Session 1.1

Title:  Disability Claims
Track:  Disability
Format:  Presentation with Q&A
Presenter:  Russell Birner, esq
Description:  Ask a layperson what a claim examiner does and you're likely to hear that the examiner decides claims. While that is the ultimate responsibility, the most important component to getting that claim decided is timely and effective communication. This interactive presentation will look at the affect of claim correspondence on disability and life insurance litigation, highlight stumbling blocks and discuss approaches to avoid them.

Session 2.1

Title:  Disability Legal Updates
Track:  Disability
Format:  Presentation with Q&A
Presenter:  Marty Rosen, esq
Description:  Keep up to date! What topics have disability insurers and their insured’s been battling about in the courts over the past year? And with what results? Come hear an outside counsel seasoned in litigating disability bad faith disputes discuss some of the issues that judges from around the country have written about in their published legal decisions.

Session 3.1

Title:  Social Networking Sites, Search Engines, and Surveillance in the Evaluation of Disability Claims
Track:  Disability
Format:  Presentation with Q&A
Presenter:  H. Sanders Carter, Jr. & Elizabeth A. Venditta
Description:  In fulfilling their objective to pay disability benefits to those properly entitled to them but deny the spurious claim, disability claims representatives at times may find themselves playing detective. This session will focus on what's potentially out there to be found and what a disability claims representative may do to make appropriate inquiries about someone who presents a suspect claim. Discussion will focus on permissible communications with the claimant, appropriate information to be sought in developing the claims file, the allowable use and purpose of surveillance, and other considerations under the case law.

Session 4.1

Title:  Social Security 101
Track:  Disability
Format:  Presentation with Q&A
Presenter:  Barbara Mountain
Description:   Learn about Social Security's programs and how they can impact disability claims. Why is there a Social Security offset provision in most LTD contracts and what is the financial impact? Learn about the benefits to your employees/claimants receiving Social Security disability benefits, and find out how Social Security encourages return to work through a vast array of work incentives.

Session 5.1

Title:  ERISA Disability Law
Track:  Disability
Format:  Presentation with Q&A
Presenter:  Mark Schmidtke
Description:   ERISA Claim Processing: Tolling and Other Dilemmas. An interactive discussion of ERISA claim processing issues,including calculation of deadlines, tolling, assembly of an administrative record, exhaustion of remedies, and other issues.

Session 1.2

Title:  Life Claim Investigation
Track:  Life
Format:  Presentation with Q&A
Presenter:  Donna Conticchio
Description:  Undisclosed health| | conditions, financial misrepresentation, drug and alcohol abuse, felony convictions, suicide - these are just some of the issues involved in contestable claims investigations. This session will supply you with a roadmap to contestable, accidental death and foreign death claim investigations.

Session 2.2

Title:  Life Insurance Case Law Updates
Track:  Life
Format:  Presentation with Q&A
Presenter:  Adrienne Publicover, esq & Kyle Jennings
Description:  Come join us for a discussion of the issues and the trends in life insurance litigation. In house counsel and a seasoned litigator will bring you up to date on all of the current case law decisions that affect your claims handling and then lead a lively discussion concerning the latest trends affecting life companies.

Session 3.2

Title:  Beneficiary Designations
Track:  Life
Format:  Presentation with Q&A
Presenter:  Dan Maquire
Description:  Identifying, Evaluating and Resolving Complex Death Claims Competing claims, missing bodies, divorce, and murder. These are only some of the challenges facingmtoday's life claims professionals. Come find out what your colleagues, cohorts and lawyers are doing with complex death claims in these challenging times.

Session 4.2

Title:  STOLI
Track:  Life
Format:  Presentation with Q&A
Presenter:  Frank Best, David McDowell
Description:  Learn of recent developments in Stranger Originated Life Insurance and their impact on rescission law and insurable interest, hear predictions for the future, and get pointers on the role of claim examiners in responding to the threat it presents to insurers.

