We are seven weeks away from the premier event for risk adjustment and quality specialists, the 23rd Risk Adjustment Forum in the heart of New Orleans. With three full-day preconference workshops, more than 25 general and concurrent sessions led by 35 industry experts and federal officials, this conference is your roadmap to risk adjustment success.
Session topics at the May 20-22 event will focus on four key themes:
- Navigating compliance and government crackdowns
- Achieving operational excellence
- Integrating innovation and technology solutions
- Directing the shift from quantity to quality-based care
Here are eight regulatory-focused sessions you don’t want to miss:
OIG FIRESIDE CHAT: EVALUATING REGULATORY PRIORITIES FOR 2024
Chris Bresette, director, Medicare Part C Audits, HHS Office of Inspector General, pictured right, and Carolyn Kapustij, senior advisor for managed care, HHS Office of Inspector General, will review the watchdog’s key priorities for 2024, including its strategic plan and Medicare Advantage (MA) audit preparation best practices. The discussion, which will include a high-level overview of the new OIG MA toolkit, will be moderated by Ana Handshuh, principal, CAT5 Strategies.
DEEP DIVE INTO OIG AUDITS & TOOLKIT EXPERIENCE
Bresette and Kapustij, pictured right, will return to the main stage to discuss what led to the creation of the OIG toolkit, the OIG’s priorities regarding MA audits, and how the toolkit can help organizations improve the accuracy of submitted high-risk diagnoses. The discussion will be moderated by Kapustij.
TWO-PART SESSION ON CMS REGULATIONS AND ACA RISK ADJUSTMENT
This 45-minute general session will be divided into two parts. First, Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, director clinical documentation and quality improvement (CDQI), will go over enhancements to MA and Medicare Part D, the effects of extrapolation on the error rate, and best practices. Next, Gabriel McGlamery J.D., director of commercial market strategic integration, Florida Blue, will examine ACA risk adjustment, including regulatory changes, the nuances of ACA RADV audits, and the influence of risk adjustment on ACA marketplace dynamics.
DEVELOPMENT OF AN RA COMPLIANCE PROGRAM
Join Colleen Gianatasio, director clinical documentation integrity and coding compliance, Capital District Physician’s Health Plan (CDPHP), and Corrina Rottum, director, clinical documentation integrity, Panoramic Health, for a discussion on establishing compliance processes and oversight roles. They will also review the RADV rule and recent OIG audits and reports that impact compliance submissions.
V28 MODEL AND THE RISK SCORE EFFECTS
During this concurrent session, Malone returns to the stage to join Laura Sheriff, RN, MSN, CPC, CRC, risk adjustment consultant, vice president, risk adjustment, Southwestern Health Resources, for a discussion on the V28 model. They will examine revenue impact and program funding, the impact on the MA capitation rate and risk adjustment methodology, and real-life examples of both positive and negative experiences.
MASTER REGULATORY COMPLIANCE: OIG AUDITS
Dive deeper into OIG audits during this concurrent session with Handshuh and John M. Barkley, vice president, enterprise risk adjustment & data integrity, EmblemHealth/ConnectiCare. They explore the “dirty dozen” high-risk codes and how to best mitigate risk, how to create a robust audit response plan, and strategies to enhance documentation workflows, reducing the risk of discrepancies and non-compliance.
EVALUATE UPDATES TO ACCOUNTABLE CARE ORGANIZATIONS (ACOS)
Dr. Shannon Decker, Ph.D., MBA, MBA, M.Ed., M.Ed, principal, VBC One, will lead a discussion on the impact of models to providers, how to protect against inappropriate risk score growth, and the nuances of the model program, including increased predictability for model participants.
RISK-ADJUSTMENT CODING IN VALUE-BASED CARE
This session will explore the similarities and differences between value-based care and risk adjustment, how to align coding practices with value-focused methodologies, and value-based care approaches that risk adjustment professional can consider to improve coding endeavors. Jeannine Bumford, director, risk adjustment operations, Christus Health, and Eric Hansen, DO, FAAFP, physician Hansen Medical, will lead the session.
The 23rd Risk Adjustment Forum will take place May 20-22 at The Roosevelt New Orleans, A Waldorf Astoria Hotel. Click here for the entire agenda, roster of speakers, and how to register.