CompliancePalooza 2022

Oct 10, 2022 ‐ Oct 11, 2022


Chair's Welcome Remarks and Risk Adjustment Litigation and Risk Areas for MA Plans, Vendors and Downstream Entities

Oct 11, 2022 9:00am ‐ Oct 11, 2022 10:25am

Identification: TUE001

Welcome and Chairperson's Opening Remarks

Oct 11, 2022 9:00am ‐ Oct 11, 2022 9:10am

Identification: TUE01


Risk Adjustment Litigation and Risk Areas for MA Plans, Vendors and Downstream Entities

Oct 11, 2022 9:10am ‐ Oct 11, 2022 10:25am

Identification: TUE02

•    Examine the current state of risk adjustment litigation and learnings from recent audit activity
•    Assess risk areas and liability under the false claims act with insights into where the government is pursuing litigation related to chart reviews, physician incentives and home health risk assessments
•    Gain a better handle on how regulators are pursuing or responding to litigation and how to stay on the right side of the line


Experts Panel Disussion: A Regulatory Retrospective and Outlook: What Happened During COVID

Oct 11, 2022 10:30am ‐ Oct 11, 2022 11:10am

Identification: TUE03

•    Learn how health plans are prepared for a review of services specifically offered during COVID that were not prior reimbursable
•    Hear the latest regulatory changes on telehealth and assess how to remain compliant and prepared for changes when PHE (Public Health Emergency) ends
•    Evaluate impact of OIG (Office of Inspector General) report on MA denials and identify critical factors to avoid complications
•    Discuss upcoming enforcement actions and penalties of No Surprises Act


CMS Audits Review: Part C, Part D, and Dual Eligible Special Needs Plans

Oct 11, 2022 11:25am ‐ Oct 11, 2022 12:05pm

Identification: TUE04

•    Gain insights from recently audited health plans and prepare your team for future audits
•    Evaluate CMS interpretation of requirements by analyzing the primary focus of audit officials to ensure successful outcomes
•    Identify common pitfalls in program audits and take away how to adjust your compliance program
•    Learn best practices for audit readiness and ensure a positive outcome during an audit


Lessons Learned from CMS’s Targeted Probe and Educate (TPE) program and Supplemental Medical Review Contractor (SMRC) from Sleep Studies Audits

Oct 11, 2022 12:35pm ‐ Oct 11, 2022 1:15pm

Identification: TUE05

•    Hear failures and bumps when providing additional documentation on claims selected for medical review of sleep studies
•    Understand what to look at when addressing an internal investigation that can affect your performance during an audit
•    Identify key actions to ensure a successful outcome during your next audit


Staying a Step Ahead: Creating and Testing your CMS Audit Universes

Oct 11, 2022 1:20pm ‐ Oct 11, 2022 2:00pm

Identification: TUE06

•    Identify the best tools to validate your universes
•    Create a plan to test your universe and avoid errors
•    Evaluate the need for a CMS playbook that outlines audit areas, timeframes, scope, and stakeholders involved to ensure collaboration and activates a sense of urgency


Effective Vendor Oversight Strategies and Closing Remarks

Oct 11, 2022 2:05pm ‐ Oct 11, 2022 3:00pm

Identification: TUE007

Effective Vendor Oversight Strategies

Oct 11, 2022 2:05pm ‐ Oct 11, 2022 2:45pm

Identification: TUE07

•    Identify critical factors in a contract to ensure appropriate oversight over delegated vendors
•    Evaluate pros and cons of including pre-delegation audits and discuss actions when they are non-compliance
•    Analyze corrective action plan processes to avoid future costly complications


Closing Remarks iconClosing Remarks

Preview Available

Closing Remarks

Oct 11, 2022 2:45pm ‐ Oct 11, 2022 3:00pm

Identification: TUE08