managed care - hcca official site...agenda | 888-580-8373 sunday, february 6 pre-con ference 8:00...

Managed Care Compliance Conference

February 6–8, 2011Scottsdale, AZ | FireSky Resort

HCCA’s MAnAged CAre CoMpliAnCe ConferenCe provides essential information for individuals involved with the management of compliance at health plans. Plan to attend if you are a compliance professional from a health plan (all levels from officers to consultants), in-house and external counsel for a health plan, internal auditor from a health plan, regulatory compliance personnel, or managed care lawyer.

Learn more at www.hcca-managedcare-conference.orgSponsored by:

Agenda

www.hcca-managedcare-conference.org | 888-580-8373

Sunday, February 6 Pre-conFerence

8:00 – 10:00 am

P1 effective Managed care organization compliance ProgramsJenny O’Brien, JD, CHC, Medicare Compliance Officer, UnitedHealth Group/PSMG

10:15 am – 12:15 pm

P2 Being a compliance “operative”: Working effectively Across Health Plan FunctionsD. Derek Jones, CHC, The Healthcare Investigations Group, Practice Management Alternatives, LLC

Holly Robinson, Assistant Director of Medicare Compliance, The Regence Group

y The Org Chart notwithstanding, how can Compliance interdependence work among Legal, Risk, Regulatory, Special Investigations, Claims, Medical and Provider Relations (among the many) to produce the result you need?

y Decide where compliance has the most beneficial impact from the beginning to the end of what you do as a health plan. It’s not always at the same level in each functional department.

y Increasingly, states are mandating investigative departments and Fraud and Abuse Plans. How can we best meet these mandates?

1:15 – 3:15 pm

P3 new State Mandates – now What?Jim Bixler, Vice President, Ethics & Compliance, WellPoint, Inc.

3:30 – 5:30 pm

P4 MedicareAnne Hance, Partner, McDermott Will & Emery LLP

Robert Slavkin, Of Counsel, Akerman Senterfitt

Monday, February 7 conFerence

8:15 – 9:00 am

General Session: Health care reform Panel: How My Plan Is Dealing with Hc reform Patrick Haley, Government Programs Compliance Officer, Blue Cross Blue Shield of Michigan

Michael Patterson, Vice President, Blue Cross and Blue Shield of Alabama

9:00 – 10:00 am

General Session: cMS Hot TopicsHelaine Fingold, Director, Division of Surveillance, Compliance and Marketing

Judy Geisler, Director, Division of Formulary & Benefit Operations, Medicare Drug Benefit and C & D Data Group

Cynthia Moreno, Division Director of Medicare Modernization Act Integrity, Center for Program Integrity

Brenda Tranchida, Director, Program Compliance and Oversight Group Director

10:15 – 11:15 am

Breakout SeSSionS

101 Who’s Knockin’ at Your Door? Identifying and Tackling Your Data Security risksTeresa Julkowski, Privacy and Data Security Officer, UCare

Lori Oleson, Compliance Director, UCare y Year of Data Security raises employee awareness

and achieves specific security measures y Data Security Risk Management Committee reviews

and prioritizes security initiatives y Internal and external resources for balanced effective

risk assessment

102 Management Behavior and the culture of complianceRandy Romrell, Director, Ethics & Compliance, The Regence Group

11:15 am – 12:00 pm

Lunch

Agenda


12:15 – 1:15 pm

Breakout SeSSionS

201 HIPAA Breach notification: case Studies on What to Do and When To reportElizabeth Callahan-Morris, Attorney and Counselor, Hall Render

Caron R. Cullen, CHC, Vice President, Compliance & Regulatory Affairs, Affinity Health Plan

y Discuss the CBS new story about ePHI stored on a photocopier’s hard drive and other real life data breach situations.

y How to deal with the media and manage public relations when there is a data breach.

y Walk through a breach analysis, risk assessment, and notification process.

