Agenda

November 9, 2020

12:00PM - 6:00PM EST

Concurrent Workshops

Workshop A:

Risk Adjustment Practitioner

  • The essentials of and differences between Medicare Advantage, Commercial and Medicaid risk adjustment  
  • Understanding how risk scores are calculated  
  • Making sense of varying payment models  
  • An intro into using data and predictive analytics to optimize your risk adjustment practices  
  • Tools for achieving data accuracy  
  • Where do we stand with the transition from RAPS to EDS? The latest in a long journey  
  • Provider engagement strategies that will impact your risk adjustment initiatives  
  • Risk adjustment vendor selection and management  
  • Determining whether you need RA vendors  
  • How do you effectively vet potential vendors and ultimately select them?  
  • Strategies for on-going, thorough vendor management  
  • The future of risk adjustment – what you need to know to stay ahead of possible changes  
  • Initial steps for preparing for a RADV audit  
  • Which staff is essential to overseeing your RADV audit prep?  
  • Staying ahead – key items to monitor well in advance of an actual audit  

 

Donna Malone, Director Coding & Provider Education,
Tufts Health Plan

Tara Russo, VP, Medicare Risk Adjustment, HEDIS and Navigate Directorate
Island Doctors 

Workshop B

Advanced HCC Auditor

The HCC Coding for Accuracy workshop is not just for those directly involved in HCC coding work. It is designed for other disciplines, as well, including finance and analytics professionals. Join us for an introduction to best practices, the opportunity to work through case examples, and to share experiences with your peers. This workshop will zero-in on regulatory compliance while teaching you how to optimize the accuracy of the information gathered and submitted at the practice level. What you will also learn about the way charting is often done, how to overcome “disconnect” with the clinicians and how their typical charting practices and EMRs can create significant problems, and how RADV views documentation in contrast with the way clinicians were taught and EMRs were built initially. Please note: Attendees are encouraged to bring questions to pose to our expert workshop facilitators and to table for the group. We provide your workbook which includes copies of the slide deck. You will not need your coding manuals, but most people bring a laptop or a tablet, as well, for note-taking.   

Dialogue, interact and work in small facilitated groups with peers and colleagues   

  • Understanding the financial overlay – HCC codes mapping to risk adjustment scores   
  • A single coding and documentation process for  
  • Risk adjustment   
  • Skill development on choosing diagnoses from portions of the encounter – permitted and not permitted   
  • Clinical documentation barriers for risk adjustment purposes (data validation audit risks)

Susan Wyatt CPC, CPMA, CPC-I, CHCCS
Healthcare Consulting LLC

Colleen Gianatasio, Director, Ambulatory CDQI
Mount Sinai

2:30PM - 6:00PM EST

Workshop C: Assess Changes to Organizational Structure During and Post Pandemic

  • Examine the positive and negative impacts of professionals working from home to identify sustainability or need to return to the office on an individual basis 
  • Analyze the operational changes that have been made to adapt to the crisis and prepare for future changes as the pandemic evolves to adjust to consumer behavior 
  • Update changes to processes and job descriptions due to changes and offer training to all involved to adapt quickly to the new working environment  

Deb Curry, Manager, Risk Adjustment,
ProMedica

Jennifer Monfils, CPC, CRC, Risk Adjustment Compliance Coding Manager
UCare

November 10, 2020

10:00AM - 10:10AM EST

Welcome Remarks



10:10AM - 10:55AM EST

Keynote Address: Analyze the True Impact of COVID-19 On Risk Adjustment

  • Analyze the possible rebound effect in 2021 with increased claims and a potential negative impact on overall revenue 
  • Calculate the damage caused by of lack of claims in 2020 impacting Risk Score Run Rate 
  • Predict how the RADV Audit postponement may impact plans in 2021 and future years 

Dave Meyer, Vice President, Risk Adjustment and Quality,
Cigna

10:55AM - 11:05AM EST
Session Transition

11:05AM - 11:50AM EST

CMS Regulation Update During Unprecedented Times

Ashby Wolfe, MD, MPP, MPH, Regional Chief Medical Officer
Centers for Medicare & Medicaid Services

11:50AM - 12:00PM EST
Tools and Technology Spotlight

Hear from tools and technology experts on how their solutions can improve efficiencies in your organization. 

