Navigating New Managed Care Guidance: Compliance Essentials

SUMMARY

The managed care landscape continues to evolve at a rapid pace, with new federal and state guidance, regulatory updates, and enforcement priorities reshaping how health plans and provider organizations approach compliance. This workshop provides a practical overview of the most significant recent developments. Participants will gain a clear understanding of what has changed, why it matters, and how these updates may impact day-to-day operations, financial performance, and regulatory risk.

Designed for compliance leaders, executives, coders, auditors, clinicians, and operational teams, this interactive session translates complex regulatory guidance into actionable strategies. Attendees will learn how to identify emerging compliance risks, strengthen governance and oversight, improve documentation and coding practices, and prepare their organizations for increased regulatory scrutiny. Through real-world examples, implementation tips, and practical compliance checklists, participants will leave with the knowledge and tools needed to confidently navigate today's managed care environment and proactively position their organizations for success. You’ll also learn how to identify emerging compliance risks, strengthen governance and oversight, improve documentation and coding practices, and prepare their organizations for increased regulatory scrutiny

Learning Objectives/Agenda

• Identify the most significant recent federal and state managed care regulatory updates and explain their impact on health care programs.
• Evaluate how evolving regulatory guidance affects organizational operations, documentation, coding, auditing, governance, and oversight, and recognize key areas of compliance risk requiring proactive attention
• Apply practical strategies and best practices to strengthen compliance programs, prepare for regulatory audits, and implement operational changes that support regulatory adherence while improving organizational performance. 
• Interpret recent enforcement trends, audit findings, and government expectations to prioritize compliance initiatives and reduce organizational, financial, and reputational risk. 
• Develop an action plan to assess organizational readiness, address compliance gaps, and implement sustainable processes that align with current managed care regulatory requirements and industry best practices.

Why is this topic timely/important?

Recent guidance, increased government oversight, and evolving enforcement priorities have heightened the financial, operational, and reputational risks associated with noncompliance across Medicare Advantage, Medicaid, and other managed care programs. This workshop equips participants with the knowledge and practical strategies needed to proactively respond to these changes, strengthen compliance programs, and position their organizations for long-term success in an increasingly complex regulatory environment.

Who would benefit from this workshop?

• Medical Coders
• Auditors
• Clinicians
• Operational Teams
• Compliance Leaders
• Executives