Agenda

June 25, 2021

10:00AM - 4:00PM EST

Virtual Pre-Conference 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  

Deborah Curry, Manager, Risk Adjustment,
ProMedica

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

TrackB

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 notetaking.   

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, Director Coding & Provider Education,
Tufts Health Plan

Colleen Gianatasio, Director, Ambulatory CDQI
Devoted Health

4:00PM - 5:00PM EST

Virtual Networking Reception

Turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of your home to access those hallway conversations we’ve all been missing. 

June 30, 2021

9:00AM - 10:00AM EST

Morning Networking Reception

In-person attendees will enjoy a socially distanced reception, compliant with CDC guidelines, providing networking opportunities among other in-person attendees, speakers, and solutions providers. For virtual attendees, turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of their home. No matter how you join, you’ll have access to those hallway conversations we’ve all been missing. 

10:00AM - 10:10AM EST

Welcome Remarks

10:10AM - 10:55AM EST

Keynote Address: Deep Dive: An In-Depth Discussion on the Impact of the Pandemic on Risk Adjustment

  • Analyze the overall impact on claims data and risk score to identify how the ripple effect may damage your plan for 2022 and onwards 
  • Discuss CMS flexibility options to enable relief from oncoming industry set back due to COVID 
  • Strategies to be best prepared to tackle 2022 and 2023 to ensure efficiency and achieve targeted goals 
  • Examine the importance of member education surrounding the COVID Vaccine to encourage them to participate and enable them to return to scheduled physician appointments  

Ben Hammersley
International Strategic Forecaster

10:55AM - 11:10AM EST
Networking Break

11:10AM - 11:55AM EST

Review of the 2022 HHS Notice of Benefit and Payment Parameters and Upcoming 2021 Benefit Yea

  • Analyze the 2022 HHS Notice of Benefit and Payment Parameters  
  • Discuss the operational and process changes for 2021, including any guidelines impacting telehealth  
  • Assess the changes to RADV Audits and schedules for the upcoming 12 months and organize your team to be ready to achieve a successful audit 

Elizabeth Parish, Group Director of Payment Policy and Financial Management Group
Centers for Medicare & Medicaid Services
Consumer Information and Insurance Oversight

Adrianne Patterson, Director, Division of Policy & Analysis in the Payment Policy and Financial Management Group,
Centers for Medicare & Medicaid Services
Consumer Information and Insurance Oversight

Milan Shah, Director, Division of Reinsurance Operations in the Payment Policy and Financial Management Group
Centers for Medicare & Medicaid Services
Consumer Information and Insurance Oversight

11:55AM - 12:05PM EST

Tools and Technology Spotlight

 

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

12:05PM - 12:20PM EST
Networking Break

12:20PM - 1:05PM EST

Seen One Managed Medicaid Program, You’ve Seen….

Exactly One Managed Medicaid Program. With six different grouper models, regional contracts within each state, quality bonuses, withholds, or penalties… no two state programs are exactly alike! 1,115 Waivers, SDOH, members moving in and out – there’s just so much to manage! The good news is that there are multiple helpful analytic tools and technologies to make sense of it all. 

  • Discover the fundamental and nuanced differences between different Medicaid and Medicare programs 
  • Understand the repercussions of COVID-19 in the 2020 market and what they mean for you 
  • Discuss best practices and strategies to reach Medicaid members and close chronic risk gaps 

Christina Keesecker, Senior Director, Medicaid Product Solutions,
Pulse8

Michael Baker, Director, Enterprise Risk Adjustment
EmblemHealth | ConnectiCare

1:05PM - 2:05PM EST
Lunch & Networking Break
2:05PM - 2:10PM EST
Transition & Opening Remarks for Track Sessions

2:10PM - 2:55PM EST

Concurrent Sessions

Track A: Technology Solutions to Improve Risk Adjustment

Best Practices for Managing Multiple EMR Systems

  • Call out the problem: Address healthcare’s data problem and improve your quality and risk adjustment programs through better data access. 
  • Lead the pack: Transport your EMR process forward by moving to prospective solutions that offer true and transparent access to unstructured data.  
  • Putting the member first: Improve member outcome by implementing strategies that identify and close risk gaps at the point of care. 

