CMS mandates that every health plan that contracts for and implements a Medicare Advantage (MA) Plan, establish a Compliance Program. Recently, CMS expanded these obligations and now requires that MA Plans demonstrate that they have established an effective Compliance Program. Additionally, the OIG has targeted MA Plans for investigations to ensure compliance with all the rules and regulations that govern managed care organizations.

In addition, CMS has recently implemented its Risk Adjustment Data Validation (RADV) program which will result in an increase in coding and documentation audits. Many plans do not have appropriate policies and procedures in place related to Risk Adjustment coding and documentation and now there is an urgent need for this portion of their compliance plans. Failure to meet the complex and stringent regulatory requirements may result in denial of your application to operate a MA Plan, prohibit you from providing services to Medicare beneficiaries and risk potential exposure to regulatory liability, sanctions and repayment obligations. 

This webinar will help to ensure you are prepared for a federal audit and will outline the critical and detailed efforts required to implement and maintain, on a day-to-day basis, a customized and effective Compliance Program that meets the mandates articulated by CMS in the unique and challenging environment of MA plans. The presentation will provide you with:

• An overview of Compliance Program requirements for MA Plans

• A How-To guide for developing a comprehensive compliance program for your plan

• Recommended policies and procedures related to HCC Coding and Documentation

• A How-To Guide for preparing for the CMS RADV Audit

• Case studies of past MA Plan coding audits

Who Should Attend

• CFO, CEO

• Chief Compliance Officer

• VP of Risk Adjustment

• VP of Client Services

• VP of Coding Services

• Director of Regulatory Affairs

About the Presenters

Greg Sinaiko is the CEO and Founder of The Coding Source, LLC. The Coding Source (TCS) was formed due to a market need for qualified medical coding professionals at many academic medical centers, large private medical groups and various payer organizations. Since the company’s inception in 2002, Greg has grown TCS into a nationally recognized and industry-leading provider of outsourced medical coding services, temporary coders, risk adjustment auditing and certified medical coding training programs.

Prior to TCS, Greg worked as a Consultant at Sinaiko Healthcare Consulting, a leading healthcare management consulting firm. He has also served as the Administrator for four skilled nursing facilities owned by Care Centers, Inc. in Chicago. From 1995 to 1998, he was the Administrator assigned to rotate to under-performing facilities, where he successfully applied his financial and management strengths to significantly improve operating performance. In 1998, Greg was recruited as the Administrator for the Jewish Home for the Aging, a 400-bed skilled nursing/assisted living facility.

Among his many accomplishments, Greg is also a renowned keynote speaker and has presented at various conferences nationwide, including America’s Health Insurance Plans (AHIP), Health Education branch of Financial Research Associates (FRA) and the California Association of Physician Groups (CAPG).

Kirsten Wild brings to Sinaiko Healthcare Consulting, Inc. the breadth and depth of experience across disciplines and environments that is so critical to meeting today’s compliance and compliance-consulting imperatives. She is a tremendous resource for our clients given that level and range of experience.

Prior to joining the firm, Kirsten served as the Corporate Compliance Officer, Privacy Officer and Risk Manager for a regional integrated health system in southeastern Wisconsin. In this position, she directed and provided oversight of the Compliance Program with respect to an acute care hospital, physician practice group, licensed hospice, ambulatory surgery center, a non-profit foundation and other specific health system operations and business units. Kirsten directed implementation teams for a wide variety of governmental regulations; including HIPAA Privacy, HIPAA Security, EMTALA, and hospice in addition to the other core areas of focus for the acute care facility and physician practice.

Complimenting her role as Corporate Compliance Officer, Kirsten developed and led the Enterprise Risk Management Program providing direct oversight of medical malpractice and litigation management, as well as management of general and other corporate liabilities, with a strong emphasis on patient quality and safety outcomes. Over the past 25 years Kirsten has excelled in a broad-spectrum of healthcare disciplines starting with her work as an RN staff/charge nurse and gaining escalating levels of responsibility in the clinical arena as a nursing and clinical manager, case management and utilization review nurse, and nurse educator, in addition to her work as a medical coder and certified professional in health care compliance. She also has prior experience providing consulting services across the United States and with the American Red Cross in Europe.

Kirsten is a member of the Health Care Compliance Association and Healthcare Financial Management Association, Wisconsin Chapter, for which she serves as the Advisory Chairperson for the Compliance Committee of the Board of Directors. She is also a member of the HIPAA Collaborative of Wisconsin and is co-chair for the HIPAA Security Networking Group.