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Thursday,
February 24th,
2011
1:00PM to 2:00PM Eastern
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Register
for $195
Call 209.577.4888 or
Click here to register |
Medicare Health Plan Compliance and CMS
Performance Assessment Review
Radical Changes in CMS Compliance Methodology
and Practices
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CMS Performance Assessment Methodology: 11 Distinct
Performance Categories & Negative Points
Building Effective Compliance Programs that Incorporate
Continuous Self-Review
Best Practices to Self-Identify, Resolve and Communicate
Non-Compliance to CMS
Top Five Operational Areas/Processes Scrutinized by CMS
How Health Plans Should Plan for CMS Practices in 2011 |
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Faculty:
Jeff Fox
President
Gorman Health Group |
Faculty:
Jordan Flynn
Senior Consultant
Gorman Health Group |
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On December 12, 2010, CMS issued a memo regarding the agency’s Past
Performance Review Methodology for the 2012 application cycle. While the
focus was on 11 performance categories to be evaluated for the 2010
applications, CMS has strongly encouraged organizations to use this
methodology to self-monitor throughout the year. CMS fully expects
organizations to pro-actively assess their operations, identify and
resolve areas of risk in a timely manner.
In the last year, CMS has radically changed both its own audit practices
and its expectation of plans’ response to those audits. Most plans have
not, relying on staffing and program design that is ill-suited for this
new era. These performance categories are a starting place for plans who
are shifting their compliance model from “internal audit” to
“performance monitoring.”
With this in mind, this webinar will offer organizations a roadmap of
recommendations to implement an effective compliance program,
incorporating continuous self-review using the Performance Assessment
Review Methodology outlined by CMS. We’ll highlight the operational
areas that tend to get attention from CMS, frequently resulting in
increased surveillance, enforcement actions and increased likelihood of
becoming a target for audits in 2011 and beyond..
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Discussion Topics will include:
- What can health plans expect from CMS in 2011? How should
organizations plan accordingly?
- What makes up the CMS Performance Assessment Review Methodology?
A discussion of the 11 distinct performance categories and “negative
points”
- How can organizations build effective compliance programs that
incorporate continuous self-review using the CMS Performance
Assessment Review Methodology
- What are best practices for organizations to quickly and
proactively self-identify, resolve, and communicate instances of
non-compliance to CMS, before receiving Notices of Non-Compliance
and Warning Letters.
- What are the top five operational areas/processes regularly
scrutinized by CMS and found to be non-compliant?
Participants will be able to engage in interactive learning through online question submission, attendee feedback and opportunity for
follow up questions, and networking with attendees, faculty and other
professionals through dedicated LinkedIn group
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Interested attendees would
include:
- CEOs and other plan executives
- Compliance Officers
- Legal, Government Relations & Regulatory Executives
& Staff
- Strategic Planning & Policy Executives Staff
- Operations Executives
- Internal Audit Staff and/or Medicare Compliance
Audit Staff
- Other Interested
Parties
Attendees would
represent organizations including:
- Health Plans
- Solutions Providers
- Associations,
Institutes and Research Organizations
- Media
- Other Interested
Organizations
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Individual Registration Fee: $195. Audio Conference CD-ROM: $40
for attendees; $255 for non-attendees after the event.
Corporate Site licensing also available. Click
here to register or call 209.577.4888. We look forward to your
participation in this event!
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Jeff
Fox
President
Gorman Health Group
(jfox@gormanhealthgroup.com)
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Jeff Fox brings Gorman Health Group clients more than 25 years of
experience as one of the nation’s leading experts on
government-sponsored programs as well as a passion for health insurance
sales, marketing, and product development.
As a partner and member of GHG's senior leadership team, Jeff is
intimately involved with aspects of both business development and client
engagement management. In addition to managing the firm’s consulting
practice, Jeff leverages his extensive knowledge in Medicare product
design, sales distribution, and marketing compliance to deliver
exceptional, hands-on insights to health plan clients across the United
States and Puerto Rico. During his tenure, Jeff has worked alongside
dozens of managed care organizations to help develop their Medicare
products, empowering health plans to deliver higher quality care to
beneficiaries at lower costs.
Prior to joining Gorman Health Group, Jeff was Vice President of
Government Programs for Health Net of Arizona. In this role, Jeff was
responsible for P&L of the product and managed a Medicare Business Unit
which was responsible for all functional areas of the plan’s Medicare
products. During his time at Health Net, Jeff developed and implemented
a provider friendly and profitable network strategy.
Earlier in his career as a sales representative, Jeff was ranked in the
top five percent nationally for his sales results with a leading senior
products organization. Jeff also served with Prudential Health Care in
Texas, where he had responsibility for their Medicare product, including
Prudential’s national marketing campaign for its Medicare product and
AARP business marketing relationship.
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Jordan Flynn
Senior Consultant
Gorman Health Group
(jflynn@gormanhealthgroup.com)
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Jordan Flynn brings to Gorman Health Group clients 13 years of experience
working for commercial and Medicare health plans. She has served in a
variety of leadership roles across areas of plan operations including in
compliance, regulatory audits, training, and operations.
Prior to joining GHG, Jordan served as the national Director of Product
Integrity for AmeriChoice, a subsidiary of United Healthcare, which
offers Medicare Advantage Dual-Eligible Special Needs Plans.
Prior to joining AmeriChoice in 2007, Jordan served as the national
Medicare Compliance & Operations Manager for Health Net’s Senior Product
Division, where she worked for nearly ten years.
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