12:00PM - 12:30PM EST
Enhanced Networking Time in the Exhibit Hall

Mix and mingle with solution providers and peers to learn the latest and greatest advancements in improving your Risk Adjustment & Quality programs.

12:30PM - 1:15PM EST

Thriving in Value Based Agreements: Addressing The Components of High Performance

  • Take a deeper dive into Value Based Payment arrangements and discover the components that drive success 
  • Understand how utilization management, network management (keepage and leakage), cost of care, and provider and patient engagement all play a role in high-quality performance 
  • Discover tools and strategies to help you implement and improve your risk adjustment, utilization management, and network keepage programs 

Eleesa Marnagh, MPH, Director, Data Strategy, 
Pulse8 

John Barkley, Vice President, Enterprise Risk Adjustment & Data Integrity, 
EmblemHealth/ ConnectiCare  

 

1:15PM - 1:25PM EST
Tools and Technology Spotlight

Hear from tools and technology experts on how their solutions can improve efficiencies in your organization. 

1:25PM - 2:25PM EST
Networking Lunch and Roundtable Discussion

1:25 PM - 2:25 PM EST

Roundtable Discussions

Roundtable A

Utilizing ICD-10 Z Codes to Capture SDoH

Utilize Z codes to predict and prevent negative health outcomes and improve quality of care 

 

Moderator:
Wynda Clayton, MS, RHIT, Risk Adjustment Manager
Providence Health Plan

Roundtable B

Documentation success for major depression, BMI, cancer, and Diabetes


Moderator:
Bill Jonakin, MD, Medical Director, Medicare Advantage and Risk Adjustment,
St. Luke's Health Partners

 

Roundtable C

HCC User Group

Experience the benefits of the RISE HCC user group facilitated by RISE faculty members as they tackle problems and challenges faced in coding and documentation related issues.

Moderator:
Deborah Curry, Manager, Risk Adjustment,
ProMedica

Roundtable D

Strategies to Increase Member Engagement and Increase Visits During the Pandemic

Evaluate new techniques to increase members desire to attend appointments to capture necessary codes

Moderator:
Jessica Savage, Vice President, Risk Adjustment
Healthcare Partners

2:25PM - 3:10PM EST

Incorporate Telehealth into your Long-Term Plan for Risk Adjustment

  • Examine the differences in telehealth opportunities between Medicare, Medicaid, and Commercial to maximize your efforts 
  • Capitalize on new CMS flexibility of virtual visits to capture as much information as possible during telehealth visits and virtual home assessments 
  • Educate your team to improve clinical documentation accuracy to avoid missing valuable codes 

Bahar Sedarati MD, National Medical Director, 
Humana 

Speaker to be announced 

 

3:30PM - 4:15PM EST

Concurrent Sessions

Track A: Clinical Documentation and Coding Precision

Capturing Codes Through Virtual Healthcare

  • Implement training for your coders and auditors on common errors when capturing codes through virtual appointments 
  • Examine commonly missed codes and highlight which codes are difficult to capture during a virtual visit to educate your team 
  • Conduct internal audits to capture any missed coding through virtual appointments in the early stages and incorporate training to improve overall quality  

Wynda Clayton, MS, RHIT, Risk Adjustment Manager
Providence Health Plan

 

Track B: Technology Solution Selection and Integration

Strategies to Improve Health Data Access Through Interoperability

  • Analyze how your current interoperability process is working an identify improvement areas 
  • Identify vendor solutions that can advance electronic data exchange to enhance your current process 
  • Streamline healthcare data exchange with partners and members to increase accessibility of documentation  

