One Team- One Goal: Identify Desired Outcomes of your Risk Adjustment, Quality Measures, and Care Management Teams

Nov 11, 2020 12:30pm ‐ Nov 11, 2020 1:15pm

Identification: WED04

• Remove the silos in plain sight from your organization by creating a value proposition from all three teams to identify a universal goal
• Reduce conflicting messages from the same organization and establish one streamlined communication approach
• Capture all vital information for all three teams in one visit including CPT II codes, reducing the member burden of multiple visits whilst creating efficiency within your workflow

A: Commercial Risk Adjustment Regulatory Update

Nov 11, 2020 1:55pm ‐ Nov 11, 2020 2:40pm

Identification: WED05A

· Analyze the impact of COVID-19 on and pray that 2022 isn’t the same as 2020 with an 8% medical trend
· Discuss the evolution of RADV audits. Will recent rule changes end the RADV nightmare or should we hope for future fixes?
· Examine the regulatory changes CMS plans to propose for 2022 and signs of wear and tear on the 10-year-old program that might need fixing

B: Provider Education in a Virtual World

Nov 11, 2020 1:55pm ‐ Nov 11, 2020 2:40pm

Identification: WED05B

• Create training programs to identify difficult to capture codes through telehealth and ways to avoid mistakes
• Incorporate advanced training over a period of time and show improvement on results from the initial phase
• Offer continued support and guidance to providers as they navigate an unusual concept of member interaction

A: Mitigate Risk and Prepare your Team for a RADV Audit

Nov 11, 2020 2:50pm ‐ Nov 11, 2020 3:35pm

Identification: WED06A

• Implement mock audits to better prepare your staff for the workload required when participating in the real thing while mitigating risk
• Examine solutions that can help you achieve success in a RADV audit and create an implementation plan
• Classify individual roles and expectations to enhance success in preparation for an audit

B: Strategies to Avoid Provider Burn Out

Nov 11, 2020 2:50pm ‐ Nov 11, 2020 3:35pm

Identification: WED06B

• Implement mock audits to better prepare your staff for the workload required when participating in the real thing while mitigating risk
• Examine solutions that can help you achieve success in a RADV audit and create an implementation plan
• Classify individual roles and expectations to enhance success in preparation for an audit

A: Case Study: Contract and National RADV Audit Success Story from Recently Audited Plans

Nov 11, 2020 3:45pm ‐ Nov 11, 2020 4:30pm

Identification: WED07A

Hear how your peers have not only survived CMS audits, but thrived through them by:
• Prepare prior to selection to attain optimal outcomes
• Implement practical processes once notification is received, to enhance efficiency in the audit process
• Utilize lessons learned post audit in preparation for future audits

B: Improve your Current Provider Incentives Program to Obtain Desired Quality

Nov 11, 2020 3:45pm ‐ Nov 11, 2020 4:30pm

Identification: WED07B

• Evaluate your current incentive program to identify areas of improvement, especially in a virtual setting
• Calculate individual provider compensation that match your providers needs, as well as a different scale for successful capturing of codes through telehealth
• Introduce a tool to measure the success of your incentive program and adapt when changes are needed