2022 Medicare Advantage Member Accounting and Reconciliation Summit

Jun 28, 2022 ‐ Jun 29, 2022


Chair's Welcome Remarks and Enrollment and Encounters Reconciliation: The Big Picture

Jun 29, 2022 8:00am ‐ Jun 29, 2022 9:10am

Identification: WED001

Chair's Welcoming Remarks iconChair's Welcoming Remarks

Preview Available

Chair's Welcoming Remarks

Jun 29, 2022 8:00am ‐ Jun 29, 2022 8:10am

Identification: WED01


Enrollment and Encounters Reconciliation: The Big Picture

Jun 29, 2022 8:10am ‐ Jun 29, 2022 9:10am

Identification: WED02

•    Gain an overview of the membership pipeline from application to CMS approval
•    As COVID gradually recedes into the background, explore the increasingly complex enrolment and encounter issues, from Dual Eligible members, D-SNPs, and DUAL D-SNPs
•    B practices to coordinate membership across plans
•    Ensure enrollment accuracy through a systematic and detailed approach to reconciliation

  • David Meyer, Managing Director, Medicaid Policy, RISE Executive Committee

Leveraging Technology to Send Accurate Data to CMS

Jun 29, 2022 9:20am ‐ Jun 29, 2022 10:10am

Identification: WED03

•    From internal operations to vendor management to protecting yourself from audit, ensure your data is complete and accurate
•    Gain b practices as MA plans currently straddle both EDPS and RAPS reconciliation models
•    Tackle both tactical and analytical challenges through effective technology management
•    Understand how CMS acquires the data and the risks of inaccuracy
•    Identify errors and uncover fraud prior to CMS submission
•    T how accurately you are collecting information on social determinants of health

  • Kwame Appiah-Yeboah, Ph.D., CRC, Director, Risk Adjustment & Revenue Management, Sentara Health Plans

Part D Reconciliation 101 iconPart D Reconciliation 101

Preview Available

Part D Reconciliation 101

Jun 29, 2022 10:20am ‐ Jun 29, 2022 11:20am

Identification: WED04

•    Optimize your Part D reconciliation process
•    Identify key difference in claims and tips for DIR protocols
•    Understand how changes to point of sale regulations may impact your bottom line
•    Learn the nitty-gritty of everything from PDE reconciliation to PBM oversight


Part C Reconciliation 101: Building Big Picture Strategies for CMS Revenue Processes

Jun 29, 2022 11:50am ‐ Jun 29, 2022 12:45pm

Identification: WED05

•    Get key takeaways to build out an overarching role and strategy for your CMS revenue process
•    Key levers to be used for revenue projections during Medicare Bid.
•    Learn about b practices as they relate to risk score management.
•    B practices and impact of quality STARs on health plan revenue
•    Covering everything from end-to-end flowchart to Mid-Year and Final Year Sweeps, learn how to maintain an overarching strategy while also keeping yourself grounded by in-the-weeds details

  • Prateek Arora, AVP of Product Systems Innovation, Visiting Nurse Service of New York
  • Cheryl Alford, Associate Director, Risk Adjustment Health Plans, Visiting Nurse Service of New York

Legal Basics: Focus on Medicare Secondary Payer Part 1

Jun 29, 2022 1:00pm ‐ Jun 29, 2022 2:00pm

Identification: WED06

•    The Medicare Trust Funds and CMS’s MSP mandates
•    MSP for Group Health Plans (GHP)
•    Evolution of MSP developments for injury coverage/non-group health plans (NGHP)
•    Introducing the PAID Act


Best Practices and Tools and Chair's Summary of Day One

Jun 29, 2022 2:10pm ‐ Jun 29, 2022 3:15pm

Identification: WED007

Best Practices and Tools: Focus on Medicare Secondary Payer, Part 2

Jun 29, 2022 2:10pm ‐ Jun 29, 2022 3:10pm

Identification: WED07

• Understanding MSP data files provided by CMS to Part C and Part D plans
•    File validation for GHP records
•    Payment avoidance and recovery from primary payers

  • Brian Bargender, CSRP, Management Consultant, Subrogation and Other Payer Liability, Humana

Chair’s Summary of Day One and Conference Adjourns

Jun 29, 2022 3:10pm ‐ Jun 29, 2022 3:15pm

Identification: WED08