Rise

Chairperson's Welcome

Rafael Gonzalez, Esq, President
Medicare and Medicaid Compliance

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

Lunch Break

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

Networking Break

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

Break

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.

Chairperson’s Closing Remarks

Rafael Gonzalez, Esq, President
Medicare and Medicaid Compliance