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A
series of one-day management seminars for health care business
and financial leaders. |
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Part
D Execution Risks
Effective
Strategies to Reduce Costly Mistakes in PDE Reconciliation,
CMS Audits, and Appeals & Grievances
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May
1, 2007
Washington, DC
Pub
Code: W027DC |
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AIS
Customer* ($895) |
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Regular
Price ($995)
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May
17, 2007
Chicago
Pub
Code: W027CH |
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AIS
Customer* ($895) |
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Regular
Price ($995)
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View
Shopping Cart |
*Current
AIS customers are eligible for the discounted price.
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Get Practical Part D Strategies that Can Save Your Organization Millions
of Dollars!
Register
today and learn how to …
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Avoid
having to write the government a check for tens of millions of dollars
because of Prescription Drug Event (PDE) claims reconciliations.
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Identify your weaknesses in handling coverage determinations and
complaints.
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Make
sure you aren’t blindsided by CMS’s upcoming Part D audits.
Learn the immediate steps you need to take when an audit notice
lands on your desk.
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Learn
the difference between an appeal and a grievance and avoid potential
civil and criminal penalties for failing to adhere to CMS time frames.
Part
D plans are now well into year two of the Medicare drug benefit and
having mixed success. Many are dealing with operational and administrative
pitfalls that could result in multi-million dollar reconciliation
payments to CMS, serious compliance problems and grave difficulties
in retaining members.
Join
John Gorman, Maureen Miller and
Jane Scott — three experts from
the industry-leading Gorman Health Group
— for a one-day management seminar that will help you identify,
assess and mitigate risks in three of Part D’s costliest problem
areas:
(1)
Limit the Major Potential Downside of PDE Reconciliations.
Failure to handle and reconcile Prescription Drug Event
(PDE) data correctly could deal a huge financial blow to your
health plan. It has been estimated that as many as 75% of all
health plans will owe money to CMS — in amounts that could
climb above $10 million for mid-sized plans with 40,000 to 50,000
members. Learn what steps you can take to reduce this potentially
enormous liability you could be facing.
(2)
Learn Effective Strategies for Upcoming CMS Audits.
Face your upcoming CMS audit with confidence, knowing what to
expect and how to respond. What steps should you take to prepare
for CMS auditors ... and how should you respond if you are labeled
as an outlier? Learn how to shape this audit process to reduce
your compliance risk.
(3)
Navigate the Dangerous Compliance Minefield of Part D Appeals
and Grievances.
Handling Part D complaints is complex and often conflicts with
how coverage disputes and complaints are handled in commercial
settings. Learn how to structure effective processes ... and avoid
potential civil and criminal penalties for failure to adhere to
specific time frames for appeals and grievances.
Our classroom-style
seminar setting will deliver the answers to your most troubling
(and potentially expensive!) Part D questions. And you’ll head
home with valuable practical tools that will be of tremendous value
to your entire team.
About
AIS One-on-One
AIS One-on-One is a new series of management seminars designed
to facilitate valuable face-to-face interaction and information-sharing
among the health care industry’s top advisers and a select group
of managers from health plans, hospitals and health systems, and pharmaceutical
companies.
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“The
small forum at AIS One-on One was great because we could
ask questions and have some dialogue. I was very engaged and
never distracted … and took 25 pages of notes. Seriously.
It was fantastic.” - Kathryn Levine, BCN Advantage,
Southfield MI
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“I
like one-day seminars where you can get in, get the information
you need and get out. I also liked the smaller size of the group.
It enables more interaction between attendees and affords the
opportunity for questions from a bigger percentage of the group.”
- Kelly Johnson, Health Management Associates, Lansing
MI
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Speakers
Don't miss
this opportunity to work one-on-one with the nation's top experts
on money-saving Part D strategies!
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John Gorman,
President and CEO of Gorman Health Group, LLC, specializes in
project management, strategic planning, and business development for
the health care industry, with a special emphasis on federal programs
and regulation. John has rich and varied experiences in Washington
politics, federal oversight, and the health care industry, which he
brings to GHG as its founder and leader. He served as press secretary
and staff director for U.S. Representative John Conyers, Jr. (D-MI),
then-Chairman of the Government Operations Committee. He also has
served as Assistant to the Director of HCFA's Office of Managed Care
under both Bruce Fried and Rodney Armstead, MD, where he provided
day-to-day management and staff and external liaison for the Medicare
and Medicaid managed care programs. John left HCFA in July 1996 to
found Managed Care Compliance Solutions, the predecessor firm to GHG.
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Maureen Miller,
a GHG Senior Consultant, is an experienced consultant who brings
to GHG and its clients 20 years of experience at CMS. Her broad experience
within CMS covered all facets of policy development, legislative reform
and regulatory affairs pertaining to Medicare managed care. As Senior
Policy Analyst for CMS's Medicare managed care program, Ms. Miller
played an integral role in developing the regulations and guidance
for the Medicare Advantage program. Her contributions covered many
operational areas, such as authoring regulations and guidance on the
beneficiary appeals and grievance processes. During her CMS career,
she was instrumental in the development of several policy initiatives
and national operational standards.
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Jane Scott,
a GHG Senior Consultant, is a seasoned health care executive with
extensive experience in the Medicare managed care industry. As Director
of Medicare Program Management for Government Programs for HealthNet
of Arizona, she had overall responsibility for their government programs,
including Medicare Advantage HMO, PPO and supplemental products. Her
experience includes utilization and medical management, claims operations,
provider/associate education, and Medicare marketing and sales.
About
Gorman Health Group
Gorman Health Group, LLC (GHG) is recognized by Lehman Brothers as “the
nation’s leading consulting firm in Medicare Managed Care.”
