Medicare Advantage Member Accounting & Reconciliation - FRA, LLC

This is the first and only conference that tackles all the facets of member accounting and reconciliation.

Healthcare Education Associates and RISE (Risk Adjustment Initiative and Society for Education) Proudly Presents

The Inaugural Symposium on

Medicare Advantage Member Accounting & Reconciliation Aligning CMS and MA Plan Membership Calibration Through Operational and Revenue Accounting and Reconciliation

RPC

Risk Adjustment

ECR S

MMR COB/MSP

Accounting & Reconciliation Enrollment

Part D TRR

June 7-8, 2012

• Present best practices and solutions for efficient and accurate CMS reconciliation • Walk MA plans through the complexities of risk adjustment, enrollment, Part D, and COB/MSP reconciliation, looking at both the operational and financial perspectives • Offer key solutions for integrating your plan’s reconciliation efforts to ensure optimal efficacy • Demonstrate how top plans have managed and mastered reporting including ECRS, TRR, PDE processing, the Common Working File, EDPS, and more! • Feature the RPC (Reed & Associates) discussing best practices for MMR Reconciliation • Illustrate how your reconciliatory and accounting practices can impact your 5star rating • Explain proactive solutions for identifying and reconciling dual eligibility within your plan's population

Conference Sponsor

PBM

Gold

APS R / S P ED

This holistic, unique, and ground-breaking event will:

The Washington Plaza Hotel in Washington, D.C. To Register: Call 866-676-7689 or visit us at www.healthcare-conferences.com

The Summit Organizers Healthcare Education Associates is a division of Financial Research Associates, LLC. HEA is a resource for the healthcare and pharmaceutical communities to improve their businesses by providing access to timely and focused business information and networking opportunities in topical areas. Offering highly targeted conferences, Healthcare Education Associates positions itself as a preferred resource for executives and managers seeking cutting-edge information on the next wave of business opportunities. Backed with over 30 years of combined conference industry experience, the producers of HEA conferences assist healthcare professionals, actuaries, attorneys, consultants, researchers and government representatives in their professional endeavors. See www.healthcareconferences.com for more information on upcoming events.

Is your plan’s internal view of each member calibrated with CMS’s? Are you getting the correct reimbursements for each one of your members at the correct times? Do you have the infrastructure and cross-silo capabilities to reconcile member disparities in an effective and timely manner? Join top-level executives from health plans, vendors, and CMS subcontractors this June at our Inaugural Symposium on Medicare Advantage Member Accounting and Reconciliation. This one-and-only industry event brings together the four major components of reconciliation: enrollment, risk adjustment, COB/MSP, and Part D to give you and your plan all the tools and tricks that you need to deal with the operational and financial components of member accounting and reconciliation. With the ever-changing regulatory landscape and shifting CMS requirements, it is more important than ever that plans are working holistically to approach reconciliation disparities. This comprehensive event is the first conference to identify reconciliatory areas where operational and financial disparities can arise with CMS. Our industry experts will identify the discrete areas of reconciliation and accounting, before illuminating their interplay and the impetus for interdepartmental cooperation to create effective and accurate reconciliatory best practices. This is the accounting and reconciliation event of the year and is not to be missed. Our renowned speaking faculty will examine: • The ‘big picture’ of reconciliation and accounting: covering all the ins, outs, and inbetweens of CMS alignment and how this ties into the new 5-Star ratings • Risk Adjustment Reconciliation: Keys to understanding the reporting and revenue impacts of EDPS and take-away practices that can be implemented today to ensure accurate coding and claim reconciliation • Part D Reconciliation: Updates on best reporting practices and new arenas for CMS reimbursement • Enrollment Reconciliation: All the latest on receiving correct retro-enrollment/retrotermination payments and best practices to avoid data problems • Coordination of Benefits/Medicare Secondary Payer: Navigating ECRS and ensuring correct COB/MSP reimbursement • The Monthly Membership Report: An in-depth investigation into the ‘bible’ of reconciliation payments We have worked carefully with top vendors, health plans, and government subcontractors to ensure that our agenda is extremely pertinent and offers a complete perspective for today’s Medicare payers inclusive of all the reconciliatory tenets. Our conference will offer a one-of-a-kind opportunity to increase your plan’s efficacy and revenue reimbursement within the reconciliation and accounting playing field. Register today! Call 866-676-7689 or register online at www.healthcareconferences.com. Sincerely,

Lori Medlen

Henry Ivry

Lori Medlen, Executive Director RISK ADJUSTMENT INTIATIVE & SOCIETY FOR EDUCATION

Henry Ivry, Conference Director HEALTHCARE EDUCATION ASSOCIATES

P.S. Have you seen the team discounts? To garner the most information and take-away tools from this event send a team that includes representatives from your risk adjustment, reconciliation, Part D, operations, and revenue departments!

