Optimizing Appeals & Grievances Summit

Jun 21, 2020 ‐ Jun 22, 2020

The Optimizing Appeals and Grievances Summit is carefully crafted to improve ODAG and CDAG outcomes, bringing together compliance experts from the nation to share insights, experience, and expertise in an intimate, open forum. Ensure you're knowledge is up to the minute by discussing critical changes to CMS regulation, audit experience, and readiness techniques at this two day immersion event.


Categorize the Differences Between an Appeal and a Grievance

Jun 22, 2020 2:15pm ‐ Jun 22, 2020 3:00pm

Identification: MON08

Learning Objectives:
  • Assess the definitions of an Inquiry, Complaint, Appeal, and Grievance to provide clarity
  • Utilize tested compliance tips to improve identification
  • Implement delegation to appropriate teams when an appeal or grievance occurs

Chairperson Closing Remarks iconChairperson Closing Remarks

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Chairperson Closing Remarks

Jun 22, 2020 3:00pm ‐ Jun 22, 2020 3:20pm

Identification: MON09


Chairperson Welcome Remarks & Conquer the Skill of Creating an Accurate Universe

Jun 23, 2020 8:00am ‐ Jun 23, 2020 8:55am

Identification: 001-TUE01-TUE02

Chairperson Welcome Remarks iconChairperson Welcome Remarks

Preview Available

Chairperson Welcome Remarks

Jun 23, 2020 8:00am ‐ Jun 23, 2020 8:10am

Identification: TUE01


Conquer the Skill of Creating an Accurate Universe

Jun 23, 2020 8:10am ‐ Jun 23, 2020 8:55am

Identification: TUE02

Learning Objectives:
  • Comb through your current universes to discover inaccuracies related to CMS requirements for ODAG and CDAG universes and tables
  • Create and implement new approaches to universe construction to avoid pitfalls in the future
  • Monitor universe accuracy on a monthly basis through universe pull and inspection to find errors

Strategies for Managing FDR Expectations

Jun 23, 2020 9:10am ‐ Jun 23, 2020 9:55am

Identification: TUE03

Learning Objectives:
  • Incorporate monthly education practices for all FDRs that highlight the expectations of the FDR, communication best practices, and documentation
  • Include FDRs in all mock audits in preparation for the CMS Audit and incorporate feedback into training exercises in areas to improve
  • Generate a strong partnership by understanding what your FDRs are dealing with and how you can help them achieve goals for both entities
  • Matt Uebele, Director of Medicare Operational Compliance, Health Partners Inc

Preparation for the 2020 Medicare Timeliness Monitoring Project

Jun 23, 2020 10:10am ‐ Jun 23, 2020 10:55am

Identification: TUE04

Learning Objectives:
  • Assess how the CMS TMP will affect your operation and what you need to do in advance to be prepared
  • Formulate a plan to perform reviews of your current systems, evaluate accuracy within your universes, analyze your timeliness standards related to CMS guidelines, to determine current benchmarks
  • Bridge the Gap: Create a plan of action on how you can improve current benchmarks, including evaluating vendor solutions that can guide you through the process
  • Osato F. Chitou, Principal Consultant, NMOC Healthcare Compliance Consulting d/b/a Compli by Osato

Strategies to Improve Quality and Mitigate Risk

Jun 23, 2020 11:30am ‐ Jun 23, 2020 12:15pm

Identification: TUE05

Learning Objectives:
  • Incorporate a grievance approach to patient centered care
  • Enhance quality improvement by utilizing grievances
  • Overview of grievances and risk mitigation to improve your processes

Reaching for the STARS: Improving Plan Performance Through CTM Analysis & Chairperson Closing Remarks

Jun 23, 2020 12:30pm ‐ Jun 23, 2020 1:25pm

Identification: 002-TUE06-TUE07

Reaching for the STARS: Improving Plan Performance Through CTM Analysis

Jun 23, 2020 12:30pm ‐ Jun 23, 2020 1:15pm

Identification: TUE06

Learning Objectives:
  • Examine how root cause analysis of 1-800-Medicare CTM cases can have impact on member experience
  • Discuss the continuous improvement cycle needed in order to maintain Complaints About the Health plan STAR metrics and beyond
  • Establish and discuss best practices for documentation and casework handling to drive stellar performance
  • Nicole Henderson, MBA, Manager, Operations Quality & Compliance - Regulatory Complaints, Blue Cross and Blue Shield of North Carolina