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: 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 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

Instructors:

Laura Sheriff, RN, MSN, CPC, CRC, Regional Director, Risk Adjustment
FL, MS, NM, NY, OH, SC, TX
Molina Healthcare, Inc.

Susan Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS, Trainer, Director, Risk Adjustment 
Scott & White Health Plan 

 

Scott Weiner, CMA, CFM, MBA, President
Quadralytics

 

 

 

8:00 AM

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  
  • 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)   

 

Instructor:  

Donna Malone, CPC, CRC, Senior Manager, Enterprise Risk Adjustment, HCC Coding and Quality Assurance
Tufts Health Plan

4:00 PM
RISE Welcome Reception in Exhibit Hall

June 10th, 2019

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

9:00 AM

Welcome Remarks

Co-Chairs:

RaeAnn Grossman, Chief Growth Officer
DataLink Software

Scott Filiault ,Chief Revenue Officer
Pulse8

9:10 AM

Keynote Address

Rebecca Paul, Acting Deputy Director, Medicare Plan Payment Group
Center for Medicare & Medicaid Services (CMS)

10:10 AM

Regulatory Roundtable: Updates, Guidance and Next Steps

  • Understand the impact and preparing for the transitions to EDPS  
  • Identify CMS’ policy direction for Medicare Advantage risk adjustment potential gaps to meet new, more stringent demands  
  • CMS RADV extrapolation  
  • Strategies for implanting the latest technologies while keeping compliant to regulatory demands  
  • HHS RADV is taking real dollars; not a practice drill any more 

     

Speaker:
Meleah Bridgeford, Director of Risk Adjustment, Payer Solutions
Episource

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 
  • Learn how do leverage data insights under HHS program to impact health care costs and quality  

Speaker:

Janette Gacaferi, Assistant Director, Risk Adjustment Operations 
Cambia Health Solutions

Sharalee Johnson, Project Manager
Pulse8

12:20 PM
Networking Lunch

1:20 PM

Implementing Key Measures to Ensure Accurate Plan & Provider Revenue

  • Who should be on the risk adjustment team?  
  • Creating a risk adjustment strategic plan and monitoring for impact  
  • Ensuring coding accuracy and data management best practices  
  • Embedding compliance into your risk adjustment plan and program  
  • When and where to audit 
  • Reporting to create confidence  

Speakers:

Timothy Burke, Vice President of Operations
HealthCare Partners

RaeAnn Grossman, Chief Growth Officer
DataLink Software

2:20 PM

2020 CMS Final Rule: Nuts of Bolts

  • Discussion of revenue impact
  • Discussing to Clinical coding impact
  • Discussing the final Model Changes
  • Analysis of actual health plan impact of new model changes

Speaker:

Deniese M. Crittenden, RN, MSN, MHA, BSW, Senior Consultant, Risk Adjustment
Dynamic Healthcare Systems

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

 

3:20 PM
Networking Break in Exhibit Hall

3:40 PM

Getting You and Your Team RADV Audit Ready

  • Training and education your coding team to ensure accuracy and compliance for CMS and HHS 
  • Capturing patient historical data  
  • Understanding the financial impact of the upcoming audit.  
  • Potential fines and implications  
  • Deep dive into audit trends from CMS and experience from other health plans 
  • Utilizing independent auditors 
  • How do plans prepare for each audit?  

 

Speaker:  

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

Jenni Monfils, CPC, CRC, Risk Adjustment Compliance Coding Manager
UCARE

5:00 PM
Networking Cocktail Reception in Exhibit Hall

June 11th, 2019

8:00 AM
Networking Breakfast
8:00 AM
Exhibit Hall Opens

9:00 AM

Opening Remarks and Day One Takeaways

Co-Chairs: 

RaeAnn Grossman, Chief Growth Officer
DataLink Software

Scott Filiault, Chief Revenue Officer
Pulse8

9:10 AM

Keynote Address: Change is Inevitable ...Growth is Optional: Balancing Risk, Certainty and Caring

  • Understand the urgency in changing our current healthcare system 
  • Understand why the disruptors are entering the market 
  • Discover your inherent leadership skills and how they can prepare you and your team for change 
  • Learn how to be an advocate for change and energize your team 

Don Taylor
Speaker. Thought Leader. Advocate for Change in Healthcare

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 
  • Applications in the HHS risk adjustment environment and how it differs from Medicare Advantage scenarios 

 

Speaker: 

Eugenia Ross, Senior Vice President Strategy & New Markets
Ciox Health

Dr. Adele Towers MPH, FACP, Senior Clinical Advisor
UPMC Enterprises

11:00 AM
Networking Break in Exhibit Hall

11:20 AM

Concurrent Sessions

11:20 AM

Track A: Mitigating Audit Risk to Ensure Integrity of the Data

  • Developing an audit plan which focuses on known conditions which pose error risk
  • Utilizing previous reviews to understand area of risk
  • Focus on the OIG work plan which now include Medicare Advantage  Audits
  • Creating front-end edits to assist with mitigation to avoid the code from getting through the claim system 

Speaker:

Donna Malone, CPC, CRC, Senior Manager, Enterprise Risk Adjustment, HCC Coding and Quality Assurance
Tufts Health Plan

Kirk L. Shanks, MAS, President
Kirsha Consulting

11:20 AM

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

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

Speaker:
Rachel Nelson, Director, Payer Solutions 
GeBBS HealthCare Solutions  

 

1:20 PM

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

• Case studies and open discussion

 

Speaker:   

Liaw Huang, PhD, FSA, MAAA, EA, FCA , Principal and Senior Research Actuary
The Terry Group

Mike Nemeth, Director Business Systems Analysis, Revenue and Quality Analytics
SS&C DST Health

2:25 PM

Concurrent Sessions

2:25 PM

Track A: Dual Eligibility Models 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  
  •  

2:25 PM

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

  • Growing risks 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 wholistic view of clients and its impact in your bottom line   
  • Utilizing data to enhance care services and personalize client experiences  
  • Cloud computing in healthcare: does it work? is it safe? 

Speaker:

Shannon Decker, MEd, MEd, MBA, MBA, PhD, Executive Director, Risk Adjustment 
NAMM California, UnitedHealth Group

Joe Wilson, Enterprise Business Architect, Risk Adjustment
WellMed  

 

3:25 PM

Conference Adjourns