To Register: Call 866-676-7689 or visit us at www.healthcare-conferences.com

RISE is the first national association totally dedicated to enabling healthcare professionals to meet the challenges of risk adjustment. We strive to serve our members on three fronts: Networking, Education, and Industry Intelligence. Through meaningful networking opportunities, roundtables, cutting edge conferences and webcast presentations, RISE brings together multiple perspectives and facilitates highly interactive discussion between professionals and provides our members with the crucial information you need to stay ahead of the risk adjustment curve. To learn more, and to join, visit us online: www.rasociety.org

Who Should Attend? The unique agenda of this conference offers invaluable information for senior professionals from across Medicare Advantage Plans and Prescription Drug Plans. Additionally, this sui generis conference offers a cornucopia of knowledge for newer employees coming to grips with the complicated and vast workings of reconciliation and accounting. This is the must-attend event of the year for managers, directors, and associates with responsibilities for: • Reconciliation • Government programs • Operations • Revenue and finance • Part D operations and revenue • Membership accounting • Membership enrollment • Risk adjustment and HCC management • IT and vendor program management • Actuarial Services

Top Reasons to Attend 1. Learn how top plans are identifying MSP and COB errors and receiving correct CMS reimbursement 2. Hear directly from the RPC on best practices for reconciling retroactive payments through the MMR 3. Ask our industry leaders questions that directly pertain to your plan in our interactive Q & A panels 4. Get invaluable insight into what other plans are doing to traverse the complexities of Part D reconciliation from both an operational and financial perspective 5. Take-away tips, tricks, and new techniques for identifying dual eligibility 6. Find out how your plan can avoid common data mishaps within the TRR, enrollment data validation, ECRS, the Common Working File, PDE processing, the MMR, and more! 7. Break down departmental silos to integrate your plan for effective reconciliatory practices, and see how this can boost your plan’s 5-star rating 8. Understand how to reconcile the disparities that will arise from the dual submissions of RAPS and EDPS, while also locating where the revenue impact is from reconciling risk scores 9. Ensure that your plan is receiving correct revenue reimbursement for retroenrollment and retro-termination payments 10. Network with industry experts! First, engage with your peers and hear what infrastructure they have in place for reconciliation and accounting processes. Next, take advantage of the plethora of top industry vendors to find out what processes can be outsourced for optimal efficacy

Sponsorship and Exhibit Opportunities Enhance your marketing efforts through sponsoring a special event or exhibiting your product at the Symposium on Medicare Advantage Member Accounting and Reconciliation. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or a unique networking event. To learn more about sponsorship opportunities, please contact Kevin Weigel at 704341-2448 or email [email protected]

Media Partners

Medicare Advantage Member Accounting & Reconciliation

DAY ONE:

1:30 – 2:30

Thursday June 7th, 2012 7:45 – 8:30

Registration & Breakfast Sponsored by

8:30 – 8:45

Chair’s Welcome

This is your chance to get the answers to your plan’s questions about accounting and reconciliation. In this fully interactive session, we bring together representatives from top health plans and vendors and the RPC. Now is the chance to find out how you can improve your reconciliatory and accounting infrastructure to ensure successful retrospective payments and reporting practices with CMS. To make sure that your questions are answered, please submit your questions ahead of time. Please email questions to [email protected].

