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2015 TPA University Schedule


 

 Schedule at a Glance

speakers and topics subject to change


Wednesday, July 15th, 2015

11:00am - 5:30pm - Registration - Zurich foyer 

1:00pm - 1:45pm - Welcome, Opening Remarks, Incoming President Introduction, Conference Overview


1:45pm - 3:15pm - Opening Keynote - Michael Hoffman

Being #1 On Purpose - How to be a Catalyst for the Winds of Opportunity

Every one of a TPA’s job descriptions can be summed up in a word… Tornadic! From the fact that so much of health care is still manual (We still rely on FAX MACHINES!) to customers and clients that stretch a TPA’s love for humanity to the people that a TPA works with – that have retired emotionally but their bodies keep coming in to work everyday…The tornado impacts attitudes and the quality of communication when it’s most critical. When the tornado rises that’s when TPA’s need to be a Master of the situation. Learning how the tornado of business impacts communication and the skill sets necessary to be an agent of influence can be a game changer in equipping and igniting a TPA to be the catalysts of progress in the winds of opportunity.  In this interactive, eye opening and hilarious keynote session, Michael Hoffman will ignite our conference and ignite the skill sets that truly help us to be #1 On Purpose in our businesses.    

Be able to identify top challenges of the industry and connect to historical challenges
Understand that culture is created and what our role is in that creation
Discover the skill sets in tactical communications needed to become a person of influence 
Demonstrate our role in the confidence and competence of those I work with
Capture the top take away ideas, skills and techniques of the conference
Identify what it takes to be the Master of my tornado and leave on an unbelievable high that I truly AM THE MASTER OF THE TORNADO!

 

3:15pm - 3:35pm - BREAK

3:35pm - 4:55pm - Collaboration for Operational Excellence Part One - Brian McDermott & Gerry Sexton of GrowthWorks

Reviewing and Identifying Common Issues

The greatest resource at TPA University 2015 will be the hundreds of industry experts coming to Chicago to learn with and from each other. This networking/idea-and-best-practice-sharing/ brainstorming session will tap deep and deliberately into the wisdom, experience, and creative ideas of this one-of-a-kind group. This collaborative, multi-part working session will give every participant the opportunity to identify specific learning needs, seek real-time solutions, and create a personal action plan for dealing with highest-priority business challenges. The focus is on helping you get what you need from this multi-day learning event, and to come out turning ideas and inspiration into real-world action. You will draw on every presentation and discussion throughout the conference.  In addition to a personal action plan, you will come away with dozens of ideas directly related to your priority business challenges, and receive after the conference a summary document with hundreds of ideas, recommendations and pieces of advice collected from your industry peers (related to our selected industry segments of Customer Service, Claims Practices, Technology, Account Management, and Leadership).

In this first of three collaborative learning segments, you will: 
- Customize TPA University 2015 specifically to your learning and development needs.
- Identify, discuss, and prioritize significant industry challenges affecting your day-to-day operations. 
- Identify your personal challenges and top learning priorities to address during this conference that would make it a resounding success for you.  
- Select a small Collaborative Learning Team based on your priority needs that will join learning forces for the conference.  
- Begin building personal contacts with peers to share personal success stories and expertise.
- Work together to generate ideas that will make you and your organization more successful.


4:55pm - 5:00pm - Wednesday Summary

5:30pm - 7:00pm - Welcome Reception

 

Thursday, July 16th, 2015

7:30am - 5:30pm - Registration - Zurich Foyer

8:00am - 8:30am - Breakfast & Networking

8:30am - 8:45am - Welcome and Notices

8:45am - 10:15am - Keynote - Nancy Friedman of Telephone Doctor Customer Service

How to Excel in the Winds of Change

It seems as though, the only thing that is consistent is change.  Handling change is critical to the TPA. In an ever changing industry, your role too as a TPA is ever changing. Knowing how to handle your communications for the best outcome – with your Clients, your co-workers,  your family and even your Boss,  are your top priority. Dealing with changing expectations has become one of the major challenges of your job.  