202 State Division of Insurance rate Disapprovals: Preparing for the onslaught Jesse M. Caplan, Partner, EPSTEINBECKERGREEN

y State DOIs are under pressure to hold down health insurance premiums by dispproving rate increases

y State authority, while broad, does have its limits, as demonstrated in Massachusetts

y The rate disapproval landscape, and strategies for avoiding, and prevailing in rate proceedings

1:45 – 2:45 pm

Breakout SeSSionS

301 regulatory compliance oversightAnne Crawford, Medicare C & D Compliance Officer, Highmark Inc.

Cindy Todd, Office of Corporate Ethics & Compliance, Privacy Office/Compliance360 System Administrator, Excellus BlueCross BlueShield

y Different approaches for internally distributing regulatory notices

y Learn efficient documentation strategies (milestone tracking)

y Techniques to validate that the successful implementation y Develop a monitoring and auditing program (closed loop

process) y Survival techniques when a regulator is auditing/validating

your regulatory notification process

302 executive Dashboards: Using Data to Make Better Decisions Matthew Cruse, CHC, Compliance Officer, Medica HealthCare Plans, Inc.

y If CMS is monitoring your organization on a daily basis, shouldn’t you?

y Early identification of potential compliance risks and areas of improvement

y Effectively communicate compliance findings and results to senior management and the board

3:00 – 4:00 pm

Breakout SeSSionS

401 cMS Mandatory compliance PlansAngela Brice-Smith, Director, Medicaid Integrity Group, Center for Program Integrity

Cynthia Moreno, Division Director of MMA Integrity, Center for Program Integrity

Vernisha Robinson, Senior Technical Advisor, Program Compliance and Oversight Group


y Recent Updates and Developments (Medicare/Medicaid) y Medicare Drug and Managed Care Health Plan Sponsors y Effectiveness Evaluation/Audits y Self Assessment Tools y Importance Of Governing Body and Senior Management

Involvement And Oversight y Lessons for Other Regulated Entities

402 compliance risk Management Strategy: Integrated ApproachKara Curtis, Director, Strategic Business Initiatives & Compliance Commonwealth Care Alliance

y Compliance Risk Management: Key Components y Building Business Case for Internal Buy-In y Roles/Responsibilities: Business Owner vs. Compliance y Practical Tools & Best Practices

Agenda


4:30 – 5:30 pm

Breakout SeSSionS

501 Fraud and AbuseSharon LG Donnelly, AHFI, CFE, Director, SIU Business Assurance Division, Blue Cross Blue Shield of Florida

502 How to Prepare for, Survive, and Learn from cMS compliance Program Audits Elizabeth Lippincott, Lippincott Law Firm PLLC

y Requirements and best practices for compliance programs under the April 2010 updates to CMS regulations for Medicare Advantage and Part D plans

y How to prepare your company for a CMS Compliance Program Audit

y Recommendations for internal management of a CMS Compliance Program Audit

y Ways to use the audit preparation process, as well as the exercise of responding to CMS’ findings, to strengthen your compliance program’s effectiveness

Tuesday, February 8

8:15 – 9:15 am

General Session: How the SIU Unit Works with complianceJeffrey Sterling, Senior Investigator, WellPoint, Inc.

9:15 – 10:30 am

General Session: case Studies: Breach notification compliance—The Feds Are WatchingErika Bol, CHC, CPHRM , Privacy Officer, Department of Health Care Policy and Financing

11:00 am – 12:00 pm

Breakout SeSSionS

601 A Day in the Life of a Privacy officer Jeannette Frey, Privacy Officer, Fallon Community Health Plan

602 Q&A PanelLori Oleson, Compliance Director, UCare

12:00 – 12:45Lunch

1:00 – 2:00 pm

Breakout SeSSionS

701 Verifying compliance Program effectiveness in Managed careCornelia M. Dorfschmid, Executive Vice President, Strategic Management

y Define and understand difference between Systems & Transaction Reviews, Evaluations in compliance

y Systems & Transactions Reviews, Evaluations can be used to evidence CP effectiveness by any entity

y Maximize CP auditing & monitoring in the managed care environment

702 records and Information Management Program—“More than Document retention”Susan B Whitmire, CRM, FAI, Manager, Enterprise Records & Information Management, Corporate Compliance, BlueCross BlueShield of TN