Chairperson: TBA

Denyse Wise, RPC Program Director REED & ASSOCIATES, CPAS AND CONSULTANTS

8:45– 10:00

Reconciliation and Accounting: The Big Picture – Ensuring CMS and MA Plan Calibration If your plan’s reconciliation efforts are fragmented, there is lack of clarity about what is necessary work versus busy work. This session will help you take appropriate action to close that gap and create a ‘system’ that is working optimally to achieve your goals. We will illustrate why a complete picture of reconciliation activities and requirements is necessary to: • Help maintain/obtain a 5-star compliance rating • Ensure resources are adequately allocated to critical areas while waste –activity with little or no value – is eliminated wherever possible • Secure ongoing leadership alignment and support (and budget dollars) • Guarantee plans are not missing opportunities to capture the full revenue they are due • Incorporate key information into subsequent years’ bids so you are not losing membership due to unnecessary price or benefit changes • Handle revenue and costs correctly in your financial statements • Accrue adequately for liabilities or income Gary Golliher, Director Healthcare Finance KELSEYCARE ADVANTAGE 10:00 – 10:15

Ask The Experts: An Interactive Discussion Addressing all of Your Most Pressing Reconciliation Questions

Refreshment break

2:30 – 2:45

Networking Break

BREAK-OUT SESSIONS Track 1: Track 2: Part D Reconciliation Enrollment Reconciliation 2:45 – 3:45

Dissecting the Structure of Part D Reconciliation: This break-out session deals with all the reporting intricacies within Part D reconciliation. Our expert speakers will cover PDE Processing, Acumen Reporting, PBM Adjudication, and More!

Liza Crowson, Director Membership Accounting MOLINA HEALTHCARE Kelly Aber, Manager Enrollment Services UPMC HEALTH PLAN

2:30 – 2:45

2:30 – 2:45

Networking Break

3:45 – 4:45

10:15 – 11:15

Part D Financial Reconciliation:

Risk adjustment reconciliation has always been key for ensuring that you receive the revenue required to provide appropriate care for your members. The transition from RAPS to EDPS is presenting new challenges to departments beyond organizations’ traditional risk adjustment stakeholders. Increasingly, risk adjustment is requiring a trans-departmental coordinated and integrated approach. In this session we will discuss: • EDPS: Bigger, Faster, Stronger – Dealing with the exponential increase in data submission • Parallel Processing – it’s a two-way street – new Encounter Data reports will provide additional information around CMS’s interpretation of risk adjustment rules • Using chart reviews and data analytics to ensure CMS sees a true picture of your members’ health

Understanding the Transaction Reply Report, Enrollment Data Validation, and More!

Speakers: TBA

Risk Adjustment Reconciliation Operational Reconciliation

Best Practice to Avoid Data Problems:

Here, our experts will look at the revenue impact of Part D reconciliation. We will present an overview of LICS, risksharing, brand gap discount coverage, Federal reinsurance, direct subsidy prospective monthly payments and annual reconciliation. Tiffany Martin, CPA, Financial Analyst NETWORK HEALTH PLAN

Sarah Dixon, Manager of Medicare Revenue and Risk Adjustment KELSEYCARE ADVANTAGE

Networking Break

Using Revenue Reconciliation to Measure the Effectiveness of Your Enrollment Function and Ensuring You are Paid Accurately and Timely This session will provide an overview of how to use CMS Monthly Reports to measure the effectiveness of your enrollment processes and systems. This will include Premium Withhold, LEP, LIS, TRR, Out of Area, and receiving correct retroactive payments for your membership. Luke Lovgren, Senior Manager of Revenue Reconciliation WELLCARE HEALTHPLAN

11:15 – 12:15

‘Bang for your Buck:’ Reconciling Risk Scores and Revenue Impact In this session we will examine how the reconciliation of risk scores affects revenue impact. We will look at ways in which identifying key member demographics can help your plan gets the most 'bang for its buck.' 4:45 - 6:00 Mital Panara, Vice President Revenue Management FREEDOM HEALTHCARE INC. 12:15 – 1:30

Day One Sessions Adjourn; Cocktail Reception Immediately Following

Luncheon


Medicare Advantage Member Accounting & Reconciliation

DAY TWO:

11:15 – 12:15

Friday June 8th, 2012

• 8:00– 8:45

Continental breakfast •

8:45 – 9:00

Chair’s Welcome & Day One Re-Cap Chairperson: TBA

9:00 – 10:00

• • • • • •

Submissions: - Navigating the Flat File and ECRS Web - Discerning the differences Corrections: - Flat File errors - ECRS web errors - Best practices for using both for maximum impact Receipts - Flat File frequency - ECRS Web frequency - What to do about delays Interim Planning - Work the errors for premium impact - Focus on easy updates - Coupling Flat File and ECRS Web - Consulting the ‘source of truth:’ ECRS Web

