Agenda

Monday - November 15, 2021

11:30 AM 12:30 PM

10:30 AM 11:30 AM

9:30 AM 10:30 AM

8:30 AM 9:30 AM

Pre-conference workshop A & B Registration and Networking Breakfast

12:30 PM 8:00 PM

11:30 AM 7:00 PM

10:30 AM 6:00 PM

9:30 AM 5:00 PM

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  

 

Deborah Curry, Manager, Risk Adjustment,
ProMedica

Scott Weiner, CRC, CMA, CFM, MBA, Director, Government Programs,
Sentara Health Plan

 

12:30 PM 8:00 PM

11:30 AM 7:00 PM

10:30 AM 6:00 PM

9:30 AM 5:00 PM

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)  

 

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP
Director Clinical Documentation and Quality Improvement (CDQI),
Mount Sinai Hospital System

Colleen Gianatasio, Director, Ambulatory CDQI
Mount Sinai

Laura Sheriff, RN, MSN, CPC, CRC,
Risk Adjustment Specialist

2:00 PM 6:00 PM

1:00 PM 5:00 PM

12:00 PM 4:00 PM

11:00 AM 3:00 PM

Workshop C: RISE Above: Critical Design Thinking for Problem Solving

  • Overcome corporate and personal challenges through a positive design approach 
  • Capitalize on misunderstandings to enable you to locate the root cause of issues 
  • Analyze current processes to identify areas of improvement 
  • Assess the best environment for idea creation 
  • Value the importance of mental breaks to regenerate 
  • Examine personal and team abilities to capitalize on positive attributes and work on abilities that need improvement 
  • Facilitate change within your daily routine to initiate positive outcomes 
  • Learn from others within your circle to increase critical thinking 

Shannon Decker, VP of Clinical Performance 
Brown & Toland 

 

8:00 PM 9:00 PM

7:00 PM 8:00 PM

6:00 PM 7:00 PM

5:00 PM 6:00 PM

Networking Cocktail Reception

Tuesday - November 16, 2021

12:00 PM 1:00 PM

11:00 AM 12:00 PM

10:00 AM 11:00 AM

9:00 AM 10:00 AM

Registration and Networking Breakfast

1:00 PM 1:10 PM

12:00 PM 12:10 PM

11:00 AM 11:10 AM

10:00 AM 10:10 AM

Welcome Remarks

Deborah Curry, Manager, Risk Adjustment,
ProMedica

Shannon Decker, VP of Clinical Performance
Brown & Toland

1:10 PM 2:00 PM

12:10 PM 1:00 PM

11:10 AM 12:00 PM

10:10 AM 11:00 AM

Keynote Address: Relate & Communicate: Simple Skills for Leading Complex Change

  • Analyze the impact of effective communication and relationships when leading changein healthcare 
  • Explore simple skills for creating stronger connections with patients, families, and the healthcare workforce
  • Consider strategies for providing information and feedback in times of complex change 

Laura Cooley, PhD, Senior Director of Education and Outreach
Academy of Communication in Healthcare

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

Strategies to Improve Risk Adjustment Algorithms to Enhance Outcomes

  • Analyze your current approach to improve your members’ risk factors and identify areas for improvement 
  • Assess solutions that can boost your predictive modeling capabilities through a streamlined approach when analyzing large amounts of data 
  • Calculate best practices when closing care gaps to avoid time-consuming approaches with little impact on overall risk score improvement

Scott Stratton, MPH, Chief Data Scientist and VP, Product Analytics, 
Pulse8 

Co-Presenter to be announced 

2:45 PM 2:55 PM

1:45 PM 1:55 PM

12:45 PM 12:55 PM

11:45 AM 11:55 AM

Tools and Technology Spotlight

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

 

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

2:55 PM 3:05 PM

1:55 PM 2:05 PM

12:55 PM 1:05 PM

11:55 AM 12:05 PM

Networking Break

3:05 PM 3:50 PM

2:05 PM 2:50 PM

1:05 PM 1:50 PM

12:05 PM 12:50 PM

Mining the Treasure Trove - AI Unlocks the HCC Coding and Care Improvement Opportunities in Unstructured Data

  • Analyze the role of AI in providing context around patient to deliver better patient care and improved outcomes
  • Understand how NLP and text mining helps derive value from the massive amounts of everyday language sitting in the EHR.
  • Explore the opportunity to improve HCC coding accuracy and alleviate provider's burden.