Session 5.2

Title:  Building A Life Claims Training Program Using the Six Sigma Approach
Track:  Life
Format:  Presentation with Q&A
Presenter:  Donna Conticchio
Description:  Ready to take a scientific approach to your life claims training program? Whether you are ready for a full blown re-engineering of your training program, creating a re-designed training model, or simply ready to establish analytic metrics to measure the effectiveness of your current program – this session will walk you through creating a training program that aligns with your objectives.

Session 1.3

Title:  Fraud Interdiction Program: Fast Track to Stopping Healthcare Fraud
Track:  Fraud / SIU
Format:  Presentation with Q&A
Presenters:  Ted Doyle & Albert McKenzie
Description:  Prosecuting a dishonest healthcare provider for health care fraud is often a highly complex and potentially lengthy process. But, is it any surprise that many health care fraud perpetrators also cheat on their taxes? In this session you'll learn how the innovative Fraud Interdiction program has turned the "Al Capone" approach into an extremely effective fast track to putting perpetrators out of the fraud game.

Session 2.3

Title:  Basics of Fraud and Abuse
Track:  Fraud / SIU
Format:  Presentation with Q&A
Presenter:  Karen Schwabacher
Description:  This workshop will review basics, background and specifically address medical necessity issues, how providers may circumvent your system, genetic testing, and new diagnostic schemes and what to look out for and why you should investigate.

Session 3.3

Title:  Emerging Healthcare Fraud Schemes
Track:  Fraud / SIU
Format:  Presentation with Q&A
Presenter:  Cathy Bailey
Description:  This workshop will be focusing on emerging healthcare fraud schemes around Manipulation Under Anesthesia, IVIG and Genetic Testing and Unlicensed Free Standing ER’s and review other claims fraud schemes.

Session 4.3

Title:  RX Peril: Fraud with Prescription Drug Dispensing
Track:  Fraud / SIU
Format:  Presentation with Q&A
Presenter:  Bill Mahon
Description:  Based on landmark research, let's look at three aspects:

1. provide a broad perspective on the widely acknowledged 'perfect storm' of prescription drug abuse and diversion

2. detail its dramatic financial impact on third-party prescription payers

3. delineate the specific ways in which prescription payers and plan sponsors can better reduce their losses and mitigate their potential liability

Session 5.3

Title:  The Serious Plague of Healthcare Fraud
Track:  Fraud / SIU
Format:  Presentation with Q&A
Presenter:  Ted Doyle
Description:  This session provides a firsthand-source look at the 'what, how and where' of the most damaging and widespread types of fraud schemes that continue to target public programs and private health plans in the West. Case examples will illustrate the 'what, how and where' of those schemes, including common denominators that facilitate the fraud, how schemes have been detected, and what data tools were used and what lessons we should apply to the future prevention of these fraud schemes.

Session 1.4

Title:  Internal Compliance Monitoring: Proactive Actions
Track:  Legal & Regulatory
Format:  Presentation with Q&A
Presenter:  Althea Barber-Smith
Description:  You can't wait until you receive the Notice from a Regulator that you'll be audited. You need to establish an internal monitoring program…more than just monitoring performance or quality of performance. This workshop will look at how to structure internal audits, how to quantify the results and how to help the organization drive improved performance...before the Auditors come knockin' at your door.

Session 2.4

Title:  CMS' New Provider Payment Dispute Process
Track:  Legal & Regulatory
Format:  Presentation with Q&A
Presenter:  Susan Herman
Description:  This presentation will look at the expansion of the Payment Dispute Resolution program that was initiated under PFFS and has expanded to all MA Plan types in 2010. You'll need to know that non-contracted providers under MA and MAPD plans now have additional appeal rights, and payment disputes involving down-coding of claims and the related medical necessity determinations are included. A CMS representative will provide all the insight needed to make this expansion program a success.

Session 3.4

Title:  Preparing the Right Way for a Deposition
Track:  Legal & Regulatory
Format:  Presentation with Q&A
Presenter:  Robert Hess, esq
Description:  "Help! They want to take my deposition!" This presentation is designed to help personnel across the insurance industry to prepare for and give a quality deposition.

