Risk Adjustment Forum

Nov 9, 2020 ‐ Nov 11, 2020

Standard: $700.00


Workshop A: Risk Adjustment Practitioner

Nov 9, 2020 12:00pm ‐ Nov 9, 2020 6:00pm

Identification: MON01

• The essentials of and differences between Medicare Advantage, Commercial and Medicaid risk adjustment
• Understanding how risk scores are calculated
• Making sense of varying payment models
• An intro into using data and predictive analytics to optimize your risk adjustment practices
• Tools for achieving data accuracy
• Where do we stand with the transition from RAPS to EDS? The latest in a long journey
• Provider engagement strategies that will impact your risk adjustment initiatives
• Risk adjustment vendor selection and management
• Determining whether you need RA vendors
• How do you effectively vet potential vendors and ultimately select them?
• Strategies for on-going, thorough vendor management
• The future of risk adjustment – what you need to know to stay ahead of possible changes
• Initial steps for preparing for a RADV audit
• Which staff is essential to overseeing your RADV audit prep?
• Staying ahead – key items to monitor well in advance of an actual audit

  • Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP, AAPC Approved InstructorDirector of Ambulatory Clinical Documentation Quality Improvement, Mount Sinai Health System
  • Tara Russo, VP, Medicare Risk Adjustment, HEDIS and Navigate Directorate, Island Doctors

Workshop B: Advanced HCC Auditor

Nov 9, 2020 12:00pm ‐ Nov 9, 2020 6:00pm

Identification: MON02

The HCC Coding for Accuracy workshop is not just for those directly involved in HCC coding work. It is designed for other disciplines, as well, including finance and analytics professionals. Join us for an introduction to best practices, the opportunity to work through case examples, and to share experiences with your peers. This workshop will zero-in on regulatory compliance while teaching you how to optimize the accuracy of the information gathered and submitted at the practice level. What you will also learn about the way charting is often done, how to overcome “disconnect” with the clinicians and how their typical charting practices and EMRs can create significant problems, and how RADV views documentation in contrast with the way clinicians were taught and EMRs were built initially. Please note: Attendees are encouraged to bring questions to pose to our expert workshop facilitators and to table for the group. We provide your workbook which includes copies of the slide deck. You will not need your coding manuals, but most people bring a laptop or a tablet, as well, for note-taking.

Dialogue, interact and work in small facilitated groups with peers and colleagues
• Understanding the financial overlay – HCC codes mapping to risk adjustment scores
• A single coding and documentation process for
• Risk adjustment
• Skill development on choosing diagnoses from portions of the encounter – permitted and not permitted
• Clinical documentation barriers for risk adjustment purposes (data validation audit risks)


Workshop C: Assess Changes to Organizational Structure During and Post Pandemic

Nov 9, 2020 2:30pm ‐ Nov 9, 2020 6:00pm

Identification: MON03

• Examine the positive and negative impacts of professionals working from home to identify sustainability or need to return to the office on an individual basis
• Analyze the operational changes that have been made to adapt to the crisis and prepare for future changes as the pandemic evolves to adjust to consumer behavior
• Update changes to processes and job descriptions due to changes and offer training to all involved to adapt quickly to the new working environment

  • Deborah Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA, Manager, Risk Adjustment, ProMedica
  • Jenni Monfils, CPC, CRC, Director Risk Adjustment Coding Compliance Coding, Bright Healthcare

Welcome Remarks iconWelcome Remarks

Preview Available

Welcome Remarks

Nov 10, 2020 10:00am ‐ Nov 10, 2020 10:10am

Identification: TUES01

Welcome Remarks


Keynote Address: Analyze the True Impact of COVID-19 On Risk Adjustment

Nov 10, 2020 10:10am ‐ Nov 10, 2020 10:55am

Identification: TUES02

• Analyze the possible rebound effect in 2021 with increased claims and a potential negative impact on overall revenue
• Calculate the damage caused by of lack of claims in 2020 impacting Risk Score Run Rate
• Predict how the RADV Audit postponement may impact plans in 2021 and future years

  • Dave Meyer, Vice President, Risk Adjustment and Quality,, Cigna

CMS Regulation Update During Unprecedented Times

Nov 10, 2020 11:05am ‐ Nov 10, 2020 11:50am

Identification: TUES03

• Examine changes for the 2021 Physician Fee Schedule, reviewing our proposed rule and any final regulation if available
• Analyze updates for the 2021 Medicare Advantage policies, reviewing the published regulations that were made available earlier this year
• Discuss current activities at CMMI (CMS Innovation Center), particularly focusing on those models which have two-sided risk sharing requirements

  • Ashby Wolfe, MD, MPP, MPH, Chief Medical Officer, Regions VIII, IX & X, Centers for Medicare & Medicaid Services (CMS)

Tools and Technology Spotlight

Nov 10, 2020 11:50am ‐ Nov 10, 2020 12:00pm

Identification: TT001

Hear from tools and technology experts on how their solutions can improve efficiencies in your organization.


Tools and Technology Spotlight

Nov 10, 2020 1:15pm ‐ Nov 10, 2020 1:25pm

Identification: TT0001

Hear from tools and technology experts on how their solutions can improve efficiencies in your organization.


Incorporate Telehealth into your Long-Term Plan for Risk Adjustment

Nov 10, 2020 2:25pm ‐ Nov 10, 2020 3:10pm

Identification: TUES05

• Examine the differences in telehealth opportunities between Medicare, Medicaid, and Commercial to maximize your efforts
• Capitalize on new CMS flexibility of virtual visits to capture as much information as possible during telehealth visits and virtual home assessments
• Educate your team to improve clinical documentation accuracy to avoid missing valuable codes

  • Bryan Lee, Vice President of Solutions, Apixio
  • Bahar Sedarati, M.D., Lead Medical Director, Clinical Performance & Operation, Pacific Desert Region, Humana

Tools and Technology Spotlight

Nov 10, 2020 3:10pm ‐ Nov 10, 2020 3:20pm

Identification: TT003

Hear from tools and technology experts on how their solutions can improve efficiencies in your organization.