What has changed more than the telephone and how it is used?  Some of us remember when you had to put a coin in a slot to make a phone call.  Some people today have never used landline.  Work forces are diverse.  We communicate in many ways – telephone, fax, text, mobile APPs. TPAs can equip their staffs with tools to develop a better customer service experience that resonates with all their employees. We must meet the changing times with flexibility and more than just the one solution!  

- Learn the Eight Killer Words that distract, confuse, annoy and stop conversations – over the phone or in writing
- Learn how to send and receive messages that make the difference in service
- Learn the Five Forbidden Phrases that instantly turn people off
- Understand the logic of repetition and the importance of interpersonal skills 

 

10:15am - 10:35am - BREAK

10:35am - 11:25am: Session - Bobby Ahrens, Director of Partner Solutions, Soluta Health

What We've Got Here, Is a Failure to Adjudicate!  An Operational Discussion on the Processing of PBM Claims

This will be an operational discussion addressing the 2015 Maximum Out of Pocket legislative requirements and the impact on Pharmacy claims workflow and adjudication.  We will also discuss the eligibility/accumulator exchanges with the PBM’s for point of sale accumulator/eligibility accuracy.

We will discuss the details of how several vendors in the market today  implemented solutions, how plan design challenges were solved and will discuss any significant work flow issues they encountered.  

Accumulator extracts and re-importation
Passive claims imports that adjust accumulators 
Adjudication of Pharmacy claims in the normal claims workflow


11:25am - 11:55am: Session - Jeff Walter of Professional Benefit Administrators

Disaster Recovery Planning: Security Breach

Fortunately, not many of us have had to rebuild our operation after a fire, relocate after a flood or put a new roof on after a tornado, but what do you do when your data is stolen?  In light of the ever increasing security breaches that corporations have been plagued with, how prepared are you to respond to your clients and the government if it happens to you?   It’s time to face reality, it CAN happen, and when it does, how ready are we to respond?

- Review the Anthem breach and their responses
- Give you key topics to cover with your operation to prepare for your response
- Review how your many business relationships can be impacted

11:55am - 12:00pm - Morning Summary

12:00pm - 1:00pm - Lunch and HCAA Business Meeting and Membership Longevity Awards

1:00pm - 2:00pm: Session - Josh Sears, JD of Freestone Corporate Law

Bulldoggin' Beats Bull Ridin': Wrestling with ERISA's Legal Challenges & the Plans it Protects

Weathering ERISA challenges and ACA compliance mandates can feel like riding a bull:  you are strapped to a dangerous animal, trying to hold on before you get stomped.  But what if you had an effective bull riding strategy?  

When it comes to protecting our clients and businesses in “regulatory rodeo”, we submit that acting more like the bulldoggers - those brave few who jump from a perfectly good horse to wrestle a sprinting steer to the ground with their bare hands – will be a better than toughing it out.  And when it comes to handling ERISA and the ACA, bulldogging will beat bull riding every time.  

In this very eclectic session we will provide you with a broad view of ERISA landscape and framework, existing and upcoming threats to its preservation, Federal Regulatory developments, most recent court decisions and the corresponding legal impact they will have on your plans, current benefit and industry trends and positive and negative repercussions of implementing them.

State of the Union for ERISA Preemption Protections:    
- Background - ERISA preemption and why we care
- ERISA threats (Amara Case, NAIC intrusion)
- Role of the Fiduciary (responsibilities and the who, what, when & why of strictest standard of civil behavior)

Federal Regulatory Developments:
- Cadillac Plan Tax: (Breach of “Ministerial Capacity”, exposures to Plans/TPA’s/Brokers)
- 6055/6056 Reporting: (what is it, why do we care, what data should be compiled, by whom, legal exposure)
- Impact of SCOTUS ACA Decision (King v. Burwell)

Benefit Issues:  
- MEC & Skinny plans (definition, and the good, bad and ugly - legal, financial, market-based)
- Same-sex Spouses (Old news, new problems, eligibility decisions, benefit design opportunities for high-density SSS population)

Current Trends & Myth Busting:
- Myth: TPAs/Brokers are not on the hook for bad plan language
- Myth: Reference Based Pricing and narrow networks are trendy gimmicks
- Myth: Captives are only for national conglomerates
- Myth: State DOIs can't mess with our self-funded ERISA plans


2:00pm - 2:20pm - BREAK


2:20pm - 3:10pm - Session - Linda Myrick, CPC of United Claim Solutions

What You Need to Know About Correct Coding for 2015

You may think that you know everything about claim coding.  You may think that you are all prepared for October and ICD-10?  You can save your clients’ healthcare dollars by better understanding ICD-9, CPT, and HCPCS Coding Rules and Guidelines that enable you to identify erroneous and inappropriate medical care billing. We will take a look at the services that are commonly overpaid by TPAs due to lack of education on the continuous changes in the coding industry.  Let’s review together the coding you are receiving!  

