What You'll Hear
The 2nd Annual Part D Mock Audit Boot Camp is comprised of a series of interactive, guided mock audit exercises focusing on the most critical components of a compliant Part D benefit, and is a truly unique opportunity to work hands-on alongside industry peers and experts through real-life mock audit scenarios:
Interactive Exercise Sessions Include:
- Avoiding Common Mistakes in Your CDAG Universe Data
- Optimizing Your Formulary Administration Universe Data
- Assessing and Accurately Describing the Beneficiary Impact
- Creating CAPs from Common CDAG & Formulary Administration Findings
- Enhancing Your Member and Provider Notifications to Ensure Compliance
- Replicating and Incorporating CMS’ Tracer Sample Approach Into Your Mock Audit
The 2nd Annual PBM Oversight for Optimal Compliance Outcomes event will deliver tips and tools for overseeing formulary administration, strategies for monitoring your PBM’s handling of coverage determinations and denials, and insights to help you enhance your partnership with your PBM.
Featured Session Topics Include:
- Refining Your Approach to PBM Contracting to Enable More Effective Oversight
- Keys to Operating Your MTM Program to Ensure Compliance
- So You’re Being Audited—Lessons Learned During Network Health’s 2016 Audit
- It’s the Little Things that Matter: Often Forgotten Elements of PBM Oversight
- Monitoring Strategies to Enhance Handling of Claims, Coverage Determinations and Denials
Top Reasons To Attend
- Gain unparalleled perspective on pharmacy compliance issues by walking through sample cases alongside industry peers in a truly interactive and engaging exercise format
- Acquire essential PBM oversight tips and tools and learn how to operationalize best practices for PBM contracting and selection
- Get hands-on with sample data and learn to spot common errors in CDAG and formulary universes to avoid mistakes that will lead to findings
- Hear from multiple plans that have been recently audited, who will share how CMS conducted their latest audits and specific areas you need to focus on
- Improve your monitoring and validation processes to ensure your Part D claims are being paid accurately and that your PBMs are sending appeals rights in accordance with CMS regulations
- Take a deep dive into the often forgotten pieces of PBM oversight
- Improve your identification and awareness of compliance gaps within your internal pharmacy department and your PBM and their downstream entities
- Master the art of beneficiary impact analyses, within the context of Part D, to ensure you are identifying and correcting compliance issues in accordance with CMS’ expectations
- Take away practical strategies for improving plan-PBM collaboration and drive more successful audit outcomes
- Find out how often you should request universes from your PBM, how to proceed if you find issues, and critical components of a successful PBM oversight committee
Two Pharmacy Compliance Conferences, One Location! All-Access Pass Available!
Who Should Attend
Senior leaders and managers from Medicare, Part D and Commercial plans, hospitals and health systems, provider groups, and healthcare consultancies with responsibilities in the following areas:
- FDR Oversight
- Pharmacy and Part D
- Internal/External Audit
- Legal Affairs
- Medicare Operations
- Risk Management
- Vendor Management and Oversight
- Appeals and Grievances
- Fraud, Waste & Abuse/Enforcement Compliance
- Government Programs
- Information Technology
Get Answers To These Important Questions
- How can we optimize our mock audits to improve our pharmacy’s audit-preparedness and outcomes?
- What are the most effective criteria to compare and select the best PBM for our plan’s needs and what steps should be taken to build an effective PBM oversight committee?
- What are the keys to operationalizing a more robust mock audit program, and why is it worth the time and energy investment?
- What internal PBM practices should we be scrutinizing more closely and how do we address gaps within our PBM’s internal compliance programs?
- How do we cater mock audits specifically for our Part D program to improve monitoring efforts and boost audit performance?
- What are the most effective criteria to compare and select the best PBM for our plan’s needs, and what steps should be taken to build an effective PBM oversight committee?
- What commonly overlooked issues do we need to avoid to optimize our CDAG and Formulary Administration universes?
- How can we ensure our PBM is administering beneficiary notices in compliance with CMS rule and regulations?
- What tips and tricks can improve the compliance of our beneficiary and provider notifications to ensure they meet CMS’ expectations?
- How can we improve our beneficiary impact analyses, and how can we avoid further scrutiny during an audit by improving how we define and characterize compliance issues to CMS?
Take the Compliance of Your Pharmacy and PBM Operations to the Next Level!
When & Where
May 1-3, 2017
Wyndham Grand Chicago Riverfront
71 E. Upper Wacker Dr
We have a limited number of hotel rooms reserved for the conference. The negotiated room rate of $217 per night will expire on April 7, 2017 although we expect the block to sell out prior to this date. To ensure you receive a room at the negotiated rate book well before the expiration date. Upon sell out of the block room rate and availability will be at the hotel’s discretion.