Document 200414

1.1 – STOLI
Track: Disability/Life
Speaker: Frank Best and David McDowell Description: Learn how to prepare for death claims on policies originated by investors and how the law
has developed on resisting such claims. The presenters are David McDowell, of Edison, McDowell and
Hetherington, and Frank Best, of Penn Mutual Life Insurance Company. Frank is Vice President,
General Counsel, Insurance Operations, and Corporate Secretary.
1.2 – The Cost Containment Playbook: How to Win the Game
Track: Fraud/SIU
Speaker: Carrie Cunningham Description: In today’s world a health plan’s game is judged by how well it manages its resources and
its risks beyond profitability. Every plan is held accountable by its stakeholders—members, clients, and
its governing body. With rising healthcare costs and the ever-increasing pressure to contain them,
winning the cost containment game is a daily challenge. There are critical plays that will help keep your
team winning year after year!
1.3 – Federal Regulatory & Legislative Update
Track: Legal & Regulatory
Speaker: Marilyn Monahan Description: This workshop will address recent developments in federal health care reform, HIPAA,
ERISA, and other federal laws and regulations that impact claims processing and the administration of
employee benefit plans. The program will include a discussion of legislative and regulatory trends in
Washington and across the nation, as well as a discussion of how one state (California) has been
implementing health care reform and addressing other changes in the insurance market.
1.4 – Essential Health Benefits: The Regulators Threw Us A Curve
Track: Healthcare Claims 1
Speaker: John Garner 1
Description: This session will discuss the complexities of compliance with the health care reform rules
on essential health benefits. Each state is defining essential health benefits differently. Come learn about
some of the many details on this complex new subject.
1.5 – Medicaid Roundtable
Track: Healthcare Claims 2
Speaker: Rikki Haffner, Lupe Medina, Rowena Roxas Description: Bring your questions or ideas to share.
1.6 – Claim Administration and Health IT – What’s Happening and What’s
to Come?
Track: Technology & Data Reporting
Speaker: Scott M. Robertson Description: From Operating Rules to EFT Enrollment, Attachments to ICD-10, Payer Certification,
Health Plan IDs and more, there is a lot happening today in the world of IT that affects day-to-day
processes for payers and providers. In this session we will discuss the current state of the industry, what
recent rules have been released, what’s in the pipeline now, and what is on the horizon. We will also
have an opportunity to discuss how it affects your operations.
2.1 – What Kinds of Cases Did Courts Look at Last Year?
Track: Disability/Life
Speaker: Michael Brisbin
Description: Learn about current cases and developments impacting life insurance claim administration.
You will hear from experienced inside and outside counsel who will explain recent cases and trends in
life insurance case law and litigation developments.
2.2 – Take a Bite out of Rising Costs of Player (Workers) Injuries
Track: Fraud/SIU
Speaker: Justine Andrews and Phyllis Bowman
Description: The presenters will discuss how to actively lower the cost of workers’ injuries through
development of policies and procedures, supervisor training and employee education.
Legal & Regulatory
2.3 – Obamacare: Its Care and Feeding at the State Regulatory Level
Track: Legal/Regulatory
Speaker: Phil Howe
Description: Learn how states are responding to Obamacare, particularly as to Exchanges.
2.4 – Common Problems with Specialty Drugs Paid Under Medical
Track: Healthcare Claims 1
Speaker: Craig S. Stern
Description: This presentation will focus on common problems identified with specialty claims paid
under the medical benefit. Stimulating discussions will be provided, as well as shared numerous deidentified examples of actual claims and problems, to include, but not be limited to, incorrect quantity,
code, NDC, etc.
2.5/2.6 – Navigating the Looming ICD-10 Business Impacts and ACA
Operating Rules
Track: Healthcare Claims 2 / Technology & Data Reporting
Speaker: Michael Wilson and Peggy Honts
Description: Focusing on the business side of the ICD-10 and ACA Operating Rules mandates, HCIM
and AXIOM Systems will walk you through the steps to identify the key critical financial impacts that
should drive your risk management plan and how to realize actual benefits from these regulatory
mandates. While ICD-10 testing should be fully underway, we’ll review business and IT system testing
best practices and demonstrate specific steps to achieve a successful implementation. We’ll also discuss
the scope, risk factors, and health plan attestation requirements of the ACA Operating Rules mandates
and explain how to effectively implement all three phases for optimum efficiency.
