In this article we look at the RISE West 2022 sessions planned as part of the Compliance and Regulatory Updates track at the annual RISE West conference, September 1-2, in Los Angeles.

We previously previewed the Risk Adjustment Track and the Quality-Related Tracks. Our final preview article will focus on the sessions in the payer/provider alignment track.

Most-pressing health policy issues

Sean Creighton, managing director, Avalere will moderate this panel discussion on pressing policy issues that impact health plans and risk-bearing providers in the managed care, Affordable Care Act marketplace, and commercial sectors.

The panel, which includes members of the RISE Risk Adjustment Policy Committee, will kick off the track session on the first day of RISE West 2022, September 1, at the InterContinental Los Angeles Downtown. Topics will likely include Medicare drug pricing negotiations, the uncertainty of Affordable Care Act expansion, Medicare Advantage (MA) equity elements and supplementary benefits that address social determinants of health, RADV, Medicaid redeterminations, Medicaid expansion, the end of the COVID-19 public health emergency, and the future of telehealth.

RELATED: RISE Radio Episode 12: RISE West 2022 panelists on the most pressing policy issues facing health plans this year

Panelists will include Michael Adelberg, providers and plans lead, Faegre Drinker Consulting; Dave Meyer, a member of the RISE Risk Adjustment Policy Committee; Mikal Sutton, managing director, Medicaid policy, Blue Cross Blue Shield Association; and Krutika Amin, associate director for program on the ACA, Kaiser Family Foundation.

The current state of risk adjustment litigation

During this session, panelists will review the learnings from recent audit activity and discuss the risk areas for Medicare Advantage plans, vendors, and downstream entities. Attendees will gain a better understanding of how government entities are pursuing or responding to litigation. The panel will be moderated by Deb Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA, director of risk adjustment and recoveries, Paramount Healthcare/ProMedica Health System. Panelists include Mary Inman, partner, Constantine Cannon; Ed Baker, of counsel, Constantine Cannon; and Stephen D. Bittinger, partner, K&L Gates, LLP.

RISE West 2022 August 30 - September 2, 2022 Live in Los Angeles

OIG audits of Medicare Advantage plans and how to mitigate risk

Speaker Osato F. Chitou, principal consultant, Esq., MPH, of Compli by Osato, will discuss OIG audits, as well as the differences in OIG and CMS RADV standards of documentation and best practices when juggling different types of audits. She’ll examine the ways that health plans are anticipating other fact patterns in its submissions that may point to improper coding and will discuss how organizations use these results and data to inform future decision-making.

RELATED: RISE West speaker Osato Chitou previews panel session on empowering women in health care and why both men and women need to hear the discussion

Checks and balances of RADV audits

Curry will return to moderate this panel discussion on the checks and balances that health plans should have in place to proactively mitigate submission of unvalidated HCCs. Panelists will discuss how they juggle audits from multiple entities and offer best practices in RADV audit preparation. Panelists include Tom Nasadoski, MBA, vice president, risk adjustment, CDPHP; Wynda Clayton, MS, RHIT, director risk adjustment, Providence Health Plan; and Susan Waterman, RHIT, CCS, CPC, CRC, director of risk adjustment, Baylor Scott and White Health Plan.

High-risk diagnosis codes

The final session of the track will go over the recent literature from the Office of Inspector General focused on integrity in diagnosis code submissions and impacts on coding in Medicare Advantage. Speakers will include Curry, as well as William Schweitzer, associate, platform strategy and solutions, and Erik Simonsen, chief operating officer, both from Episource. Attendees will leave the session better able to understand the power of data analysis of medical and pharmacy claims for surfacing problematic diagnoses, and of NLP for evaluating these diagnoses; how to efficiently follow-up on high-risk diagnosis codes in preparation for a potential future audit, and what data available in standard claims is key for customizing and expanding the search for high-risk diagnosis codes.

RISE West 2022 will take place September 1-2, with preconference workshops on August 31, at the InterContinental Los Angeles Downtown. Proof of a negative COVID-19 test, or proof of vaccination is required to attend the live event. Click here for the complete agenda, roster of speakers, registration information, and our health and safety protocols.