Judith Nelson, Vice President, Chief Compliance Officer BlueCross BlueShield of TN

y Examine organizational business issues and approaches to assessing risks that gain momentum for enterprise content management

y Apply methods for planning, strategizing, and managing the overall project and program to gain user awareness, adoption, and acceptance of your policies, programs, and tools

y Identify your internal risks to aid the development of the strategy for your organization

2:15 – 3:15 pm

Breakout SeSSionS

801 new enforcement era for MA and Part D Plans: What PLAns need to Do now to Be readyMarci Handler, EPSTEINBECKERGREEN

y Lessons learned from recent federal enforcement actions involving managed care companies

y Program Integrity provisions enacted in Health Reform that affect managed care

y How to modify your compliance plan to protect yourself

802 oIG Hot TopicsRussell Hereford, Deputy Regional Inspector General for Evaluation and Inspections, US Department of Health and Human Services


Speakers

Jim Bixler, Vice President, Ethics & Compliance, WellPoint, Inc.

Erika Bol, CHC, CPHRM, Privacy Officer, Department of Health Care Policy and Financing

Angela Brice-Smith, Director, Medicaid Integrity Group, Center for Program Integrity

Elizabeth Callahan-Morris, Attorney and Counselor, Hall Render

Jesse M. Caplan, Partner, EPSTEINBECKERGREEN

Anne Crawford, Medicare C & D Compliance Officer, Highmark Inc.

Matthew Cruse, CHC, Compliance Officer, Medica HealthCare Plans, Inc.

Caron R. Cullen, CHC, Vice President, Compliance & Regulatory Affairs, Affinity Health Plan

Kara Curtis, Director, Strategic Business Initiatives & Compliance Commonwealth Care Alliance

Sharon LG Donnelly, AHFI, CFE Director, SIU Business Assurance Division Blue Cross Blue Shield of Florida

Cornelia M. Dorfschmid, Executive Vice President, Strategic Management

Helaine Fingold, Director, Division of Surveillance, Compliance and Marketing

Jeannette Frey, Privacy Officer, Fallon Community Health Plan

Judy Geisler, Director, Division of Formulary & Benefit Operations, Medicare Drug Benefit and C & D Data Group

Patrick Haley, Government Programs Compliance Officer, Blue Cross Blue Shield of Michigan

Anne Hance, Partner, McDermott Will & Emery LLP

Marci Handler, EPSTEINBECKERGREEN

Russell Hereford, Deputy Regional Inspector General for Evaluation and Inspections, US Department of Health and Human Services

D. Derek Jones, CHC, The Healthcare Investigations Group, Practice Management Alternatives, LLC

Teresa Julkowski, Compliance Privacy and Data Security Officer, UCare

Elizabeth Lippincott, Lippincott Law Firm PLLC

Cynthia Moreno, Division Director of Medicare Modernization Act Integrity, Center for Program Integrity

Judith Nelson, Vice President, Chief Compliance Officer BlueCross BlueShield of TN

Jenny O’Brien, JD, CHC, Medicare Compliance Officer, UnitedHealth Group/PSMG

Lori Oleson, Compliance Director, UCare

Michael Patterson, Vice President, Blue Cross and Blue Shield of Alabama

Holly Robinson, Assistant Director of Medicare Compliance, The Regence Group

Vernisha Robinson, Senior Technical Advisor, Program Compliance and Oversight Group

Randy Romrell, Director, Ethics & Compliance, The Regence Group

Robert Slavkin, Of Counsel, Akerman Senterfitt

Jeffrey Sterling, Senior Investigator, WellPoint, Inc.