Moderator
Bryan Lee, Vice President, Solutions,
Apixio

Panelists
Shannon Decker, VP of Clinical Performance
Brown & Toland

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

Track B: Risk Adjustment Compliance

Introduce Incentive Programs to Achieve Compliance

  • Create and implement incentives for providers to ensure compliant documentation and eliminate costly errors 
  • Provide continued education to providers to avoid under or over coding to remain compliant and achieve incentive 
  • Install audits for each provider to examine success rate of incentive program and also highlight problematic areas that could relate to issues in a RADV Audit 

Laura Sheriff, RN, MSN, CPC, CRC, National Director, Risk Adjustment, 
Molina Healthcare, Inc.

Jason McDaniel, Vice President, Risk Adjustment & Quality 
Intermountain Healthcare, Nevada  

Track B: Risk Adjustment Compliance

Strategies to Identify Fraudulent Activity in Coding

  • Best practices when overviewing billing practices to identify fraud through over coding including the key items to look out for 
  • Generate mechanisms for compliance members to easily track continuous issues of over coding and create a plan to educate the provider 
  • Examine the steps that need to be taken when fraudulent activities occur to remain compliant and avoid costly sanctions from CMS 

Deborah Curry, Manager, Risk Adjustment, 
ProMedica 

Sherry Miller, D.M., CHC, CHPC, CPC, CRC, CEMC, Compliance Officer,  
Beaver Medical Group and EPIC Health Plan  

 

Track C: Technology and Compliance

Solutions to Capture Valuable Codes in Real Time

  • Examine possibilities of capturing missed codes within a minimal timeframe of the physician interaction with member to make amendments to the records 
  • Prepare your physician in advance with as much data as possible to reduce physician burden and reduce error rate 
  • Provide education to physician on commonly missed codes to increase valuable accurate coding  

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

 

Track C: Technology and Compliance

Improve Outcomes by Identifying Solutions to Assist Pre and Post RADV Audit

  • Examine the process in preparing for a RADV audit, or multiple audits, and which areas can be improved to achieve a smooth audit 
  • Implement training mechanisms for team members to balance their daily workload as well as preparation needs for an audit 
  • Evaluate your organizations post audit action plan in preparing documentation to finalize the process 

Jessica Savage, Vice President, Risk Adjustment
Healthcare Partners (Invited)

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

2:55PM - 3:10PM EST
Networking Break / Transition

3:10PM - 3:55PM EST

Concurrent Sessions

Track A: Technology Solutions to Improve Risk Adjustment

Capitalize on Natural Language Processing to Improve Compliance within your Organization

  • Avoid potential lawsuits with the DOJ or complications with CMS audits by utilizing NLP solutions to increase coding accuracy 
  • Adjust invalid claims through redaction to confirm accuracy of documentation 
  •  Maximize your tools to increase provider awareness of coding challenges to dramatically reduce error rate in coding 

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

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

Track B: Risk Adjustment Compliance

Strategies to Identify Fraudulent Activity in Coding

  • Best practices when overviewing billing practices to identify fraud through over coding including the key items to look out for 
  • Generate mechanisms for compliance members to easily track continuous issues of over coding and create a plan to educate the provider 
  • Examine the steps that need to be taken when fraudulent activities occur to remain compliant and avoid costly sanctions from CMS 

Deborah Curry, Manager, Risk Adjustment,
ProMedica

Sherry Miller, D.M., CHC, CHPC, CPC, CRC, CEMC, Compliance Officer,
Beaver Medical Group and EPIC Health Plan

Track B: Risk Adjustment Compliance

Introduce Incentive Programs to Achieve Compliance

  • Create and implement incentives for providers to ensure compliant documentation and eliminate costly errors 
  • Provide continued education to providers to avoid under or over coding to remain compliant and achieve incentive 
  • Install audits for each provider to examine success rate of incentive program and also highlight problematic areas that could relate to issues in a RADV Audit 

 

Laura Sheriff, RN, MSN, CPC, CRC, National Director, Risk Adjustment, 
Molina Healthcare, Inc.  

Jason McDaniel, Vice President, Risk Adjustment & Quality 
Intermountain Healthcare, Nevada 

 

Track C: Technology and Compliance

Improve Outcomes by Identifying Solutions to Assist Pre and Post RADV Audit

  • Examine the process in preparing for a RADV audit, or multiple audits, and which areas can be improved to achieve a smooth audit 
  • Implement training mechanisms for team members to balance their daily workload as well as preparation needs for an audit 
  • Evaluate your organizations post audit action plan in preparing documentation to finalize the process 

 

Jessica Savage, Vice President, Risk Adjustment 
Healthcare Partners (Invited) 

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

 

