The two-day virtual event will take place June 17-18 and will offer a deep dive into the financial, operational, and regulatory challenges that Medicare Advantage (MA) plans face in today’s shifting health care landscape. Here’s a look at a new keynote session and other hot topics on this year’s agenda.
The event will kick-off with a timely keynote session on the road ahead to understanding policy changes and their financial impact for MA.
Aldiana Krizanovic, senior health policy consultant, federal government relations, Florida Blue, will lead the session focused on navigating policy uncertainty in the wake of recent Medicaid funding freezes and shifting Medicare regulations.
Throughout the session, Krizanovic will discuss how emerging policies could shift reimbursement models and member care strategies, the proactive strategies for MA plans to adapt to regulatory uncertainty, and the role of new administration priorities, current legislative agenda, and upcoming regulatory changes in shaping future plan operations and strategy.
Krizanovic will present the session, The Road Ahead: Understanding Policy Changes and their Financial Impact for Medicare Advantage, at 10:10 a.m. on Tuesday, June 17.
Other pressing topics on this year’s agenda include:
Mitigating financial risk through retrospective reconciliation
The session will cover strategies to resolve discrepancies between interim and final settlements; methods to reconcile Part C and Part D payments effectively; and how risk corridors influence financial settlements in MA plans.
Effective cost reporting strategies for MA plans
This presentation will review how accurate cost reporting impacts future capitation rates and risk adjustment; the key challenges in reconciling MA administrative costs with Centers for Medicare & Medicaid Services’ (CMS) requirements; and the implications of inaccurate cost reporting on compliance and revenue.
Managing Part D payment reconciliation
During this session, speakers will address the complexities of reconciling direct subsidy, reinsurance, and risk-sharing payments; the role of drug utilization data in accurate Part D reconciliation; and how rebate accounting influences final settlement adjustments.
Preparing for Medicare RADV audits
This session will focus on the scope and purpose of Risk Adjustment Data Validation (RADV) audits, common findings in RADV audits and their impact on financial performance, and documentation standards to mitigate risk adjustment audit penalties.
Preparing for value-based contracting and reconciliation
This session will wrap the first day of the event and will cover the role of value-based contracts in shaping future Medicare payments, reconciliation strategies for shared savings and risk-bearing arrangements, and how provider collaboration impacts value-based payment reconciliation.
Elevating data quality to drive reconciliation success
Opening the second day of the summit, this presentation will spotlight the best practices to ensure data accuracy in member-level submissions, solutions for managing large-scale data corrections in risk adjustment and claims, and data validation protocols to mitigate CMS compliance risk.
Revenue optimization through proactive payment error identification
This session will cover common sources of payment discrepancies across MA plans, predictive analytics tools that help forecast and mitigate financial shortfalls, and strategies to build a cross-functional reconciliation task force to address revenue risks proactively.
From billing to payment: strengthening provider financial reconciliation in MA
This presentation will review strategies to align risk-sharing agreements and value-based payments with Medicare reconciliation cycles; the common misalignments between provider contracts, fee schedules, and actual claim reimbursements; and the financial impact of capitated vs fee-for-service provider arrangements on reconciliation efforts.
Managing dual-eligible risk: reconciling Medicare and Medicaid data for financial accuracy
For the final session, industry leaders will discuss strategies to align Medicaid and Medicare data to prevent financial inaccuracies, the evolving role of state Medicaid agencies, and common reconciliation challenges including misclassified dual-eligible status, Low Income Subsidy payment discrepancies, and incorrect subsidy applications.
The Medicare Advantage Member Accounting and Reconciliation Summit will take place virtually 10 a.m. to 4:55 p.m. EST, Tuesday, June 17, and 10 a.m. to 2:55 p.m. EST, Wednesday, June 18. Click here for more information, including how to register for the event.