Join presenter, Elaine Taverna, SVP of Risk Adjustment and Quality for Advantasure, to learn today’s best practice approaches for balancing business needs with regulatory and compliance standards.

Compliance is an essential business roadmap item that high-performing plans prioritize with continual investments. From baseline audit to designing and executing a multi-year strategy, success depends on a multi-disciplinary approach and the ability to unite business units under a common goal. Successful programs identify gaps and enhance coding accuracy, incorporate mitigation activities for error reduction, and implement plans for long-term improvements. In this presentation, plans will learn:

• Self-audit tactics to generate a baseline, identify gaps, and provide strategic direction
• Key elements for improving coding accuracy
• How to manage internal and vendor coding reviews
• Contracting strategies for incentivizing provider engagement and education
• Ways to optimize retrospective program output
• EDPS/RAPs submission management trends
• Data and analytic use cases for risk mitigation of inaccurate submissions

Topics at a glance include:

• Means to improve coding accuracy (via internal audits, error trend analysis, and strategy development
• RA program design (Prospective/Retro programs and vendor management, EDPS/RAPS Submissions, Provider Engagement improvements
• Risk Mitigation activities (using analytics and oversight to catch inaccurate Hierarchical Chronic Conditions
• Building all considerations into a longitudinal strategy that makes sense for your organization