Track C: Technology and Compliance

Solutions to Capture Valuable Codes in Real Time

  • Examine possibilities of capturing missed codes within a minimal timeframe of the physician interaction with member to make amendments to the records 
  • Prepare your physician in advance with as much data as possible to reduce physician burden and reduce error rate 
  • Provide education to physician on commonly missed codes to increase valuable accurate coding  

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

 

3:55PM - 4:10PM EST
Networking Break

4:10PM - 4:55PM EST

Discuss the Evolving Role of the Coder and Coder Education

  • Analyze new techniques to enhance your working relationships with providers to benefit both parties 
  • Understand the value of precise, clear, and timely communication to achieve the best outcomes 
  • Examine additional educational practices that are now a necessity to educate your coders for best possible results 

 

Dawn Peterson, Director of Risk Adjustment,  
Martin’s Point Health Care (Invited) 

Donald Hendrix, Manager of RA and HEDIS Chart Review,  
Martin’s Point Health Care (Invited) 

 

4:55PM - 5:00PM EST

Closing Remarks

5:00PM - 6:00PM EST

Networking Reception

In-person attendees will enjoy a socially distanced reception, compliant with CDC guidelines, providing networking opportunities among other in-person attendees, speakers, solutions providers and guests. Be sure to RSVP when you register. As an attendee you can bring a guest to our evening reception. 

For virtual attendees, turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of their home. No matter how you join, you’ll have access to those hallway conversations we’ve all been missing. 

July 1, 2021

9:00AM - 10:00AM EST

Morning Networking

In-person attendees will enjoy a socially distanced reception, compliant with CDC guidelines, providing networking opportunities among other in-person attendees, speakers, and solutions providers. For virtual attendees, turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of their home. No matter how you join, you’ll have access to those hallway conversations we’ve all been missing. 

10:00AM - 10:10AM EST

Welcome Remarks and Day One Recap

10:10AM - 10:55AM EST

The Final Push: Preparations for Complete Transition from RAPS to EDS

  • Examine the changes that you have implemented already to identify opportunities for improvement leading into 2022 
  • Introduce training to all stakeholders to ensure consistency in reporting to achieve optimal results 
  • Discuss how you have utilized the CMS 6-month extension to your advantage to overall preparation for the transition 

Shannon Decker, VP of Clinical Performance 
Brown & Toland 

Fahad Ahmed 
Independent Consultant   

 

10:55AM - 11:10AM EST
Networking Break

11:10AM - 11:55AM EST

Panel Discussion: Examine Changes to RADV Audits in MA and Commercial Plans

  • Examine recent changes that focus on targeted audits for commercial plans to prepare make certain you are ready for the next audit 
  • Discuss changes to MA RADV Audits including the postponement of audits in 2020 
  • Analyze CMS changes to the HHS-RADV Error rate calculation and HHS- RADV risk adjustment transfer to confirm you will benefit from the changes 

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


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

Dean Ratzlaff, Director, Actuary/Revenue Management,
Sentara Health Plans

 

11:55AM - 12:05PM EST

Tools and Technology Spotlight

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

12:05PM - 12:20PM EST
Networking Break & Opening Remarks for Track Sessions

12:20PM - 1:05PM EST

Concurrent Sessions

Track A: Risk Adjustment Leadership Techniques for Development and Progress

Strategies for Remote Worker Success

  • Best practices to assure optimal performance with remote team members to motivate them to reach valuable team goals 
  • Identify areas of improvement needed and address them in a positive manner by offering support, understanding challenges that remote workers are facing 
  • Create a communication balance to allow team members freedom to complete their objectives, while providing enough engagement, information, guidance, and support  


Colleen Gianatasio, Director, Ambulatory CDQI
Devoted Health 


Dean Ratzlaff, Director, Actuary/Revenue Management
Sentara Health Plans

 

Track B: Telehealth Impact on Risk Adjustment

Assess the Success of Telehealth within your Organization So Far

  • Assess the success of your current telehealth operation and how it has helped risk adjustment within your organization since the beginning of the pandemic 
  • Calculate which areas were less effective and how it may harm you in the long run 
  • Explore which strategies were most impactful when engaging members through telehealth 

Laura Sheriff, RN, MSN, CPC, CRC, National Director, Risk Adjustment,
Molina Healthcare, Inc.