Cindy Todd, Office of Corporate Ethics & Compliance, Privacy Office/Compliance360 System Administrator, Excellus BlueCross BlueShield


Susan B. Whitmire, CRM, FAI, Manager, Enterprise Records & Information Management, Corporate Compliance, BlueCross BlueShield of TN


Registration

session seleCTion: Please indicate below which breakout sessions you would like to attend. This information will be used in room planning. You are not obligated to attend selected sessions.

sunday, february 6 P1 P2

P3 P4

Monday, february 710:15–11:15 am

101 102

12:15–1:15 pm 201 202

1:45–2:45 pm 301 302

3:00–4:00 pm 401 402

4:30–5:30 pm 501 502

Tuesday, february 811:00–Noon

601 602

1:00–2:00 pm 701 702

2:15–3:15 pm 801 802

Managed Care Compliance Conference | February 6–8, 2011

ConTACT inforMATion mr mrs ms dr

HCCA Member ID

First Name MI Last Name

Credentials (CHC, CHRC, CHPC, etc.)

Title

Place of Employment

Address

City State Zip

Phone

Fax

Email (required for registration confirmation & conference information)

regisTrATion opTions by or on 12/22/10 after 12/22/10

HCCA Members ....................................................................$645......................$695 Non-Members .......................................................................$745......................$795 HCCA Membership & Registration .............................$845......................$895

New members only / Dues regularly $295 annually

Membership Renewal & Registration .......................$940......................$990 Pre-Conference Session Sunday ...............................FREE ...................$100 Conference Binder ................................................................ $45........................ $45

Available as a pre-sale only and for registered conference attendees only

TOTAL pAYMenT opTionsMail check to: HCCA | 6500 Barrie Road, Suite 250 | Minneapolis, MN 55435

fax to: 952-988-0146

Invoice me | Purchase Order # Check enclosed I authorize HCCA to charge my credit card (choose below)

CREDIT CARD: AmericanExpress Diners Club MasterCard Visa

Credit Card Account Number

Credit Card Expiration Date

Cardholder’s Name

Cardholder’s SignatureMC0211

Please fax your completed registration form with payment information to 952-988-0146, or visit www.hcca-managedcare-conference.org to register.


Details

ConferenCe objeCtives HCCA’s Managed Care Compliance Conference provides essential informa-tion for individuals involved with the management of compliance at health plans. Plan to attend if you are a compli-ance professional from a health plan (all levels from officers to consultants), in-house and external counsel for a health plan, internal auditor from a health plan, regulatory compliance personnel, or managed care lawyer.

Hotel & ConferenCe loCation

FireSky Resort & Spa 4925 n Scottsdale Rd Scottsdale, AZ 85251 www.fireskyresort.com

A special rate of $179.00 (plus tax and gratuities) per night has been arranged for the conference. The special room rate will be available until January 15, 2011, or until the group block is sold out, whichev-er comes first. Please call the hotel direct-ly at 480-945-7666 or 1-800-KIMPTON for reservations, and request the dis-counted rate for the HCCA Managed Care Compliance event. The special room rate is offered three days pre and post the offi-cial conference dates based on availability.

No audio or video recordiNg of Hcca coNfereNces is allowed.

registration termsPlease make your check payable to HCCA. Enclose payment with your registra-tion and return it to the HCCA office, or fax your credit card payment to 952-988-0146. If your total is miscal-culated, HCCA will charge your card the correct amount. For information on group discounts, please see below. The cost of any exams and the hotel accomodations are not included in the registration fee.

Cancellations and substitutions: No refunds will be given for no-shows or cancellations. You may send a sub-stitute or receive a conference credit. If you have questions, please call HCCA at 888-580-8373. Additional charges may apply. Cancellation by telephone is NOT valid. Please fax written can-cellations to 952-988-0146 or e-mail [email protected].

group Discounts: Five or more indi-viduals from the same company receive a $100 conference registration discount per person, based on membership status. Please complete a registration form for each attendee and fax or mail in simulta-neously.

tax Deductibility: All expenses incurred during training to maintain or improve skills in your profession (includ-ing tuition, travel, lodging, and meals) may be tax deductible. Please consult your tax advisor. (Federal Tax ID 23-2882664.)

Continuing eDuCation CreDitsHCCA is in the process of applying for certification for continuing education credits. For updates, please visit www.hcca-managedcare-conference.org, contact [email protected], or call 888-580-8373.

