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Last Year's Agenda

Monday - Monday, June 15

12:00 AM 12:00 AM

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Chairperson's Welcome

Rafael Gonzalez, Esq, President
Medicare and Medicaid Compliance

12:00 AM 12:00 AM

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Best Practices for Enrollment Reconciliation

  • Hear best practices for timely and accurate reconciliation for membership pipeline from application to CMS approval to MMR  
  • Understand how to manage the enrollment process to ensure your handling of special need members such as D-SNPs are optimized  
  • Gain an overview of the membership pipeline from application to CMS approval to ensure you are getting the right payments for the right claims 

Jennifer Young, Partner and Executive Vice President
Madena Solutions

12:00 AM 12:00 AM

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Lunch Break

12:00 AM 12:00 AM

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A Focus on Non-Group Health Plan Healthcare Economics

  • Review the statutory provisions permitting Medicare Advantage plans the right to seek reimbursement from NGHP 
  • Understand the regulations and policy provisions allowing Medicare Advantage plans the right to seek reimbursement from NGHP 
  • Explore the Federal district court and appeals decisions affecting Medicare Advantage plans right of reimbursement from NGHP 

Rafael Gonzalez, Esq, President
Medicare and Medicaid Compliance

12:00 AM 12:00 AM

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Networking Break

12:00 AM 12:00 AM

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MSP Compliance 2.0: What else is Medicare doing?

  • Review case samples in which the US Department of the Treasury has offset beneficiaries’ benefits or responsible plans’ monies due 
  • Analyze case samples in which the US Department of Justice has collected monies due from attorneys representing injured parties 
  • Understand proposed rules on mandatory reporting civil money penalties to be imposed for responsible reporting entity’s noncompliance 

Rafael Gonzalez, Esq, President
Medicare and Medicaid Compliance

 

12:00 AM 12:00 AM

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Break

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Reconciling and Reporting on Hospice

  • Hear how the changes by CMS to hospice reporting can impact payments to your plan 
  • Understand how best to deal with hospice claims and ensure you aren’t paying claims for hospice members within this uncertain landscape 
  • Overcome operational challenges of dealing with hospice claims to ensure changes don’t impact your bottom line 

Kwame Appiah-Yeboah, Ph.D., CRC, Assistant Vice President, Risk Programs
Virginia Premier Health Plan, Inc.

12:00 AM 12:00 AM

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Chairperson’s Closing Remarks

Rafael Gonzalez, Esq, President
Medicare and Medicaid Compliance

Tuesday - Tuesday, June 16

12:00 AM 12:00 AM

12:00 AM 12:00 AM

12:00 AM 12:00 AM

12:00 AM 12:00 AM

Chairperson’s Opening Remarks

Rafael Gonzalez, Esq, President
Medicare and Medicaid Compliance

12:00 AM 12:00 AM

12:00 AM 12:00 AM

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12:00 AM 12:00 AM

Understanding Risk Adjustment and the Impact of COVID-19 on MA

  • Discuss the latest CMS regulatory changes  
  • Understand more deeply the model for calculating risk score 
  • Get to grips with Risk Adjustment Data Validation (RADV) audits terminology and definitions 
  • Learn the Do’s and don’ts – How to effectively manage emerging risk areas  

Scott Weiner, Director, Risk Programs
Virginia Premier Health Plan, Inc.

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12:00 AM 12:00 AM

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Break

12:00 AM 12:00 AM

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CMS Best Practices

  • Dive deeper into CMS data around reconciliation and best practice 
  • Refresh on reconciliation points around co-ordination of benefits (COB) recovery, 
  • Analyse membership opportunities around data trends

Kate Riordan, Director, MSP Initiatives
ISO Claims Partner

Brian Bargender, Management Consultant, Subrogation, Medicare Secondary Payer and Other Payer Liability
Humana

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12:00 AM 12:00 AM

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Break

12:00 AM 12:00 AM

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Streamlining Reconciliation Processes & Technology

  • Hear how to streamline processes, whether you are reconciling daily, weekly, or monthly  
  • Get best practice on technologies and processes that can support your reconciliation no matter what size your plan is 
  • Learn how to administer inventory management optimally when you don’t have technology or automation systems in place 

Denyse Wise, CEO & Founder
Madena Solutions

12:00 AM 12:00 AM

12:00 AM 12:00 AM

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12:00 AM 12:00 AM

Closing Remarks

Rafael Gonzalez, Esq, President
Medicare and Medicaid Compliance