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Organizational risk management and compliance value visit

Event Date: 5/10/2016 - 5/12/2016

Event Overview

Organizational risk management and compliance 

Join your Alliance peers for a 2 1/2 day deep-dive into enterprise risk management and compliance.  This value visit will examine both the risk management process itself, as well as specific high-risk areas such as cybersecurity, CMS audits, data governance, and fraud, waste and abuse.

Who should attend?

Executives with responsibility for risk management, compliance, internal audit, and legal.

Functions

Tuesday, May 10, 2016

6:00 - 8:00 pm Networking dinner for event delegates.  Restaurant location to be announced.

 

Wednesday, May 11, 2016

6:30 - 9:00 pm Networking dinner for event delegates.  Restaurant location to be announced.

 
Agenda

For a printable, detailed agenda, visit the Documents tab noted above

AGENDA AT A GLANCE  

Tues, May 10

 

8am

Registration and Breakfast

8:30am

Welcome and introductions

9:30am

Enterprise risk management: Preparing your health plan to stay ahead

10:30am

Break

10:45am

Intro to CGAD models and the possible impact to plans

11:15am

Case study: Medical Associates on the formation of the governance committee of the board

12:15pm

Lunch

1:15pm

Communication and training in corporate governance – risk management

1:45pm

Case study: Network Health Plan on the shifting roles of compliance leaders and CRO

2:45pm

Fitness Break

3:15pm

Case study: Health Alliance Medical Plan on the formation of the risk management team

4:15pm

Your risk incident team and reporting of incidents – SWAT team, Triage team

4:45pm

Small Group Discussion: Mapping your risk management procedures from occurrence to final report out

5:15pm

Day adjourns

6:30pm

Dinner - Cooper’s Hawk Winery & Restaurant

Wed, May 11

 

8am

Breakfast

8:30am

Facility risks and business continuity: the audits expect more than a check-the-box approach

9:45am

Break

10am

QHP audits: Preparing for them, and what to expect when it comes to enforcement actions

11:15am

Case study series -- Life after a CMS Audit: How to survive the fall out

12:30pm

Lunch

1:30pm

The secret to compliant operations (Hint: It’s not about P&Ps)

2:30pm

Fitness Break

3pm

The CMS Journey to EDS: Mitigating the risks inherent to revenue cycle management

4:15pm

Case Study: SummaCare on RADV risk mitigation

5:15pm

Day adjourns

6:30pm

Dinner – P. F. Changs

Thurs, May 12

 

8:00am

Breakfast

8:30am

Case study: The Health First strategy to mitigate data security risks

9:45am

Break

10am

Managing a breach response without losing members

11am

Case study: Paramount shares their risk mitigation strategy development process

12pm

Working Lunch: Roundtable discussion
Documents
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5/23/2016

Presentation: Enterprise risk management: Preparing your health plan to stay ahead
Enterprise Risk Management is a new way for boards and senior management to attempt to manage the specific risks associated with a particular business enterprise. This session features Patricia Wagner of Epstein Becker Green, who explores ways in which the board and senior management can establish Enterprise Risk Management priorities.

5/23/2016

Presentation: Intro to CGAD models and the possible impact to plans
This session features CJ Rathbun of First Consulting, who provides an intro to the CGAD models, the possible impact to fraternal board structure, and the changing roles of internal staff to support board objectives.

5/11/2016

2015 HMS Document Review List
At the May 2016 Organizational Risk Management and Compliance Value Visit, Dawn Stocker of Geisinger shared an excel file of the document submission list she prepared during a QHP audit in 2015.

5/6/2016

Question to CMS regarding SOD/EOD universe
HTMS asked CMS to clarify when a pre-auth request should be placed in the expedited universe.

4/25/2016

CMS answers a question regarding DMR vs PREC
HTMS consultants ask CMS to clarify which universe a payment appeal belongs in -- PREC or DMR?

