 3:00 Optimizing your Mock Audit Process to Include Presentation of Your Findings and Integ ration of Tracers • Using mock audits as a tool to identify areas of inaccuracy and improve timeliness • Discovering methods to introduce tracers into the mock audit process in preparation for CMS audit • Evaluating your current process and sample selection to resemble the CMS process Angela Lloyd, Director of Medicare Audit and Corrective Action HEALTH PARTNER PLANS

Best Practices to Ensure a Smooth Independent Validation Audit E xperience • Streamline your ODAG and CDAG best practices to enhance CMS audit outcomes • Adopt strategies to improve call center operations to reduce grievances which could be costly in an audit • Identifying best practices in Medicare data validation Babette Edgar, Principal BLUEPEAK ADVISORS Beth Socoski, Former Compliance Officer

Bridget Williams, Manager of Divisional Compliance and Business Security BLUECROSS BLUESHIELD OF NORTH CAROLINA

3:00

Conference Concludes


PRICING EARLIEST BIRD RATE: BUY ONE, GET ONE

ends 7/20

EARLY BIRD RATE ends 9/28

STANDARD RATE

Health Plan

$1,695

$1,495

$1,695

Service Provider

$1,995

$1,695

$1,995

THREE WAYS TO REGISTER Register Online Click here

Call (704) 341-2439

Mail Wilmington FRA 3420 Toringdon Way, Suite 240 Charlotte, NC 28277 Make checks payable to Wilmington FRA and please write H536 on your check.

TEAM DISCOUNTS Three people will receive 10% off Four people will receive 15% off Five people or more will receive 20% off

In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For more information, please call Kathie Eberhard at (704) 341-2439 Refunds & Cancellations For information regarding refund, complaint and/or program cancellation policies, please visit our website: risehealth.org/the-fine-print/


THE CONFERENCE ORGANIZER

RISE is the premier community for healthcare professionals who aspire to meet the extraordinary challenges posed by the emerging landscape of accountable care and government healthcare reform. Recognized industry-wide as the number one source for information on risk adjustment and quality improvement within healthcare, RISE strives to serve the community on four fronts: networking, education, industry intelligence and career development. Through cutting-edge conferences, online courses, in-house training, webinars as well as an association comprised of over 2,500 members, RISE provides professionals with industry insights and critical information they need to stay ahead of the curve. RISE produces more than 30 conferences annually, focused on sophisticated topics and ample networking opportunities for thousands of executives from mid- to senior-level and C-suite. Our team of subject matter experts is often first to market with emerging topics and we pride ourselves on consistently delivering on top-quality operations and logistics to produce a seamless event. Established in 2006 as an extension of Healthcare Education Associates (HEA), RISE now operates as the sole healthcare arm offering the original capabilities of HEA as well as an expanded product line. Headquartered in Charlotte, North Carolina, RISE operates alongside its counterpart, Foundation Research Associates (FRA), which serves the finance, law enforcement, government, legal and compliance communities in a similar capacity.

SPONSORSHIP & EXHIBIT OPPORTUNITIES Enhance your marketing efforts through sponsoring a special event or exhibiting your product at this event. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or custom-designed networking event. To learn more about sponsorship opportunities, please contact Michelle Elam at MElam@frallc.com or 704-341-2393.


GOLD GORMAN HE ALTH GROUP

As the leading consulting and software solutions firm specializing in government health programs, Gorman Health Group (GHG) combines innovation with proven, integrated approaches and technology solutions to help organizations operating in Medicare, Medicaid, and the Health Insurance Marketplace reduce costs, improve quality, and optimize revenues. Since 1996, GHG’s unparalleled teams of subject matter experts, former health plan executives, and seasoned healthcare regulators have been providing strategic, operational, financial, and clinical services to the industry across a full spectrum of business needs. Further, GHG’s software solutions have continued to place efficient and compliant operations within our clients’ reach. GHG’s mission is to empower health plans and providers, through a compliant, member-centric focus, to deliver higher quality care to members at lower costs while serving as valued, trusted partners. Learn more at www. gormanhealthgroup.com.

BLUEPEAK ADVISORS

BluePeak Advisors assists health plans, pharmacy benefit management companies, pharmaceutical companies and health care alliance companies with Medicare Parts C and Part D operational and compliance issues. BluePeak consultants, with experience from CMS and the industry, perform many mock audits and CMS validation audits each year, assist with actual CMS audits onsite, design staffing plans and act as interim staffing, and assist with remediation efforts. Please visit us at www.bluepeak.com.

CompliancePALOOZA 2018  

INNOVATIVE TECHNIQUES AND STRATEGIES FOR CMS PROGRAM AUDIT PROFICIENCY & IMPROVING FDR OVERSIGHT

CompliancePALOOZA 2018  

INNOVATIVE TECHNIQUES AND STRATEGIES FOR CMS PROGRAM AUDIT PROFICIENCY & IMPROVING FDR OVERSIGHT