Dr. Mansoor Khan, ScD, CEO,
Persivia, Inc

Kathy Lyall, Vice President of Specialty Programs,
U.S. Medical Management (USMM) 

 

3:50 PM 4:00 PM

2:50 PM 3:00 PM

1:50 PM 2:00 PM

12:50 PM 1:00 PM

Tools and Technology Spotlight

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

Vijaya Vishwanathan, Director,
Episource

4:00 PM 4:45 PM

3:00 PM 3:45 PM

2:00 PM 2:45 PM

1:00 PM 1:45 PM

Networking Lunch

Concurrent Sessions 4:45 PM - 5:30 PM 3:45 PM - 4:30 PM 2:45 PM - 3:30 PM 1:45 PM - 2:30 PM

4:45 PM 5:30 PM

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

Is 95% Coding Accuracy Good Enough? The Power of NLP-Targeted Second-Level Review

Track A: Coding Accuracy and Technology Coding Resources
  • Understand the challenges and risks associated with under and over-coding
  • Learn what to look for in an NLP engine and how to leverage NLP-powered second-level reviews to “look both ways”
  • Assess the importance of closing the loop and improving future documentation

Erik Simonsen, Chief Operating Officer,  
Episource 

Thomas Nasadoski, Director, Risk Adjustment and Recovery,  
CDPHP 

 

4:45 PM 5:30 PM

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

Methods to Improve and Target Recapture and Suspecting Conditions

Track B: Cost Cutting Tech Solutions and Services
  • Analyze strategies to capitalize on the low hanging fruit accessible through recapture
  • Ensure that the data that you recapture is accurate and compliant
  • Examine successful criteria when suspecting to ensure accuracy

Bryan Lee, VP Solutions,
Apixio

Christopher Towner, CCS, Manager, Risk Adjustment Analytics
Providence

 

Concurrent Session 5:30 PM - 6:15 PM 4:30 PM - 5:15 PM 3:30 PM - 4:15 PM 2:30 PM - 3:15 PM

5:30 PM 6:15 PM

4:30 PM 5:15 PM

3:30 PM 4:15 PM

2:30 PM 3:15 PM

Are we Coders or Auditors?: Understand the Complete Role of a Coder

Track A: Coding Accuracy and Technology Coding Resources
  • Evaluate your role as both a coder and an auditor to guarantee you are completing the full task at hand
  • Examine strategies to adapt, evolve, and grow as a coder to remain a valuable asset to your organization
  • Explore educational training methods for coders to continue your growth and development
  • Understand the organizational structure to streamline communication with the appropriate stakeholders within your organization

 

Moderator
Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP
Director Clinical Documentation and Quality Improvement (CDQI),
Mount Sinai Hospital System

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

Deb Curry, MBA, RHIA, CCS-P, CRC, Manager, Risk Adjustment,
Promedica

 

5:30 PM 6:15 PM

4:30 PM 5:15 PM

3:30 PM 4:15 PM

2:30 PM 3:15 PM

Strategies to Calculate ROI for Suspecting Integrity Analytics

Track B: Cost Cutting Tech Solutions and Services
  • Analyze best practices with strategic targeting to confirm that your approach has the optimal chance for success
  • Minimize the noise by streamlining your efforts to pinpoint errors
  • Assess the value of your suspecting efforts after strategic targeting to ensure you are maximizing your return

 

Stephen Muldoon, Actuary, Risk Adjustment,
Sentara Health Plans

Rafi Cices, Associate Director, Value Capture Strategy & Analytics
Oscar Health

 

6:15 PM 6:30 PM

5:15 PM 5:30 PM

4:15 PM 4:30 PM

3:15 PM 3:30 PM

Networking Break

Concurrent Sessions 6:30 PM - 7:15 PM 5:30 PM - 6:15 PM 4:30 PM - 5:15 PM 3:30 PM - 4:15 PM

6:30 PM 7:15 PM

5:30 PM 6:15 PM

4:30 PM 5:15 PM

3:30 PM 4:15 PM

Establish, Improve, and Maintain a Successful Outpatient CDI Department

Track A: Coding Accuracy and Technology Coding Resources
  • Generate an understanding of personnel needs to operate an efficient and successful CDI department
  • Examine which critical metrics need to be measured to improve the value of data retrieved from chart review
  • Create and implement benchmarks to calculate the success of the CDI department and implement changes to increase accuracy

Colleen Gianatasio, Director, Ambulatory CDQI
Devoted Health

 