Kevin Wang, Chief Medical Officer,
Vera Whole Health

4:15PM - 4:25PM EST
Session Transition

4:25 PM - 5:10 PM EST

Concurrent Sessions

Track A: Clinical Documentation and Coding Precision

Minimize the Time Lag by Improving Realtime Coding and Documentation

  • Incorporate workflow best practices to review EMRs within 24 hours of member visit to capture inefficiencies in coding 
  • Improve collaboration with providers to eliminate missed codes 
  • Strategies to communicate with providers to fix coding errors immediately while the initial visit is top of mind to achieve a higher risk capture 

Adele Towers, MD MPH FACP, CRC, Associate Professor of Medicine and Psychiatry, Director, Risk Adjustment
UPMC Enterprises

Susan Wyatt CPC, CPMA, CPC-I, CHCCS
Healthcare Consulting LLC

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Track B: Technology Solution Selection and Integration

Maximize the Effectiveness of Retrospective Chart Review and Retrieval  

  • Examine how your current retrospective chart review is operating to identify challenges that need to be overcome 
  • Utilize solutions to improve your current retrospective chart review process to capture missed codes 
  • Create an implementation plan of action for new solutions in advance to reduce workflow disruption 
5:10PM - 5:20PM EST
Networking Break

5:20PM - 6:05PM EST

Concurrent Sessions

 

 

Track A: Clinical Documentation and Coding Precision

Process to Establish a Successful Outpatient CDI Department

  • Identify personnel needs and develop your team to obtain desired outcomes 
  • Calculate the critical metrics that need to be measured to optimize retrieved data 
  • Determine healthcare outcomes you wish to achieve and strategies to meet your goal 
  • Discuss how the emergence of SDoH Codes may impact your organization  

Colleen Gianatasio, Director, Ambulatory CDQI
Mount Sinai

 

Track B: Technology Solution Selection and Integration

Maximize Return on Investment Through Virtual Encounters with Members

  • Assess codes being captured virtually to identify areas of improvement 
  • Identify new approaches to enable the capture of more codes to improve risk adjustment 
  • Educate providers on coders to avoid codes slipping through the cracks 

 

Speaker to be announced 

6:05PM - 6:15PM EST

Chairperson Closing Remarks

November 11, 2020

10:00AM - 10:10AM EST

Opening Remarks

10:10AM - 10:55AM EST

Strategies for Improving Encounter Data Collection and Accurate Submission to CMS

  • Preparation for a complete transition to EDPS by January 2022 in order to streamline the change to avoid complications 
  • Generate new work processes for to confirm operational changes are in place and ready to be rolled out 
  • Evaluate data collection and submission methods to ensure accuracy and quality to prevent complications 

 

Speaker to be announced 

10:55AM - 11:05AM EST
Session Transition

11:05AM - 11:50AM EST

Incorporate the Risk Adjustment Playbook to Attain Organizational Goals

  • Analyze every single component of the risk adjustment program to identify areas of improvement 
  • Define and incorporate best practices and targets for each role within the process 
  • Create and implement metrics to achieve and ensure quality from your team to operate efficiently and successfully 

Moderator:
Will Dukes, Director of Business Development
iCare Intelligence, Inc. 

Panelists:
Ryan C Dodson CRC, Regional Manager, Risk Adjustment
Mississippi, New Mexico, and Texas,
Molina Health Care 

Rachel Musacchio, Director of Revenue Operations
Health First Health Plans

  •  

11:50 AM - 12:00 PM

Tools and Technology Spotlight

Hear from tools and technology experts on how their solutions can improve efficiencies in your organization. 