Session 4.4

Title:  Medicare Policy Updates
Track:  Legal & Regulatory
Format:  Presentation with Q&A
Presenter:  Neal Logue
Description:  More perspective and insight regarding CMS operations
An overview of the Recovery Audit Contractors (RACs) process;
Medicare Provider Enrollment;
Physician Quality Reporting Initiative (PQRI);
Pay for Performance and Quality Reporting;
Claims Processing involving the submission of claims to the appropriate A/B MAC;
Medicare Fraud and Abuse.

Session 5.4

Title:  Federal Regulatory & Legislative Update
Track:  Legal & Regulatory
Format:  Presentation with Q&A
Presenter:   Marilyn Monahan
Description:  This workshop will provide an overview of bills the California legislature passed in 2009 and how those bills will impact the way you do business in the claims benefit environment and address the legislative and regulatory trends in Washington. Updates on recently implemented regulations will be provided, along with a discussion of issues of on-going interest, trends, and emerging initiatives on the federal and state level.

Session 1.5

Title:  Staffing Up Strategically: Outsourcing
Track:  Claims Management & Oversight
Format:  Presentation with Q&A
Presenter:  Eileen Whitley
Description:  Every organization struggles with staffing the right number of people at the right time, for the right amount of time. Budgets and office space can play a role in the staffing game. But there are solutions that are right on price, right on location, and right on the timeframe. In this workshop, participants will discuss practical solutions to using an outsource vendor to meet the business's needs, which can be seasonal or cyclic.

Session 2.5

Title:  Leveraging Claim Data Acquisition to Improve Quality
Track:  Claims Management & Oversight
Format:  Presentation with Q&A
Presenters:  Dr. Rus Billimoria
Description:  Claims adjudication in a coordinated care environment produces large volumes of useful data. The workshop presenters contend that a simultaneous effort to comply with claims payment regulatory requirements while investing time in data acquisition, mining and extrapolating can lead to improved quality in the delivery of care

Session 3.5

Title:  Work at Home Inventory & Production Controls
Track:  Claims Management & Oversight
Format:  Presentation with Q&A
Presenters:  Leslie Casey, Charles Davis, and Dante Jackson
Description:  Many companies are embracing the remote worker concept and providing a structured program for working at home. This workshop will look at some of the WAH program challenges of monitoring production, accuracy and inventory management.

Session 4.5

Title:  Maximizing Productivity Through Employee Concentric Environment
Track:  Claims Management & Oversight
Format:  Presentation with Q&A
Presenter:  Tom Everett
Description:  Case study example of how performance, job satisfaction and other success indicators increased when management began creating an employee concentric environment

Session 5.5

Title:  Triumph of the Human Spirit
Track:  Claims Management & Oversight
Format:  Presentation with Q&A
Presenter:  Stephani Victor
Description:   Can you imagine losing both of your legs? No one can, but Stephani Victor did when she was hit by an out of control car while standing in the driveway. Hear her remarkable story about how after losing her legs she decided to recreate herself as an alpine ski racer. Stephani has gone on to become a world-class athlete, documentary filmmaker, and motivational speaker. As a renowned Paralympic athlete, she most recently won a Gold Medal and two Silver Medals at the 2010 Vancouver Paralympic Games, adding to her Gold and Bronze Medals from the 2006 Torino and 2002 Salt Lake Paralympic Games.

Session 1.6

Title:  Medicare Modernization Act (MMA) Part D
Track:  General Claims & Related Issues
Format:  Presentation with Q&A
Presenter:  Craig S. Stern, PharmD, MBA
Description:  This presentation will focus on the changes to Medicare Part D over the past year. Specific topics addressed will include, but not be limited to:

➢ Reduced barriers for low-income beneficiaries
➢ CMS authority to cover more drugs on plan formularies
➢ Changed definition of a Part D drug to conform with Part B
➢ Services moved from Part B to Part D
➢ Employer Group Waiver Plan (EGWP)
➢ Changes to Medication Therapy Management (MTM) criteria
➢ Use of PDE data by agencies, states and researchers
➢ Physician e-prescribing bonuses
➢ Prompt payment to pharmacies
➢ Impact on dual eligibles

Please join us for a robust conversation on one of the defining benefits of our times!

