Organizational risk management and compliance value visit

Audio: Case study: The Health First strategy to mitigate data security risks
Large breaches and large sanctions have dominated healthcare security news for some time now with one key message for all of us: It’s time to move from "being compliant" to "being secure". Jutta Williams, Chief Compliance Officer of Health First Health Plans, focuses on what Health First did to operationally improve security, from assessing risk - reading and interpreting the HIPAA Risk Assessment – to gaining board support to invest more in security. She shares how they built an action plan that is achievable, are measuring results and sustaining changes.

Presentation: Case study: Network Health Plan on the shifting roles of compliance leaders and CRO
Augustine Doe, VP of Enterprise Risk Management at Network Health Plan covers: how to create a more robust ERM program; the changing role of compliance leadership and the changing role of CRO

Presentation: Facility risks and business continuity: The audits expect more than a check-the-box approach
Based on over 25 years of disaster recovery experience, and thousands of recoveries conducted for institutions of all types, these straight-forward and simple to implement steps from Mike Merz of Agility Recovery could mean the difference between surviving a disaster, and giving in to one.

Presentation: QHP Audits: Geisinger - Preparing for them, and what to expect when it comes to enforcement actions
With the expiration of the "Good Faith Compliance" standard in the Federally-run exchanges, insurers in the 37 states where CMS manages the health insurance exchange are now subject to fines and other penalties for not meeting federal requirements. Informal "compliance reviews" will become more formal, audit-like, and potentially punitive. Dawn Stocker of Geisinger and Mike Adelberg of FaegreBD Consulting share insights with Value Visit attendees regarding what to expect next.

Presentation: Case study series: New West - Life after a CMS Audit: How to survive the fall out
Understanding audit protocols is one thing: But making it through an audit successfully and - more challenging - all of the subsequent to-dos following an audit, is what often precipitates unexpected consequences for health plan compliance leaders. In this series of case studies, CMS audit veterans Alissa Beattie of New West and Deborah Marine from SummaCare share their perspective and lessons learned.

Presentation: Case study series: SummaCare - Life after a CMS Audit: How to survive the fall out
Understanding audit protocols is one thing: But making it through an audit successfully and - more challenging - all of the subsequent to-dos following an audit, is what often precipitates unexpected consequences for health plan compliance leaders. In this series of case studies, CMS audit veterans Alissa Beattie of New West and Deborah Marine from SummaCare share their perspective and lessons learned.

Presentation: The secret to compliant operations (Hint: it's not about P&Ps)
In 2010, CMS completely revamped their audit process, shifting what had always been a preoccupation with documented policy and procedures to a strong focus on outcomes ... meaning a strong focus on Data. CMS auditors are completing more and more invasive sampling and extrapolation, seeking to identify problems, identify the root, and quantify the scope of the beneficiary impact. Former CMS auditor Shelley Stevenson of Change Healthcare shares her insights for health plan compliance leadership.

Presentation: The CMS Journey to EDS: Mitigating the risks inherent to revenue cycle management
Particularly with the recent announcement from CMS that MA payment source is shifting to 25% Encounter Data, data governance best practices are more critical than ever to your overall risk mitigation strategies as it relates to your revenue cycle. In this session, Jim Corbett of Dynamic Healthcare Systems discusses EDS versus RAPS and the ways in which this much more complicated data set, driving plan revenue, requires aggressive risk mitigation from a multi-disciplined team. We focus on the compliance component of this challenge, rather than risk adjustment operations and tactics, and will address issues related to reconciliation, data governance, vendor oversight, quality assurance, and provider education strategies.

Presentation: Case study: SummaCare on RADV risk mitigation
Rick Alexsonshk of SummaCare provides a Medicare Risk Adjustment Overview and addresses the need For Risk Mitigation, as well as what A Plan Can Do To Protect Themselves. He also covers the RADV process and shares what SummaCare has done to mitigate this risk.

Presentation: Managing a breach response without losing members
Anyone responsible for risk management, compliance, internal audits, and legal should pay special attention to the increasing cybersecurity threat that's darkening the healthcare industry landscape. Breaches can't be stopped, but there are ways to prepare for the worst and minimize the fallout. This presentation from Erich Lambert with AllClear ID provides four valuable tips to help an organization respond to a breach in a way that not only reassures members and stakeholders, but that also sets the stage for recovery.