Tom Martin, Director UNIVERSAL AMERICAN

Part I:

COB Alignment: Savings, Recoveries, and Filings •

•

•

A Three-Part Exploration of Coordination of Benefits and Medicare Secondary Payer Reconciliation

Part III:

ECRS Explained: Submissions, Corrections, Receipts, and Planning for the Interim

Savings (and Avoidance) - Not Third Party Liability – keep subrogation (TPL) separate from COB - Revenue Impact Calculations – what health plans stand to lose - Pay/pursuing (savings) vs. Upfront coordination or denial (avoidance) - Avoidance adjustments – keep in mind items may be avoided today and paid tomorrow Recoveries (Pay/Pursue) – Savings - Best practices for: Timely denials Upfront recovery vs. pay/pursue Retro-denials CSRs ready to answer primacy Filing: Monthly- Daily Files – What to use and how - CMS Systems Flow - MA File - PCUG File (a.k.a. the Pug file)

12:15 – 1:30

Luncheon

1:30 – 2:30

Reconciling Changes to Dual Medicare/Medicaid Eligibility • • • • •

Identifying dual members SNP Plan vs. non-SNP Handling dual eligibility Loss of dual status Reconciling dual populations

Jody A. Miller, Operations Manager, Enrollment and Eligibility CIGNA MEDICARE SERVICES

Tom Martin, Director UNIVERSAL AMERICAN

A Two-Part Panel on the ‘Bible’ of Reconciliation Payments: The Monthly Membership Report

Speaker TBA DYNAMIC HEALTHCARE SYSTEMS 10:00 – 10:15

Morning Break

10:15 – 11:15

Part II:

The Three R’s of MSP Status: Review, Recovery, and Reconciliation • • •

Connecting the Dots: - MSP-COBC and the Common - Working File Best practices for ensuring correct MSP status - Are you paying secondary? - Should you be paying secondary? Reconciling incorrect MSP status

Shannon Peterson, Medicare Operations Analyst FIRSTCARE HEALTH PLAN Tiffany Martin, CPA, Financial Analyst NETWORK HEALTH PLAN

2:30– 3:30

Panel 1:

An In-Depth Look at the Structural Components of the MMR • •

MMR Components and how they affect your member capitation - Demographics, normalization and coding intensity, RAF, MSP, LIS Best practices for reconciling and understanding the structure of the MMR

Anna Pozon-Gibbs, CPC, Senior HCC Manager – Risk Adjustment/Reimbursement CITIZENS CHOICE HEALTHPLAN HMO Sarah Dixon, Manager of Medicare Revenue and Risk Adjustment KELSEYCARE ADVANTAGE 3:30 – 3:45

Networking Break

To learn more about sponsorship opportunities, please contact Kevin Weigel at 704-341-2448 or email [email protected]

Medicare Advantage Member Accounting & Reconciliation 3:45– 4:45

Panel 2:

Reconciling Members to the MMR and Resolving Discrepancies with the Retroactive Processing Contractor • • • • • • •

Calculating the MMR all the way to the dollar formula Reconciling member months: eligibility and enrollment Certification of Monthly Enrollment and Plan Data Schedule timely reviews (avoid Category 3 submissions) Understanding Category 2 versus Category 3 submissions When to submit CCM -1 (CCM -3/EGHP): Retros to the RPC vs. MARx Reconciling RPC Adjustments to the TRR

Anna Pozon-Gibbs, CPC, Senior HCC Manager – Risk Adjustment/Reimbursement CITIZENS CHOICE HEALTHPLAN HMO Denyse Wise, RPC Program Director REED & ASSOCIATES, CPAS AND CONSULTANTS 4:45

Conference adjourns

Get Answers to these Critical Questions: 1) How can I effectively integrate my plan’s organizational departments to ensure reconciliatory efficacy and efficiency? 2) How can I can best utilize ECRS to ensure correct MSP/COB reimbursements? 3) Are my EDPS submissions painting an accurate picture of my members to CMS that is aligned with our internal view? 4) What are the processes and avenues through which I can receive revenue reimbursement stemming from the MMR? 5) Have I received correct retro-enrollment and retro-termination payments for each of my members for the correct time periods? 6) What is the relationship between reconciliation and 5-star compliance? 7) Where are common disparities between CMS and plans with operational and financial reimbursement for Part D?