The firm fields a team of senior managed care professionals and former
health care regulators. It has been providing strategic, operational,
financial, and clinical services to the health care industry since 1996.
Seminar
Agenda
8:00-8:30 Registration
& Breakfast
8:30-9:00 Part
D Outlook and Execution Risks for Year Two
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The Part D enrollment picture and what it means
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The
competitive landscape and how it will change
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The
outlook for employer group retiree markets
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Major
threats for year 2: Execution risks to prepare for
9:00-10:30 PDE
Reconciliation: How to Avoid Cutting CMS a Multi-Million Dollar Check
Failure to correctly
handle prescription drug event (PDE) data can cost your plan millions
of dollars in settlements from CMS. PDE records are rejected for
many reasons including:
Despite the
potential financial blow PDPs and MA-PDs face, many have not been
able to properly analyze complicated PDE data and conduct the required
member-by-member and claim-by-claim reconciliation. They are struggling
with data submission, rejected records and internal data tracking.
The sheer volume of work it takes to reconcile the data has also
proven to be a massive hurdle.
Learn the best
practices for PDE data analysis, error resolution and database development
to avoid hefty reconciliation payments. Avoid repaying CMS by making
sure that your original PDE data, gathered from beneficiaries and
providers, is accurate and "clean."
10:30-10:45 Refreshment
Break
10:45-12:15
A CMS Audit Notice Just Arrived. What Is Next?
CMS is sending
out audit notices to Part D plans despite the fact that the agency
has not yet revealed all requirements for plans to review and what
penalties will be assessed if plans are not complying. With all
this uncertainty:
With the agency's
compliance grace period now officially over, CMS is likely to:
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Scrutinize
plans for how well they are adhering to literally hundreds of
CMS-specified operational elements related to part D, and;
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Review
thousands of plan-specific sample files.
In this session,
you will learn how to identify specific compliance risks —
and best practices for monitoring and auditing — before CMS
or their contractors come knocking.
12:15-1:15
Lunch & Networking
Hear the insightful
views of John Gorman on dynamic changes taking place in Washington,
DC, and the impact they are likely to have on Part D and Medicare
Advantage.
1:30-3:00 Appeals,
Grievances and Formulary Exceptions: Strategies for Minimizing Compliance
Risks
Appeals, grievances
and formulary exceptions are some of the most expensive compliance
minefields for Part D plans. Plans can not only face financial penalties,
but can also experience serious member retention problems as disgruntled
beneficiaries abandon them to move to
other plans. You will learn:
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The difference between an appeal and a grievance
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How
to identify your weaknesses in handling coverage determinations
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The
benefits of having a good "work flow" and what it reveals
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Lessons
from real-life case studies in long-term care, pharmacy and other
industries, so you can see what is working and what is not.
3:00-3:15 Refreshment
Break
3:15-4:15 Wrap
Up: Lessons Learned and Tools to Take Back to the Office
Key takeaway
points and review of the valuable, practical tools you can take
back to your office — guaranteed to help you implement successful
strategies to deal with the execution risks discussed throughout
the day.
Register
above (or call 800-521-4323 to register).
Choose
the most convenient location for you and your management team:
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Washington,
DC, May 1, 2007
Ronald
Reagan Building and International Trade Center
1300 Pennsylvania Ave., NW, Washington, DC 20004
(202) 312-1310
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Chicago,
May 17, 2007
The
University of Chicago Gleacher Center
450 North City Front Plaza Drive, Chicago IL 60611
(312) 464-8787
You
will receive a confirmation of your registration, including a
detailed schedule, by e-mail from AISconferences@aispub.com, as well
as by regular mail.
IMPORTANT
NOTE: If you are registering within two weeks of the conference,
please make sure we have your e-mail address and make sure that the
AISconferences@aispub.com e-mail address will be accepted by your e-mail
program.
Cancellations
and Substitutions: If you are unable to attend, you are welcome
to send a substitute. A $100 cancellation fee will be charged after
the following cut-off dates: April 15 (Washington, DC); May 1 (Chicago),
provided we receive a written cancellation before the conference. Registrants
who do not cancel and who do not attend are liable for the full conference
fee.
Seminar
attendees who need hotel accommodations should make their own reservations
at one of the convenient hotels below, or use the Web links provided.
Attendees are urged to select a hotel and book early. Both cities
are extremely popular at this time of the year.
Hotels
near the Reagan Building in Washington, DC:
Hotels
near the Gleacher Center in Chicago:
- Embassy Suites
Chicago Downtown Lakefront
511 North Columbus Drive, Chicago, IL 60611
(888) 903-8884
- Hilton Suite
Chicago/Magnificent Mile
198 E. Delaware Place, Chicago, IL 60611
(312) 664-1100
- Chicago Marriott
Downtown
540 N. Michigan Ave., Chicago, IL 60611
(312) 836-0100
For more information
about Chicago and hotel accommodations go to: www.orbitz.com
or http://hotel-guides.us
Designed
For
Who Will
Benefit from This Highly Practical One-Day Seminar?
Health plan
CEOs, CFOs and other top business and financial managers; compliance
officers; program managers; provider-relations managers and other
managers with Part D responsibilities at:
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Medicare
Prescription Drug Plans
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Pharmacy
Benefit Companies
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Seminar
Workbook and Companion CD
Seminar attendees
will receive valuable print and electronic content to take home
and share with their Part D management team, including:
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PDE reconciliation workflows
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Timelines
for PDE submission and CMS reconciliation deadlines
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CMS
audit guides for PDP and MA-PD plans
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CMS
Audit Strategy Document (for Part D contractors)
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