- The financial impact of applying correct CCI Edits, MPPR (Multiple Procedure Payment Reductions), and Modifiers
- How just a few overlooked edits and guidelines can generate provider overpayment and set an unhealthy precedent
- The pitfalls of unlisted(unspecified) codes
- The potential impact of the implementation of ICD-10 codes

3:10pm - 3:35pm - Session - Tim Callender of Ameriben

Common Causes of HIPAA Disclosures and Lessons Learned 

During this 25 minute session, Tim Callender, AmeriBen’s Corporate Counsel and HIPAA Privacy Officer will use real-world examples to demonstrate common causes of HIPAA disclosures and the subsequent “lessons learned,” which can lead to operational and procedural corrections being implemented in an organization.

- EHRs and Information Exchange
- Cyber threats
- Remote Access
- Lost or Stolen Devices
- Texting and Email

3:35pm - 4:55pm - Collaboration for Operational Excellence Part Two - Brian McDermott & Gerry Sexton of GrowthWorks

Applying Learning to Real-Time Business Situations

In the second of three collaborative learning segments, you will meet in small groups prepared to:
- Share the most important things learned to that point during the conference from all sessions, presentation and discussions, including specific ideas on how to apply the learning to real-time business situations. 
- Share learning specific to priorities of your Collaborative Learning Team.  Learn “the best ideas heard so far” through a series of prioritized reports from all the Collaborative Learning Teams.

4:55pm - 5:00pm: Thursday Summary


5:30pm - 7:00pm - Thursday Reception

 

Friday, July 17th, 2015

7:30am - Noon - Registration - Zurich Foyer
 

8:00am - 8:30am - Breakfast & Networking

8:30am - 8:40am - Welcome and Notices

8:40am - 9:40am - Session - Trina Rich and Jeanne Noe of htms, an Emdeon company

Managing projects in our changing, fast-paced, world

Are you juggling multiple projects? Wondering how to manage yet another project due to regulatory changes?  Trying to figure out how to get through the noise and determine the important items to focus on?  If so, you’ll be interested in the session ‘Managing projects in our changing, fast-paced, world’.  This session will provide practical, hands-on, advice related to managing multiple projects or multiple project tracks, engaging your resources, and keeping team members and stakeholders informed. 

Attendees will learn:
1. How to stay on focus while juggling multiple projects
2. How to prioritize and eliminate the noise
3. How to keep your team motivated and engaged
4. How to keep everyone informed


9:40am - 10:00am - BREAK

10:00am - 11:30am - Collaboration for Operational Excellence Part Three - Brian McDermott & Gerry Sexton of GrowthWorks

Creating Personal Action Plans

In the final collaborative learning segment, you will: 
- Get ideas and recommendation specific to your most pressing business challenge, using GrowthWorks’ Improv Idea Builder Tool. 
- Create a personal action plan to identify specific steps to take in the first 90 days following the conference to make changes and improvements based on personal priorities, lessons learned during the conference, and suggestions in the Improv Idea Builder. 
- Identify the most important advice provided at TPA University – to share at the conference and to be compiled into a post-event publication that will include hundreds of ideas and recommendations related to Customer Service, Claims practices, Technology, Account management, Leadership and other industry issues and practices. 


11:30am - 11:50am - Prize Drawings (must be present to win)

11:50am - 12:00pm - Closing Remarks and Adjourn

 

5353 Wayzata Blvd. Suite 350
Minneapolis, MN 55416

Phone: 888.637.1605
Fax: 952.252.8096
Email: hcaainfo@hcaa.org

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