Agenda

June 9th, 2019

7:00 AM
Workshop A & B Registration Opens
7:00 AM
Networking Continental Breakfast

8:00 AM

Concurrent Sessions

8:00 AM

Workshop A: Foundations of Risk Adjustment

• 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 EDPS? The latest in a long journey
• Provider engagement strategies for impacting 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

8:00 AM

Workshop B: HCC Coding Accuracy

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. 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 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 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 quality improvement
• Billing E&M CPT codes
• 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)

 

4:00 PM
RISE Welcome Reception in Exhibit Hall

June 10th, 2019

8:00 AM
Registration Desk Opens and Networking Breakfas
8:00 AM
Exhibit Hall Opens

9:00 AM

Opening Remarks

9:10 AM

Keynote Address

CMS

10:10 AM

Regulatory Roundtable: Updates, Guidance and Next Steps

• Understand the impact and prepare for the transitions to EDPS
• Identify CMS’ policy direction for Medicare Advantage risk adjustment potential gaps to meet new, more stringent demands
• Strategies for implanting the latest technologies while keeping compliant with regulatory demands

11:00 AM
Networking Break in Exhibit Hall

11:20 AM

Best Practices for Improving Health Outcomes and Reducing Spending

• Payer/provider collaboration, engagement and education
• Provider network, reporting and quality of care
• Developing partnerships, improving communication and incentives that actually make a difference
• Reducing the silo effect » How to use risk adjustment and HEDIS data analytics to improve prospective  activity outcomes for both initiatives

12:20 PM
Networking Lunch

1:20 PM

Implementing Key Measures to Ensure Accurate Plan Revenue

• Learn how to evaluate your risk adjustment program and close compliance gaps
• Maximizing coding accuracy
• Developing best practices for successful internal audits
• Selecting and keeping the right revenue tea

2:20 PM

Creating a High-Performance Risk Adjustment Revenue Team

• Developing an efficient and future-focused team
• Discussing best practices for resource allocation
• Setting quality assurance measures
• Understanding the pros and cons of cross-functioning team

3:20 PM
Networking Break in Exhibit Hall

3:40 PM

Getting You and Your Team RADV Audit Ready

• Training and educating your coding team to ensure accuracy and compliance
  Capturing patient historical data
• Understanding the financial impact of the upcoming audit
  Potential fines and implications
• Deep dive into audit trends from CMS and experiences from other health plans » Utilizing independent    auditors
• How are plans getting ready?

5:00 PM
Networking Cocktail Reception in Exhibit Hall

June 11th, 2019

8:00 AM
Registration Desk Opens and Networking Breakfast
8:00 AM
Exhibit Hall Opens

9:00 AM

Welcome Remarks and Day One Takeaways

9:10 AM

Keynote Address

Healthcare futurist in RA
IBM Watson group
Machine learning and AI from MIT

10:00 AM

Technology Advancements – The Impact in Your Risk Adjustment Program and Beyond

• Utilizing the right technology to help reduce cost
• Recap on the latest technology solutions and their role in coding accuracy
   -Is NLP the way of the future?
• Learn how technology can enhance the member experience and improve engagement
• Hear tips on how to use technology to improve communication with providers and integrate systems

11:00 AM
Networking Break in Exhibit Hall

11:20 AM

Concurrent Sessions

11:20 AM

Track A: Risk Adjustment Strategies

Risk-Based Compliance Approach


• Tap into member-centric data analysis to identify the greatest areas of compliance risk
• Foresee potential future compliance problems and line up resources to prevent or mitigate negative       impact
• Address highest impact risk areas in the short and long term

11:20 AM

Track B: Technologies and Innovations

Managing Operations and Outcomes During Contract Consolidation and Acquisitions


• Hear from your peers how to survive and thrive during acquisitions, while keeping costs low and utilizing resources efficiently
• Identifying strategies for consolidating benefits
• Developing a plan for combining conflicting practices involving pay for performance, pay for quality, reimbursements and staff models
• Creating a smooth transition for members as well as staff

 

12:20 PM
Networking Lunch

1:20 PM

Concurrent Sessions

1:20 PM

Track A: Dual Eligibility Models/Medi Operations and Programs Optimization


• Learn how to develop a sustainability plan for dual eligibility models
• Leveraging existing resources to provide high quality, integrated healthcare services
• Addressing payment challenges surrounding dual eligible beneficiaries

1:20 PM

Track B: Lessons Learned from Coders and Tips to Achieve Maximum Accuracy

• Case studies and open discussion

2:25 PM

Concurrent Sessions

2:25 PM

Track A: The Increasing Critical Role of Vendors: Partnering and Achieving Success

• Scaling your CEO’s request for SDoH activity
• Discussing the latest trends in outsourcing
• Establishing line of oversight and setting KPI’s
• Identifying a process of onboarding and off boarding vendors and solution providers
• Strategies for getting your vendors audit ready
• Selecting and comparing vendors and mastering the RFP process

2:25 PM

Track B: Risk Adjustment, Data Governance and Compliance, and Why Do We Need It?

• Growing risks and skills risk adjustment leaders need to help plans mitigate
• Implementing procedures and policies to keep enterprise data’s integrity, usability and security
• Leveraging existing data to create holistic view of clients and its impact on your bottom line
• Cloud computing in healthcare: Does it work? Is it safe?
• Utilizing data to enhance care services and personalize client experience

3:25 PM

Conference Adjourns