With the Centers for Medicare & Medicaid Services (CMS) days away from releasing its final policies on risk adjustment and Star ratings for 2024, this is one conference that risk adjustment and quality specialists won’t want to miss.
By April 3, CMS will finalize the payment policies in the CY 2024 Rate Announcement, including whether the changes will include revisions to the Part C risk adjustment model, Hierarchical Condition Categories (HCCs) , and Star ratings.
RISE will bring together industry experts at the The 21st Risk Adjustment Forum to analyze the final changes and discuss how risk adjustment and quality specialist can best prepare to remain compliant and maximize encounters to capture accurate codes. The conference will take place May 9-10, with preconference workshops on May 8, at the Fairmont Chicago, Millennium Park. In addition to general sessions, the event will offer concurrent track sessions, tools and technology spotlights, and opportunities to network during cocktail receptions, breakfasts, and lunches.
Take a look at the sessions and speakers who will take the main stage:
CMS regulatory update
There is so much to discuss we’ve broken this into two parts! Gabriel McGlamery J.D., senior health policy consultant, government relations, Florida Blue, will lead the discussion.
Part one will explore CMS changes that will affect risk adjustment including:
- Adjustments to RADV extrapolation and their financial impact on upcoming audits
- The impact of the changes between version 24 and 28 coding model and the process of change implementation
- Which HCC codes have been removed or added
- Conditions that remain but with a new HCC code identification number and how that impacts EHR and coding software
- Changes to risk adjustment coefficients
Part two will examine the outcomes of CMS changes for 2023 and beyond, including:
- CMS Medicare Advantage RADV and the CY2024 Advance Payment Notice to identify impacts to risk adjustment and RADV audits, including the new HCC model
- Post pandemic data and how it impacts risk adjustment moving forward
- How CMS can turn ACA RADV into a functional audit using three easy steps
Navigate through CMS changes to remain compliant and productive
Michelle Zilisch, director, product management, Ciox Health, is scheduled to review the adjustments implemented by CMS in CY 2023/2024 and how they impact your risk adjustment program. She’ll assess how it has altered the way participants operate and modifications that need to be made to remain compliant. The session will also look at technology solutions that can streamline organizational changes and help achieve goals. She’ll also review outcomes of adjustments to ensure success and correct errors.
Social determinants of health (SDoH) and value-based care’s impact on risk adjustment
During this session, we will explore the correlations between SDoH, value-based care, and risk adjustment to assess critical changes to health care delivery. Participants will evaluate the impact of SDoH measures on their current risk adjustment program and how it may change the way they approach coding. Speakers (to be announced) will also discuss cost cutting strategies that will have a positive effect on risk adjustment efforts.
Medical expense management for risk adjustment
Join Gregg Kimmer, president and CEO, ATRIO Health Plans, for a session that evaluates the overarching goal of Medicare risk adjustment, assess acuity levels at various times of the year to ensure accuracy, and explore samples of low hanging fruit to address those that can benefit your organization.
Diagnose risk adjustment data to create guardrails with coding and compliance
During this session, participants will assess how much pressure their organizations are exerting on providers to capture HCCs. Speakers will explore the risks of failing a clinical validation audit when it includes risk-adjusting diagnoses without evidence of diagnostic workups, treatments, and/or plans of care. They’ll also conduct a deep dive on common misinterpretations in ICD-10 diagnosis coding and recent clarifications from AHA Coding Clinic.
Speakers include Khush Singh M.D., director, risk adjustment & value-based care program operations & compliance, Granite GRC Consulting; Colleen Gianatasio, director clinical documentation integrity and coding compliance, Capital District Physician’s Health Plan (CDPHP); and Hemanshu Patel, M.D., board certified, chief quality officer, medical director, Choice Healthcare Associates.
The future of risk adjustment
Industry experts will discuss the impact of CMS regulation changes and how the industry must adapt to remain successful. The panel will discuss the effect of increased health care at home on risk adjustment and code capture; evaluate the increased inclusion of SDoH and value-based care on risk adjustment; and the importance of overcoming provider burnout and best approaches streamline education.
Deb Curry, MBA, director risk adjustment & Recoveries, Paramount Healthcare/ProMedica Health System, will moderate the discussion. The panel will include: Wilson Gabbard, vice president, quality and clinical risk adjustment enterprise population health, Advocate Aurora Health; and Shannon Decker, Ph.D., M.Ed., risk adjustment specialist.
The 21st Risk Adjustment Forum will take place May 9-10, with preconference workshops on May 8, at the Fairmont Chicago, Millennium Park. Click here for the full agenda, roster of speakers, and how to register.