FEBRUARY 3, 2022
WELCOME & OPENING REMARKS: HOW TO MAXIMIZE YOUR VIRTUAL CONFERENCE EXPERIENCE
Satish Kavirajan Conference ManagerStrategic Solutions Network
EXAMINING RECENT CMS GUIDANCE AND ODAG & CDAG UPDATES
This session will examine changes to CMS guidance regarding Part C and Part D appeals and grievances, including the implications for Part C/D reporting and the ODAG and CDAG audit protocols.
Deborah Marine, JD, CHC Chief Compliance Officer, Health Plan OperationsSummaCare
Tracy JonesSenior Compliance CoordinatorSummaCare
YOU GET THE CMS PROGRAM AUDIT NOTICE – DON’T PANIC
The general themes of the presentation are what to do when you get the CMS Program Audit Notice and what to expect if you have to conduct an Independent Validation Audit (IVA). For the Program Audit Notice section, I will discuss, at a high level, the timeline of the audit including engagement; submissions; field work; and reporting. These items reflect what is in the CMS Program Audit Guidance. I will provide an overview of what to expect if there are findings in the audit which cause the health plan to have to conduct an IVA. Finally, I will share some best practices and lessons learned.
Tammy Chadd, CHC, CHPC Compliance Program ManagerIU Health, Inc.
CONVERTING COMPLAINTS TO OPPORTUNITIES WITH THE POWER OF AI
Right and timely resolution of appeals and grievances (A&G) motivates members to stay with the Plan and enables compliance for the Plan.
The session will demystify how payers can unleash the potential of artificial intelligence to convert complaints into opportunities with
minimum disruption and boost customer satisfaction.
Alok Mandal Vice President – TechnologyVirtusa
Virtual Networking Break
HOW TO IMPROVE WORKFLOW IN THE A&G PROCESS
The speakers will review requirements for an A&G system, while maintaining compliance, prioritization, timeliness and efficiencies.
Hannah LaMere, MASr. Director, Consulting Cody Consulting Group
Michelle Larson, CHCSr. Consultant, Compliance SolutionsCody Consulting Group
DEVELOPING OPERATIONAL EFFICIENCIES WITH A COMPLIANCE MINDSET
UPMC Health Plan has implemented best industry practices which involve:
Rebecca Richards Senior Manager, Medicare/SNP Complaints and Grievances UPMC Health Plan
Virtual Lunch Break in the Exhibit Hall
DRIVING STAR RATING SUCCESS THROUGH COMPLAINT ANALYSIS
The speaker will:
Nicole Henderson, MBA, CSM Director, Stakeholder EscalationsBlueCross BlueShield of North Carolina
BEST PRACTICES IN GRIEVANCE CLASSIFICATION
In order to combat the misclassification of grievances, CHRISTUS Health Plan has incorporated the following best practices to be utilized on a case-by-case basis.
Krishelle Watts, MHAManager of Regulatory ComplianceCHRISTUS Health Plan
A&G BEST PRACTICES – GOING BEYOND REGULATORY COMPLIANCE
The speaker will share best practices based on his health plan’s experience with CMS. In some instances, an exclusive focus on regulatory compliance is not enough. For example, Medicare Advantage plans have 30 days for working grievances, but CMS expects that members who urgently need a drug or service receive a decision sooner. The health plan needs to have a process in place to identify these high-priority cases. Other examples include ensuring that all areas within a health plan that have contact with members receive training on A&G processes and conducting initial evaluations of potential grievances.
Michael Soto Maldonado, MHCM A&G Manager, Medicare Advantage & MedicaidMMM Holdings LLC
Virtual Networking Break
BEST PRACTICES IN ADDRESSING QUALITY OF CARE GRIEVANCES
Understanding the complexity of quality of care grievances is a key element to a successful grievance and appeals department. I will be discussing best practices to manage this type of grievances to ensure success in regulatory audits.
Karla Rosado-Torres Medicare Product ManagerHealth Plan of San Mateo
ENRICH ENROLLEE EXPERIENCE AND LOWER OPERATING COSTS: COMPLIANCE-DRIVEN AUTOMATION IS HERE
After this presentation, attendees will:
Craig Giangregorio Senior Vice President, Healthcare SolutionsInovaare
Gabe Viola Senior Vice President, Customer Relations and ImplementationsInovaare
Virtual Networking Reception in the Exhibit Hall
Close of Conference