CMSAudits12/4/08

MedTourism12/17/08

Future Care1/22/09

Int'l PPO's 2/12/09

1. Medicare Advantage today
2. Audit preparation
3. How much data is sufficient and who should be part of the process?
4. Identifying specific compliance risks 
   a. File and documentation set up
   b. Universal listings
   c. Entrance/Exit interviews
5. Internal Compliance monitoring
6. Post-audit actions and corrective action responses

In just 75 minutes and without leaving your office, an expert from Gorman Health Group, an industry leader in Medicare Managed Care Consulting, will provide you with the information needed to better understand CMS' expectations.
 

• What plans must do internally to be ready for a CMS audit
• Internal compliance monitoring
• Post audit compliance issues
• What plans need to focus on post MIPPA
• Audit readiness
• Audit prep pitfalls and tips
    

• Compliance Officers 
• Internal audit departments
• Plan staff responsible for oversight/audit
   

Jane Scott
Vice President, Clinical Services, Gorman Health Group

Jane Scott brings to Gorman Health Group more than seventeen years of professional experience in the healthcare industry and an extensive Medicare compliance and operations background. Her diverse experience includes oversight in the areas of utilization and medical management, claims operations, and provider/associate education. She also has an exhaustive knowledge of federal regulations and health plan compliance. 

While at GHG, Jane has provided her broad expertise to a number of health plans and providers around the country on a diverse set of engagements. She has helped establish new Medicare Advantage plans by assisting in the development of CMS applications and plan implementation processes. In addition, she has ensured plans remain compliant with Medicare regulations and guidelines by performing audit readiness assessments, and mock CMS audits. Furthermore, she has worked on prescription drug event (PDE) and membership reconciliation engagements, which are aimed to reduce a plan’s financial liability to CMS.

Jane has also presented on behalf of GHG at numerous industry conferences around the country on such topics as Prescription Drug Events, membership reconciliation, Medicare Part C and Part D audits and Special Needs Plans.

Prior to joining GHG, Jane served as the Director of Medicare Program Management for Government Programs for HealthNet of Arizona. While there, she had overall responsibility for its government programs, including Medicare Advantage HMO, PPO and Medicare Supplemental products. Under her leadership, HealthNet of Arizona experienced increased total revenue for their Medicare programs of over 6% per year. Prior to this position, she served as Director of Medicare Compliance and Operations for Health Net of Arizona, and a number of other senior positions in the Medicare Managed Care industry.

Jane has 15 years of clinical nursing experience and remains a licensed vocational nurse. She lives in Tucson, Arizona with her husband and two stepsons.
 

Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!