3.1 – Impact of Disability Court Decisions
Track: Disability & Life
Speaker: Sherril Colombo, Dan Cozzo and Richard Lodi
Description: Learn the impact of recent court decisions on disability claim handling.
3.2 – Current Medical Fraud Trends
Track: Fraud/SIU
Speaker: Mike McKee
Description: Attendees will be provided with national, regional and California-specific medical fraud
trends observed by the National Insurance Crime Bureau in the recent past, with emphasis on 2012/13
activities. These trends will not only cover medical services, but will also cover office activities, billing
issues, and ancillary medical activities such as transportation, copying service, and translation services.
3.3 – California Legislative Update: A Review of New Laws and Trends
Track: Legal & Regulatory
Speaker: Marilyn Monahan
Description: This workshop will provide an overview of bills the California legislature passed in 2012
and how those bills will impact the way you do business in the claims benefit environment. We will also
discuss bills of interest newly introduced in 2013 and their progress through the legislature,
supplemented with a discussion of recent legislative trends.
3.4 – HEDIS and Code Editing, Finding the Right Balance
Track: Healthcare Claims I
Speaker: Erin Mellas and Lori MacLeish
Description: How to properly refine and/or manage your claims editing solution to maximize your return
and prevent a negative impact on your HEDIS rates.
3.5– How was I supposed to know??
Track: Healthcare Claims 2
Speaker: David Rosen
Description: The Affordable Care Act will create stress for health plans by applying unprecedented
government scrutiny on any claim paid with Federal or State dollars to ensure quality and payment
accuracy. Subrogation is one of the categories of scrutiny that is often misunderstood and
underestimated by health plans in government business. The experts in subrogation, First Recovery
Group, will share insight into how to protect your government business so that you know what you are
supposed to know about subrogation.
3.6 – HIPAA Regulations: End-to-End Testing and Pilot Testing New
Track: Technology & Data Reporting
Speaker: Debbie Meisner
Description: CMS/OESS has initiated programs to explore the concept of end-to-end testing and pilot
testing of new versions of HIPAA standards. This session will provide a brief overview of each of the
programs along with status of the initiatives and any outcomes.
4.1 – Top Ten Things You Need to Know to Rescind in California
Track: Disability/Life
Speaker: Phil Howe Description: This session will take you through each of the key steps to rescind a life insurance policy
in California with references to the CA Insurance Code and the essential CA cases. It will show you what
you must do and must avoid.
4.2– Medical Identity Theft: Do You Know Whose Claim You Are Paying?
Track: Fraud/SIU
Speaker: Linda Vincent
Description: Medical Identity Theft is the nefarious underworld of identity theft. Hearing more about
data breaches? Wondering how it happens? Have you thought of what to do if your medical records are
compromised? And do you realize someone can be making money on your medical information? These
and other thought provoking questions will be addressed during this lively presentation.
4.3 – Getting A Prosecution Home Run
Track: Legal & Regulatory
Speaker: Phyllis Bowman
Description: This workshop is geared towards helping those in the field understand the prosecution
perspective and what it takes to put together a successful case referral. Various factual scenarios will be
given and participants will be expected to work them into given jury instructions to determine if there is
sufficient evidence or not.
4.4 – Maximizing Your Audit Recovery Program: Best in Class in
Payment Integrity
Track: Healthcare Claims 1
Speaker: John-Michael Loke
Description: This session will provide a discussion of the challenges and solutions payers are facing in
building a best-in-class Payment Integrity Program. This workshop will focus on Audit & Recovery, PostPay and Pre-Pay Programs that work together to deliver a comprehensive approach to Payment Integrity.
4.5– Medicare Roundtable
Track: Healthcare Claims 2
Speaker: Rikki Haffner and Marty Astor
Description: Bring your questions or ideas to share.
4.6– New HIPAA Regulations: Are You Safe?
Track: Technology & Data Reporting
Speaker: John Garner
Description: New HIPAA Privacy and Security Regulations require compliance by September 23, 2013.
There is not much time left to come into compliance! This session will discuss the changes to the HIPAA
Privacy and Security Regulations that affect health plans.