Track C: Audits and Workflow

Firsthand Experience: Lessons Learned from Conducting Two Simultaneous RADV Audits

  • Examine the necessary preparation to conduct multiple audits and identify the challenges to overcome 
  • Create an action plan for all stakeholders involved to avoid miscommunication or errors when conducting the audit 
  • Implement training and education prior to the audits to prevent errors during the actual HHS RADV Audits    

Deborah Curry, Manager, Risk Adjustment,
ProMedica

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

Track B: Telehealth Impact on Risk Adjustment

Examine the Differences and Advantages Between Telehealth for MA v’s Commercial Plans

  • Analyze the key differences between telehealth across multi lines of business to ensure you are capturing all codes through telehealth visits
  • Identify commonly missed codes or codes that cannot be captured through telehealth and examine best practices to obtain all information necessary
  • Discuss the differences between traditional claims v’s telehealth claims as you prepare to balance both forms of coding members health with a hybrid approach

 

Speaker to be announced

Track C: Audits and Workflow

Techniques to Generate Efficient Workflow from your Multi Product Team

  • Examine your current workflows managing membership in a variety of insurance backgrounds to identify areas of improvement 
  • Create and implement developmental techniques to improve productivity and communication throughout your departments 
  • Evaluate total membership population to confirm that the appropriate resources within your department are assigned accurately to be most effective.  

Shannon Decker, VP of Clinical Performance 
Brown & Toland  


Speaker to be announced 

 

1:05PM - 2:20PM EST
Lunch & Networking Break - Return to Tracks

2:05PM - 2:50PM EST

Concurrent Tracks

Track A: Risk Adjustment Leadership Techniques for Development and Progress

Building the Dream Team: Strategies to Improve Communication and Collaboration with Valuable Teams within your Organization

  • Worker smarter! Generate success from the key departments within your organization to achieve overall operational goals rather than individual team goals
  • Examine the importance of risk adjustment on the CAHPS survey which is heavily weighted for quality measures to ensure best outcomes
  • Generate goals and metrics to identify success and areas of improvement to promote collaboration as the key to success

 

Jason McDaniel, Vice President, Risk Adjustment & Quality
Intermountain Healthcare, Nevada

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

Track B: Telehealth Impact on Risk Adjustment

Examine the Differences and Advantages Between Telehealth for MA v’s Commercial Plans

  • Analyze the key differences between telehealth across multi lines of business to ensure you are capturing all codes through telehealth visits
  • Identify commonly missed codes or codes that cannot be captured through telehealth and examine best practices to obtain all information necessary
  • Discuss the differences between traditional claims v’s telehealth claims as you prepare to balance both forms of coding members health with a hybrid approach

 

Speaker to be announced

Track B: Telehealth Impact on Risk Adjustment

Assess the Success of Telehealth within your Organization So Far

  • Assess the success of your current telehealth operation and how it has helped risk adjustment within your organization since the beginning of the pandemic
  • Calculate which areas were less effective and how it may harm you in the long run
  • Explore which strategies were most impactful when engaging members through telehealth

Laura Sheriff, RN, MSN, CPC, CRC, National Director, Risk Adjustment
Molina Healthcare, Inc.

Speaker to be announced

 

Track C: Audits and Workflow

Techniques to Generate Efficient Workflow from your Multi Product Team

  • Examine your current workflows managing membership in a variety of insurance backgrounds to identify areas of improvement
  • Create and implement developmental techniques to improve productivity and communication throughout your departments
  • Evaluate total membership population to confirm that the appropriate resources within your department are assigned accurately to be most effective.

 

Shannon Decker, VP of Clinical Performance
Brown & Toland

Speaker to be announced

Track C: Audits and Workflow

Firsthand Experience: Lessons Learned from Conducting Two Simultaneous RADV Audits

  • Examine the necessary preparation to conduct multiple audits and identify the challenges to overcome
  • Create an action plan for all stakeholders involved to avoid miscommunication or errors when conducting the audit
  • Implement training and education prior to the audits to prevent errors during the actual HHS RADV Audits

 

Deborah Curry, Manager, Risk Adjustment,
ProMedica

Jenni Monfils, Director Risk Adjustment Coding Compliance Coding
Bright Healthcare

 

2:50PM - 3:05PM EST
Networking Break

3:05PM - 3:50PM EST

Industry Leader Wrap Up Discussion

  • Examine the state of the industry and identify trends that may impact risk adjustment in the near future  
  • Analyze necessary changes to workflow that can improve productivity and increase your bottom line 
  • Anticipate and prepare for upcoming changes from CMS based on the resent change to presidential leadership  

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

Panelists
Jessica Savage, Vice President, Risk Adjustment
Healthcare Partners (Invited)

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

3:50PM - 4:00PM EST

Conference Closing Remarks