4/25/2016

Sample Compliance Dashboard post-CMS audit
This sample compliance dashboard has been created by Change Healthcare and is incredibly useful AFTER an audit from CMS.

4/4/2016

Agenda: Organizational Risk Mgmt and Compliance_051016
This value visit will examine both the risk management process itself, as well as specific high-risk areas such as cybersecurity, CMS audits, data governance, and fraud, waste and abuse.

3/22/2016

CMS tests waters for enhanced Medicare Advantage audits
The federal government is examining how it can beef up medical record auditing of Medicare Advantage insurers, which have been accused of exaggerating patient diagnoses to pad their payments. New procedures outlined by the feds will lead to heftier payment recoveries, perhaps tens of millions of dollars more compared with past audits.

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Attendees

Below is a list of all delegates registered to date for this event

  • Rick Alexsonshk
  • ALLIANCE MEMBER
  • Director ACA Risk Adjustment at SummaCare
  • Nicole Beadle
  • ALLIANCE MEMBER
  • Manager, Medicare Compliance at Paramount Health Care
  • Alissa Beattie
  • ALLIANCE MEMBER
  • Vice President, Operations & Compliance at New West Health Services
  • Jaime Gonzalez
  • ALLIANCE MEMBER
  • Chief Business Development Officer at Health Plan Alliance
  • Karen Hoffmann
  • ALLIANCE MEMBER
  • Director of Operations at Medical Associates Health Plans
  • Tracy Jones
  • ALLIANCE MEMBER
  • Chief Compliance Officer at SummaCare
  • Sabrina LeBeau
  • ALLIANCE MEMBER
  • Director of Human Resources and Compliance Officer at Alliant Health Plans
  • Alan Lederman
  • ALLIANCE MEMBER
  • Chief Operating Officer at Community Health Plan of Washington
  • Rachel Reimann
  • ALLIANCE MEMBER
  • AVP Regulatory Compliance at SelectHealth
  • Jason Rio
  • ALLIANCE MEMBER
  • Sr. Director of Revenue Assurance and Risk Management at Health New England
  • Ben Steiner
  • ALLIANCE MEMBER
  • Director of Internal Audit at Community Health Plan of Washington
  • Dawn Stocker
  • ALLIANCE MEMBER
  • Program Manager, Health Care Reform Compliance at Geisinger Health Plan
  • Mike Adelberg
  • SPEAKER
  • Executive Director at National Association of Dental Plans
  • Jim Corbett
  • SPEAKER
  • Founder and Chief Strategy Officer at Reveleer
  • Mike Merz
  • SPEAKER
  • Strategic Sales Manager at Agility Recovery Solutions
  • Patricia Wagner
  • SPEAKER
  • Member of the Firm & Chief Privacy Officer at Epstein Becker Green (EBG)
  • Tina Bailey
  • SPONSOR
  • Senior Director, Compliance Solutions at Gorman Health Group
  • Becky Erbe
  • SPONSOR
  • Chief Business Development Officer at hunterAI
  • Thomas Joyer
  • SPONSOR
  • Chief Commercial Officer at Altruista Health, Inc
  • Brad Piper
  • SPONSOR
  • Principal and Consulting Actuary at Milliman
  • Deb Curry
  • VIRTUAL ATTENDEE - MEMBER
  • Director Risk Adjustment & Recoveries at Paramount Health Care
  • JoAnna Destino
  • VIRTUAL ATTENDEE - MEMBER
  • Government Relations Manager at Fidelis Care New York
  • Erin Heckethorn
  • VIRTUAL ATTENDEE - MEMBER
  • Director of Operations and Program Management at FirstCarolinaCare Insurance Company
  • Mark Mixer
  • VIRTUAL ATTENDEE - MEMBER
  • Chief Executive Officer at Alliant Health Plans
  • Jack Randolph
  • VIRTUAL ATTENDEE - MEMBER
  • Chief Executive Officer at MediGold
Speakers