Agenda
Explore the full schedule of sessions at the RISE Virtual Event Series: Appeals & Grievances
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Tuesday - May 12, 2026
10:00 AM
10:00 AM – 10:05 AM
Welcome and Opening Remarks
10:05 AM
10:05 AM – 10:50 AM
Regulatory Update: Preparing Appeals & Grievances Programs for Heightened Oversight
- Interpret new guidance and enforcement priorities from regulators
- Adjust policies, workflows, and documentation to meet updated requirements
- Strengthen processes that withstand regulatory scrutiny and audits
Speaker
Mark Dwinnells
Director, Compliance at CareSource
10:50 AM
10:50 AM – 11:00 AM
Break
11:00 AM
11:00 AM – 11:50 AM
Strengthening Utilization Management to Reduce Appeals
- Examine how UM determinations influence appeal rates and member complaints
- Strengthen collaboration between Utilization Management and Appeals teams
- Establish documentation practices that support defensible medical necessity determinations
Speaker
Tina Dueringer
CEO, Principal Advisor at Dueringer Advisors
11:50 AM
11:50 AM – 12:00 PM
Break
12:00 PM
12:00 PM – 12:50 PM
Preparing for CMS Audits and State Audits
- Review common findings from recent regulatory audits
- Strengthen documentation practices that support defensible decisions
- Establish internal controls that support audit readiness year-round
Speaker
Deb Curry
Manager, Risk Adjustment Coding Quality & Operations at Medical Mutual
12:50 PM
12:50 PM – 1:30 PM
Lunch Break
1:30 PM
1:30 PM – 2:15 PM
Strengthening FDR Oversight: Preventing Complaints and Strengthening Accountability
- Establish structured onboarding and implementation processes for FDR partners
- Strengthen oversight frameworks that support ongoing monitoring and accountability
- Implement sales oversight programs that review broker and agent enrollment activity for compliance
Speaker
Porsche Glover
Senior Compliance Analyst at VillageCareMAX
2:15 PM
2:15 PM – 2:25 PM
Break
2:25 PM
2:25 PM – 3:10 PM
Using Technology and Automation Responsibly in Appeals Management
- Assess case management platforms that support appeals and grievance operations
- Implement workflow automation that improves documentation and case tracking
- Establish guardrails that ensure responsible use of AI and automation
3:10 PM
3:10 PM – 3:20 PM
Break
3:20 PM
3:20 PM – 4:10 PM
Ensuring ADA Compliance in Member Engagement, Communications and Marketing
- Identify ADA requirements that apply to member communications, marketing materials, and notices
- Evaluate communication practices to ensure accessibility for individuals with visual, hearing, cognitive, and other disabilities
- Develop processes that provide materials in accessible formats such as large print, braille, audio, and digital accessibility standards
Speaker
Matthew Books
Senior Medicare Compliance Specialist at Longevity Health Plan
4:10 PM
4:10 PM – 4:15 PM
Closing Remarks
Wednesday - May 13, 2026
10:00 AM
10:00 AM – 10:10 AM
Welcome and Opening Remarks
10:10 AM
10:10 AM – 10:55 AM
Improving Member Communication During the Appeals Process
- Draft denial letters that meet regulatory standards and improve clarity
- Communicate timelines and expectations clearly to members
- Support vulnerable populations throughout the appeals process
Speaker
Beth Socoski
VP, Compliance, Medicare Compliance Officer at Longevity Health Plan
10:55 AM
10:55 AM – 11:05 AM
Break
11:05 AM
11:05 AM – 11:50 AM
Expedited Appeals: Balancing Speed, Clinical Judgment, and Compliance
- Define criteria that justify expedited review requests
- Establish clinical workflows that support rapid review timelines
- Ensure consistent clinical judgment under tight deadlines
Speaker
Natasha C. Miller
Health Information Management Consultant at NCM Healthcare
11:50 AM
11:50 AM – 12:00 PM
Break
12:00 PM
12:00 PM – 12:45 PM
Managing Repeat Grievances: Communication Strategies that De-Escalate and Resolve
- Identify common drivers behind repeat grievances and persistent member complaints
- Draft grievance responses that meet readability standards while clearly explaining plan decisions
- Apply communication strategies that acknowledge concerns and set realistic expectations for members
12:45 PM
12:45 PM – 1:30 PM
Lunch break
1:30 PM
1:30 PM – 2:15 PM
Preparing Appeals & Grievance Data for Program Audits
- Identify required universe data elements for appeals and grievances under Medicare reporting requirements
- Establish processes that capture and document every case touchpoint from receipt through resolution
- Prepare teams to respond to auditor requests and walk through cases during program audits
2:15 PM
2:15 PM – 2:25 PM
Break
2:25 PM
2:25 PM – 3:10 PM
The Future of Appeals & Grievances: Preparing for the Next Wave of Reform
- Evaluate policy trends that shape the future of appeals and grievances
- Assess how transparency and member advocacy influence plan operations
- Anticipate reforms that affect prior authorization and coverage determinations
3:10 PM
3:10 PM – 3:15 PM
Closing Remarks
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