Session 2.6

Title:  Intro to ICD-9 CM and ICD-10 PCS
Track:  General Claims & Related Issues
Format:  Presentation with Q&A
Presenter:  Theresa Rihanek
Description:  This presentation will highlight the major differences to the current ICD-9-CM system that will be implemented and assist in familiarizing the attendees with the key changes on the horizon while providing a timeline to compliance and an illustration of the new expanded features. .

Session 3.6

Title:  Industry Collaboration Effort (ICE) Updates
Track:  General Claims & Related Issues
Format:  Presentation with Q&A
Presenters:  Bobby Antee & Javier Lizardi
Description:  The ICE claims standardization team updates on the following: review and revised claims audit tool workbook, PDR 101, review and revised ER auto pay diagnosis code list, review and revised commercial denial reason guide and any other updates you may have missed during the ICE conference.

Session 4.6

Title:  Stop Improper Billing Practices by Hospitals & Medical Providers
Track:  General Claims & Related Issues
Format:  Presentation with Q&A
Presenter:  Michael Bernacci
Description:  This presentation will address insurers and self-funded plans contractual and legal options to stop improper billing methods by Hospitals and Medical Providers. It will discuss an insurer’s contractual and legal rights to demand audits from medical providers as well as methods to compel timely and complete audits from providers. It will also discuss when it is proper to decline payment for improperly billed claims under the policy or network contract and how to prevent a medical provider from balance billing the insured as a result of the dispute.

Session 5.6

Title:  Case Development
Track:  General Claims & Related Issues
Format:  Presentation with Q&A
Presenter:  Cathy Bailey
Description:  Explore case assessment by review the following:

• Referral source
• Determining allegation
• Contract issues (provider, policy holder)
• Dollar paid
• Prioritization
• Database Searches
• Licenses, web sites, disciplinary issues
• Data review and analysis

Session 1.7

Title:  Declutter to Energize Your Life
Track:  Personal Development
Format:  Presentation with Q&A
Presenter:  Lynne S. Rosiak
Description:  Is clutter blocking, slowing you down or preventing you from finding things and or accomplishing what you want to achieve each day? The purpose of this presentation is to identify ways to remove clutter from your life, both internally and externally. When you remove clutter from your home/office, this allows abundance to flow and relationships to expand. If you have been procrastinating addressing the physical items piled on your desk or stuff in your closets and drawers, then this presentation will give you an opportunity to clear them, and open more space to live your life.

Session 2.7

Title:  Financial Planning
Track:  Personal Development
Format:  Presentation with Q&A
Presenter:  Jose Vitela
Description:  Some people struggle to balance their check books…can you imagine the challenge they face in balancing their retirement and future income? This workshop is focuses on the basic elements of financial planning for your future, and is geared to those who considered themselves non-financial planners.

Session 3.7

Title:  (Medical) Identity Theft
Track:  Personal Development
Format:  Presentation with Q&A
Presenter:  Linda Vincent, RN, PI
Description:  You might think this 'only happens to someone else', but think again. Identity theft is on the rise, and you usually don't discover it until it has created a monstrous situation for you or a family member. Be proactive: Understand that it happens, how it can happen and how you can take action to prevent it from happening to you.

Session 4.7

Title:  Hire, Inspire, Fire
Track:  Personal Development
Format:  Presentation with Q&A
Presenter:  Sam Alibrando, Ph.D.
Description:  There is NOTHING more important than hiring the right people for you organization. Almost every person that you have to fire was a bad hire and/or they were not properly integrated (inspire) into the position or culture. By the end of this workshop participant should be able to: identify practical tools and approaches to hiring people based on Knowledge & Skills (the easy part), good-fit to the position and emotional intelligence list particular ways to help new hires integrate into both the position and the organizational culture, increasing their chances of success and identifying problem in the “nip-in-bud” phase before it is too late identify conditions and situations when a person needs to be transferred or let go in order to increase morale and productivity.

Session 5.7

Title:  Say What You Mean, & Mean What You Say
Track:  Personal Development
Format:  Presentation with Q&A
Presenter:  Lynne Rosiak
Description:  Discover ways to set boundaries with others and say polite, powerful statements to handled conflicts, sticky situations and verbal challenges from others; identify benefits of positive confrontation