Will Dukes, Director of Business Development,
ICare Intelligence

12:00PM - 12:30PM EST
Enhanced Networking Time in the Exhibit Hall

12:30PM - 1:15PM EST

One Team- One Goal: Identify Desired Outcomes of your Risk Adjustment, Quality Measures, and Care Management Teams

  • Remove the silos in plain sight from your organization by creating a value proposition from all three teams to identify a universal goal 

  • Reduce conflicting messages from the same organization and establish one streamlined communication approach

  • Capture all vital information for all three teams in one visit including CPT II codes, reducing the member burden of multiple visits whilst creating efficiency within your workflow

    Moderator

    Bill Jonakin, MD, Medical Director, Medicare Advantage and Risk Adjustment,
    St. Luke's Health Partners

    Panel

     

    Jatin Dave, Chief Medical Officer and Director of Clinical Affairs
    MassHealth

    Shannon Decker, VP of Clinical Performance
    Brown & Toland

1:00 PM - 1:45 PM
Networking Lunch

1:55PM - 2:40PM EST

Concurrent Sessions

Track A: Audit Uncertainty and Preparation

Commercial Risk Adjustment Regulatory Update

  • Analyze the impact of COVID-19 on and pray that 2022 isn’t the same as 2020 with an 8% medical trend
  • Discuss the evolution of RADV audits. Will recent rule changes end the RADV nightmare or should we hope for future fixes?
  • Examine the regulatory changes CMS plans to propose for 2022 and signs of wear and tear on the 10-year-old program that might need fixing

J. Gabriel McGlamery J.D., Sr. Health Policy Consultant, Government Relations,
Florida Blue

Track B: Provider Engagement

Provider Education in a Virtual World

  • Create training programs to identify difficult to capture codes through telehealth and ways to avoid mistakes 
  • Incorporate advanced training over a period of time and show improvement on results from the initial phase 
  • Offer continued support and guidance to providers as they navigate an unusual concept of member interaction

Randi Escobedo, West Region Director of Strategic Programs
United HealthCare

Kevin Wang, Chief Medical Officer
Vera Whole Health

2:40PM - 2:50PM
Session Transition

2:50PM - 3:35PM EST

Concurrent Sessions

Track A: Audit Uncertainty and Preparation

Mitigate Risk and Prepare your Team for a RADV Audit

  • Implement mock audits to better prepare your staff for the workload required when participating in the real thing while mitigating risk
  • Examine solutions that can help you achieve success in a RADV audit and create an implementation plan
  • Classify individual roles and expectations to enhance success in preparation for an audit

Wynda Clayton, MS, RHIT, Risk Adjustment Manager
Providence Health Plan

Track B: Provider Engagement

Strategies to Avoid Provider Burn Out

  • Balance provider education to filter areas of improvement gradually to avoid overload
  • Prepare provider to be successful with area of education by simplifying desired changes to clinical documentation
  • Delay advancement to next education until provider is comfortable with initial educational changes

Moderator
Bill Jonakin, MD, Medical Director, Medicare Advantage and Risk Adjustment,
St. Luke's Health Partners

Panelists
Eric Harman, MD,
Mountain Region Family Medicine

Steven Graessle, Compliance Review Specialist
St. Elizabeth Physicians

3:35PM - 3:45PM EST
Session Transition

 

 

3:45PM - 4:30PM EST

Concurrent Sessions

Track A: Audit Uncertainty and Preparation

Case Study: Contract and National RADV Audit Success Story from Recently Audited Plans

Hear how your peers have not only survived CMS audits, but thrived through them by:

  • Prepare prior to selection to attain optimal outcomes
  • Implement practical processes once notification is received, to enhance efficiency in the audit process
  • Utilize lessons learned post audit in preparation for future audits


Deborah Curry, Manager, Risk Adjustment,
ProMedica

Jennifer Monfils, CPC, CRC, Risk Adjustment Compliance Coding Manager
UCare

Track B: Provider Engagement

Improve your Current Provider Incentives Program to Obtain Desired Quality

  • Evaluate your current incentive program to identify areas of improvement, especially in a virtual setting
  • Calculate individual provider compensation that match your providers needs, as well as a different scale for successful capturing of codes through telehealth
  • Introduce a tool to measure the success of your incentive program and adapt when changes are needed

Jennifer Ross, Director Risk Adjustment and Compliance Programs,
Aegis Medical Group

Ryan C Dodson CRC, Regional Manager, Risk Adjustment
Mississippi, New Mexico, and Texas
Molina Health Care

4:30PM - 4:40PM EST

Closing Remarks