Other Upcoming RISE events

Important Information To Register: Fax: Phone: Online:

Mail: 704-341-2640 866-676-7689 www.healthcare-conferences.com

Healthcare Education Associates 18705 NE Cedar Drive Battle Ground, WA 98604

The Inaugural Symposium on Medicare Advantage Member Accounting & Reconciliation June 7-8, 2012 Washington Plaza Hotel in Washington D.C. 10 Thomas Circle Washington, D.C. 20005 202-842-1300 Discover the fresh new feel of the Washington Plaza. Designed in 1962 by world-famous architect Morris Lapidus, this recently renovated Washington DC hotel offers an engaging balance of cosmopolitan ambiance and unpretentious hospitality - perfect for international business trips, romantic getaways, and once-in-a-lifetime family vacations. Step out our front door and explore chic, fashionable Thomas Circle, one of DC's hippest neighborhoods. We have a small block of rooms reserved at a reduced group rate. Make sure to mention the 'Medicare Advantage Accounting & Reconciliation' conference when placing your room reservation. The group rate is limited and we expect it will sell out. Upon sell out, room rates will be at the hotel's discretion. We urge you to book your room early if you need overnight accommodations.

Fees and Payments: The fee for attendance at The Inaugural Symposium on Medicare Advantage Member Accounting and Reconciliation are: Health Plans = Early Bird Special - $1595 before April 27th, 2012; thereafter $1795 Standard Rate: $2095 Please make checks payable to Healthcare Education Associates, and write code H145 on your check. You may also pay by Visa, MasterCard, Discover, or American Express. Purchase orders are also accepted. Payments must be received no later than May 31, 2012.

Team Discounts: • Three people will receive 10% off. • Four people will receive 15% off. • Five people or more will receive 20% off. In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For more information, please call Theresa Powers at 704-341-2437.

Conference Sponsor Gold: Dynamic Healthcare Systems, Inc. delivers comprehensive solutions for Medicare Advantage health plans striving to succeed amid new and evolving regulatory requirements. Our Medicare solutions address the following business areas of a health plan operations: Enrollment processing, Plan Reconciliation, Risk Adjustment Analytics and Data Submission, Prescription Drug Event Data Management and Audit and Member Premium Billing Processing. We deliver our solutions either as integrated software and services or standalone software solutions to the strongest plans in the market.

Cancellations: If we receive your request to cancel 30 days or more prior to the conference start date, your registration fee will be refunded minus a $250.00 administrative fee. Cancellations occurring between 29 days and the first day of the conference receive either a 1) $200 refund; or 2) a credit voucher for the amount of the original registration fee, less a $250.00 administrative fee. No refunds or credits will be granted for cancellations received after a conference begins or for no-shows. Credit vouchers are valid for 12 months from the date of issue and can be used by either the person named on the voucher or a colleague from the same company. Please Note: For reasons beyond our control it is occasionally necessary to alter the content and timing of the program or to substitute speakers. Thus, the speakers and agenda are subject to change without notice. In the event of a speaker cancellation, every effort to find a replacement speaker will be made.


The Inaugural Symposium on Medicare Advantage Member Accounting and Reconciliation To Register: Fax: 704-341-2640 Call: 866-676-7689 Online: www.healthcare-conferences.com

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Healthcare Education Associates and RISE (Risk Adjustment Initiative and Society for Education) Proudly Presents

This is the first and only conference that tackles all the facets of member accounting and reconciliation.

The Inaugural Symposium on

Medicare Advantage Member ECRS RPC Accounting & Reconciliation Aligning CMS and MA Plan Membership Calibration Through Operational and Revenue Accounting and Reconciliation

S/ P ED

PS A R

Risk ent stm u j d A

R M M

SP M / COB

June 7-8, 2012 The Washington Plaza Hotel in Washington, D.C.

& g n i t n To Register: Call 866-676-7689 or visit us u o n c o i c t A a at www.healthcare-conferences.com ncili