Rise

Registration Desk Open

Registration Desk Hours: 8:00AM - 4:00PM

Exhibit Hall Open

Chairperson’s Opening Remarks

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 

Director Risk Capture, Population Health Management  

Mass General Brigham 

Keynote Address: Empowered and Prepared: Excellence in OIG Audit Readiness

Christopher G. Bresette, CPA, Director, Medicare Part C Audits 
HHS Office of Inspector General 

Carolyn Kapustij, Senior Advisor for Managed Care 
HHS Office of Inspector General 

State of the Industry- Part 1: Examine the Audit Crisis Impacting the Health Care Industry

• Evaluate high profile audits being conducted by CMS and OIG to Identify trends and costly errors
• Discuss common challenging activities that may attract attention and increase probability of audit selection
• Evaluate the damaging financial penalties that have been awarded to educate leadership and employees on the importance of accuracy and compliance
• Analyze the financial Impact on organizations including the possibility of staffing lay offs
• Understand the differences between audits related to Medicare Part C versus Parts A and B to identify common themes

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 

Director Risk Capture, Population Health Management  

Mass General Brigham 

State of the Industry- Part 2: A Lawyers Perspective: The Legal Impact of Non- Compliance

• Assess different types of fraud, waste, and abuse that have been identified in recent cases
• Analyze the process, timelines, and documentation requirements of high-level audits with the OIG
• Discuss recent “whistle blower” cases that alerted the OIG and DOJ to investigate fraudulent activity
• Benefit from other practitioners’ mistakes by implementing changes in your organization to eliminate fraud, waste, and abuse

Mary Inman, Partner  

Whistleblower Partners

Achieving Excellence in CMS Program Audits

• Prepare comprehensively for a CMS audit by gaining a deep understanding of the audit process, key documentation requirements, and critical areas of focus
• Execute the audit efficiently by effectively coordinating internal teams, responding swiftly to auditor inquiries, and delivering precise and thorough information
• Implement corrective measures and foster continuous improvement, using audit findings to address compliance gaps, strengthen regulatory adherence, and optimize overall plan performance

Ken Nuñez, MBA, CHC, Chief Compliance Officer

Provider Partners Management Services

Niejadd Evans, Director of Corporate Compliance Assurance

MedImpact Healthcare Systems

Utilize Sample Audits to Avoid Costly Errors

• Assess the necessity of completing regular mock audits to identify non-compliant activity
• Evaluate the performance post mock audit to identify errors and offer education and guidance for performance improvement
• Identify third parties that can help conduct mock audits and offer input to improve outcomes
• Examine the 60-day rule related for internal audits and discuss the process if an overpayment is identified

Colleen Gianatasio, Director Clinical Documentation Integrity and Coding Compliance

Capital District Physician’s Health Plan (CDPHP)

Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, Chief Operating Officer,

First Class Solutions, Inc.

Chart Retrieval: Streamlined for Accuracy and Efficiency

• Explore common errors in the chart retrieval process that can be costly during an audit
• Investigate solutions to help improve chart retrieval and avoid costly mistakes
• Educate your team on common pitfalls and the potential penalties that could be awarded

Wynda Clayton 
Risk Adjustment Specialist 

Industry Leader Recap Session- Day One Recap: Lessons Learned and Best Practices

• Revisit the current climate of health care audits to evaluate organizational changes that can be made
• Discuss lessons learned from a lawyer’s perspective of recent audits to identify red flags that could be avoided
• Assess the benefits of utilizing sample audits and vendor organizations to improve audit outcomes

Moderator 

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 

Director Risk Capture, Population Health Management  

Mass General Brigham 

Mary Inman, Partner 

Whistleblower Partners

Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, Chief Operating Officer,  

First Class Solutions, Inc. 

Chairperson’s Closing Remarks

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 

Director Risk Capture, Population Health Management  

Mass General Brigham 

Registration Desk Open

Registration Desk Hours: 8:00AM - 11:00AM

Exhibit Hall Open

Welcome Remarks and Day One Takeaways

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 

Director Risk Capture, Population Health Management  

Mass General Brigham 

Tactics for Audit Survival

• Reevaluate mistakes made in previous audits and mock audits to ensure they are not repeated
• Implement prospective processes to limit errors
• Identify outsources solutions to help eliminate costly mishaps

Ava Johnson, Associate Director, Ambulatory CDQI

Mount Sinai Hospital, NYC

Wynda Clayton 
Risk Adjustment Specialist  

Analyze Key Differences Between Varying Types of Audits

• Explore process differences between RADV Audits, ACA HHS-RADV, DOJ, and OIG audits to best prepare your organization for success
• Understand different types of documentation and timelines to ensure accuracy
• Create checklists, timelines, and audit team member responsibilities to achieve a successful audit
• Implement a communication system with senior leadership to confirm they are informed during every step of the process and are engaged in the audit

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 

Director Risk Capture, Population Health Management  

Mass General Brigham   

Susan L Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS Trainer

Director, Risk Adjustment

Baylor Scott and White Healthcare 

Audit Preparation: Key Stakeholders and Team Member Selection

• Create a watertight action plan to avoid hazardous mistakes during an audit
• Identify the personnel that will enhance your audit team to achieve a seamless audit
• Generate team member roles, responsibilities, and timelines to avoid audit pitfalls
• Examine internal and external legal duties related to audits to ensure compliance

Colleen Gianatasio, Director Clinical Documentation Integrity and Coding Compliance 

Capital District Physician’s Health Plan (CDPHP) 

CMS Program Audit Lessons Learned in 2024

• Examine CMS priorities in 2024 audits, including targeted areas such as Formulary Administration, Coverage Determinations and Appeals (CDAG), and Program Integrity Audits 

• Identify common pitfalls and compliance risks observed during recent audits to proactively address vulnerabilities within your organization 

• Evaluate essential questions plans should ask themselves to ensure they are ready for a CMS Program audit 

Joy Enright, Lead Director, Client Audit  

CVS Health 

Tami Ben-Dor, Sr. Manager, Client Audit 

CVS Health 

Erin Comer, Sr. Manager, Client Audit  

CVS Health 

Industry Leader Conclusion Session: Lessons Learned for Audit Survival

• Discuss key takeaways discussed regarding current audits, common trends, and preparing to survive an audit
• Understand the steps needed to be taken post audit including documentation and timeline requirements
• Assess critical changes that need to be made in your organization to avoid costly penalties resulting from an audit
• Anticipate CMS plans for future audits and what can be expected in an evolving industry landscape

Moderator

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 

Director Risk Capture, Population Health Management  

Mass General Brigham 

Panelists

Susan L Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS Trainer

Director, Risk Adjustment

Baylor Scott and White Healthcare 

Laura Sheriff, RN, MSN, CPC, CRC, Risk Adjustment Industry Expert

Chairperson’s Closing Remarks

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 

Director Risk Capture, Population Health Management  

Mass General Brigham