6:30 PM 7:15 PM

5:30 PM 6:15 PM

4:30 PM 5:15 PM

3:30 PM 4:15 PM

Seamless Integration of all Services with Providers

Track B: Cost Cutting Tech Solutions and Services
  • Identify which services need to be integrated or updated with your providers to generate a plan of action
  • Coordinate and communicate the objective and changes to the providers to avoid disruption within their daily workflows
  • Implement, test, and analyze the integration to ensure quality and accuracy have been achieved through the seamless integration

Shannon Decker, VP of Clinical Performance 
Brown & Toland 

 

7:15 PM 8:00 PM

6:15 PM 7:00 PM

5:15 PM 6:00 PM

4:15 PM 5:00 PM

Analyze Key Risk Adjustment Metrics to Enhance Efficiency

  • Assess different strategies to identify key risk adjustment metrics 
  • Create an accurate system to measure and analyze the key metrics impacting your risk adjustment program   
  • Examine the impact on your overall program, and which processes can be developed to increase efficiency 

Eric Hedrick, VP of Analytics
Advantmed

Mark Ishimatsu, Director of Enterprise Risk Adjustment
L.A. Care

8:00 PM 8:10 PM

7:00 PM 7:10 PM

6:00 PM 6:10 PM

5:00 PM 5:10 PM

Tools and Technology Spotlight

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

 

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

8:10 PM 8:20 PM

7:10 PM 7:20 PM

6:10 PM 6:20 PM

5:10 PM 5:20 PM

Chairperson Closing Remarks

Deborah Curry, Manager, Risk Adjustment,
ProMedica

Shannon Decker, VP of Clinical Performance
Brown & Toland

8:20 PM 9:20 PM

7:20 PM 8:20 PM

6:20 PM 7:20 PM

5:20 PM 6:20 PM

Networking Cocktail Reception

Wednesday - November 17, 2021

11:00 AM 12:00 PM

10:00 AM 11:00 AM

9:00 AM 10:00 AM

8:00 AM 9:00 AM

Networking Breakfast

12:00 PM 12:10 PM

11:00 AM 11:10 AM

10:00 AM 10:10 AM

9:00 AM 9:10 AM

Opening Remarks

Deborah Curry, Manager, Risk Adjustment,
ProMedica

Shannon Decker, VP of Clinical Performance
Brown & Toland

12:10 PM 1:00 PM

11:10 AM 12:00 PM

10:10 AM 11:00 AM

9:10 AM 10:00 AM

Keynote Address: Exclusive CMS Update to the RISE Risk Adjustment Forum

  • Industry Update: Post COVID-19 reflection on risk adjustment 
  • Review of CMS policy changes in 2021 
  • Analyze the Physician Fee Schedule regulation update 
  • Contract year Medicare Advantage advance notice  
  • Explore the CMMI models to gain a valuable understanding  

 

Moderator 
Moderator to be announced 

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

 

1:00 PM 1:10 PM

12:00 PM 12:10 PM

11:00 AM 11:10 AM

10:00 AM 10:10 AM

Tools and Technology Spotlight

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

 

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

1:10 PM 1:55 PM

12:10 PM 12:55 PM

11:10 AM 11:55 AM

10:10 AM 10:55 AM

Examine the Top Three Commercial Risk Adjustment Issues

  • Analyze the importance of mitigating the impact of adverse selection to ensure integrity 
  • Discuss the value of differentiation in market segments and comprehend potential problems for small groups  
  • Analyze the CSR factors and social determinants of health for different populations 

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

1:55 PM 2:10 PM

12:55 PM 1:10 PM

11:55 AM 12:10 PM

10:55 AM 11:10 AM

Networking Break

2:10 PM 2:55 PM

1:10 PM 1:55 PM

12:10 PM 12:55 PM

11:10 AM 11:55 AM

Case Study: Create Valuable Connections Between Medicare Advantage and Commercial

  • Analyze best practices with in MA and Commercial risk adjustment to improve accurate code capture 
  • Assess the quality of your contracting to increase vertical integration and reduce total cost of care 
  • Understand the direct crossover of direct primary care between MA and Commercial for varying populations within your membership 

 

Kevin Wang, M.D., Chief Medical Officer
Vera Whole Health

Khrista Achtermann, Executive Director
Columbus – Agilon
Director of Population Health Services
Central Ohio Primary Care

Concurrent Sessions 2:55 PM - 3:40 PM 1:55 PM - 2:40 PM 12:55 PM - 1:40 PM 11:55 AM - 12:40 PM