AApC: This program has the prior approval of the American Academy of Professional Coders (AAPC) for 7.0 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

ACHe: The Health Care Compliance Association is authorized to award 19.0 hours of pre-approved Category II (non-ACHE) continuing education credit for this program toward advancement, or recertification in the America College of Healthcare Executives. Participants in this program wishing to have the continuing education hours applied toward Category II credit should indicate on their attendance when submitting application to the American College of Healthcare Executives for advancement or recertification.

CA nursing Credit: The Health Care Compliance Association is preapproved by the California Board of Registered Nursing: Provider Number CEP 12990, for a maximum of 23.7 contact hour(s). The following states will accept CA Board of Nursing Contact Hours: Alabama, Alaska, Arkansas, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oregon, Texas, West Virginia and Wyoming. The following states do not have continuing education requirements: Arizona, Colorado, Connecticut, Georgia, Hawaii, Indiana, Maine, Missouri, Montana, New York, Oklahoma, Pennsylvania, South Dakota, Tennessee, Vermont, Virginia, Washington and Wisconsin. The following states will not accept CA Board of Nursing contact hours: Delaware, Florida, New Jersey and Utah. Massachusetts and Mississippi nurses may submit CA Board of Nursing contact hours to their state board, but approval will depend on review by the board. Please contact the Accreditation Department at [email protected] with any questions you may have.

Cle: The Health Care Compliance Association/Society of Corporate Compliance and Ethics is a State Bar of California Approved MCLE provider, a Rhode Island Accredited Provider, and a Texas Accredited Sponsor. A maximum of approximately 19.75 clock hours will be available to attendees. The Utah State Board of Continuing Legal Education has approved this conference for 19.0 CLE credits at maximum. The Supreme Court of Pennsylvania Continuing Legal Education Board has approved this conference for 19.5 General Credits. All CLE credits will be awarded based on individual attendance.

Compliance Certification Board (CCB): Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), Certified in Healthcare Research Compliance (CHRC), Certified in Healthcare Privacy Compliance (CHPC): CCB has awarded a maximum of 23.7 CEUs for these accreditations in the following subject areas: Application of Management Practices for the Compliance Professional / Application of Personal and Business Ethics in Compliance / Written Compliance Policies and Procedures / Designation of Compliance Officers and Committees / Compliance Training and Education / Communication and Reporting Mechanisms in Compliance Enforcement of Compliance Standards and Discipline / Auditing and Monitoring for Compliance / Response to Compliance Violations and Corrective Actions / HIPAA Privacy Implementation and/or Complying with Government Regulations.

nAsBA/Cpe: The Health Care Compliance Association is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE sponsors, Sponsor Identification No: 105638. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit and may not accept one-half credits. To verify if your state board of accountancy has adopted one-half credits, please visit our website at www.hcca-info.org/accountancycredits. Complaints regarding registered sponsors may be addressed to the National Registry of CPE Sponsors, 150 Fourth Avenue North, Suite 700, Nashville, TN 37219-2417. Website: www.nasba.org. A recommended maximum of 23.5 credits based on a 50-minute hour will be granted for the entire learning activity. This program addresses topics that are of a current concern in the compliance environment. This is an update, group-live activity. For more information regarding administrative policies such as complaints or refunds, call the HCCA at 888-580-8373 or 952-988-0141.

community.hcca-info.org

6500 Barrie Road, Suite 250Minneapolis, Mn 55435www.hcca-info.org

Managed Care Compliance ConferenceFebruary 6–8, 2011| Scottsdale, AZ | FireSky Resort

HCCA’s MAnAged CAre CoMpliAnCe ConferenCe provides essential information for individuals involved with the management of compliance at health plans. Plan to attend if you are a compliance professional from a health plan (all levels from officers to consultants), in-house and external counsel for a health plan, internal auditor from a health plan, regulatory compliance personnel, or managed care lawyer.

LeARn MoRe AT www.hcca-managedcare-conference.org

Managed Care Compliance ConferenceFebruary 6–8, 2011 | Scottsdale, AZ | FireSky Resort

managed care - hcca official site...agenda | 888-580-8373 sunday, february 6 pre-con ference 8:00...

Documents