2:55 PM 3:40 PM

1:55 PM 2:40 PM

12:55 PM 1:40 PM

11:55 AM 12:40 PM

Remote Teamwork Success! Preparing for a RADV Audit with a Remote Workforce

Track A: Post Pandemic RADV Audits
  • Generate a watertight schedule with deadlines for all important milestones for each stakeholder to ensure accountability
  • Address potential communication issues and set expectations on timeliness of responses to avoid complications
  • Assess potential challenges that may be faced and create an action plan in case of an emergency
  • Work through mock audits to improve collaboration and teamwork in preparation for the RADV Audit

 

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

PaHua Cha, Lead of Program Integrity,  
Devoted Health 

Jennifer Ross, Director of Revenue Cycle Management,
Aegis Medical Group

 

2:55 PM 3:40 PM

1:55 PM 2:40 PM

12:55 PM 1:40 PM

11:55 AM 12:40 PM

Total Education: Reach Every Staff Member Within the Office

Track B: Engaging and Educating Valuable Providers
  • Reduce costly errors be ensuring that every stakeholder within the providers office receives quality education and guidance to catch errors and assist with accurate documentation
  • Increase the sense of value by introducing a structured incentive program for the entire staff to obtain “buy-in” and commitment to success
  • Install training programs for all new employees to guarantee that they enter the organization equipped and prepared to be successful

 

Moderator
Ryan C. Dodson, CRC , Senior Vice President of Operations,
New Vision Healthcare Solutions

Panelists
Susan Waterman RHIT, CCS, CPC, CRC, Director of Risk Adjustment,
Scott and White Health Plan

Laura Sheriff, RN, MSN, CPC, CRC,
Risk Adjustment Specialist

 

3:40 PM 3:50 PM

2:40 PM 2:50 PM

1:40 PM 1:50 PM

12:40 PM 12:50 PM

Tools and Technology Spotlight

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

 

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

3:50 PM 4:45 PM

2:50 PM 3:45 PM

1:50 PM 2:45 PM

12:50 PM 1:45 PM

Networking Lunch

Concurrent Sessions 4:45 PM - 5:30 PM 3:45 PM - 4:30 PM 2:45 PM - 3:30 PM 1:45 PM - 2:30 PM

4:45 PM 5:30 PM

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

We Survived! Audit Complete- What’s Next?

Track A: Post Pandemic RADV Audits
  • Assess what documentation is needed after completing an OIG audit, to eliminate any post audit complications
  • Analyze the best ways to use results from ACA audits to prepare for annual audits in advance and reduce administrative burden
  • Prepare in advance for a CMS RADV Audits , as CMS are dramatically increasing the number of plans they audit each year
  • Examine the changes to RADV Audit sample selection and specific HCC code requirements

Deborah Curry, Manager, Risk Adjustment,
ProMedica

Jenni Monfils, Director, Risk Adjustment Coding and Compliance,
Bright Healthcare

4:45 PM 5:30 PM

3:45 PM 4:30 PM

2:45 PM 3:30 PM

1:45 PM 2:30 PM

Strategies to Maximize Valuable Providers Time with Precise Training

Track B: Engaging and Educating Valuable Providers
  • Maximize your training efforts with providers to utilize their valuable time and capture their attention with short video training series that are easily accessible and provide essential content.
  • Utilize pocket guides with critical information that can be carried easily by busy providers that are constantly on the go
  • Generate a calendar to set up reminders during providers less busy periods to increase the probability that your providers will act on them

Sony Naing, MSN, FNP-C, RN, Family Nurse Practitioner,
Providence-Axminster Medical Group

Dr. Carlos Rodriguez, IMG, Senior Medical Risk Adjustment Analyst,
Aegis Clinics MRA Manager

5:30 PM 6:15 PM

4:30 PM 5:15 PM

3:30 PM 4:15 PM

2:30 PM 3:15 PM

The Final Word: Risk Adjustment Specialist Industry Review

  • Examine the changes that have been a success post pandemic and the direction you plan to take moving forward 
  • Discuss the changes announced from CMS, how they will impact your operation, and adjustments that will need to be made to remain successful 
  • Explore what the outlook of 2022 will have on risk adjustment and how to prepare for a prosperous year  

Moderator

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP
Director Clinical Documentation and Quality Improvement (CDQI),
Mount Sinai Hospital System

Panelists
Scott Weiner, CRC, CMA, CFM, MBA, Director, Government Programs,
Sentara Health Plan

Shannon Decker, VP of Clinical Performance
Brown & Toland

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

 

6:15 PM 6:25 PM

5:15 PM 5:25 PM

4:15 PM 4:25 PM

3:15 PM 3:25 PM

Closing Remarks

Deborah Curry, Manager, Risk Adjustment,
ProMedica

Shannon Decker, VP of Clinical Performance
Brown & Toland