RISE National 2021

Mar 26, 2021 ‐ Mar 30, 2021

Standard: $1000.00


Workshop A: Risk Adjustment Practitioner

Mar 26, 2021 10:00am ‐ Mar 26, 2021 4:00pm

Identification: FRI01

  • 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

  • Susan Waterman, RHIT, CCS, CPC, CRC, Director of Risk Adjustment, Scott and White Health Plan
  • Laura Sheriff, RN, MSN, CPC, CRC, Risk Adjustment Specialist

Workshop B: HCC Coding Accuracy

Mar 26, 2021 10:00am ‐ Mar 26, 2021 4:00pm

Identification: FRI02

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 the 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 take notes on their laptop or tablet.

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)

  • Colleen Gianatasio, Devoted Health
  • Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP, AAPC Approved InstructorDirector of Ambulatory Clinical Documentation Quality Improvement, Mount Sinai Health System

Workshop C: Utilizing Telemedicine to Augment Care Delivery

Mar 26, 2021 1:00pm ‐ Mar 26, 2021 4:00pm

Identification: FRI03

This interactive and informative workshop will explore the following topics through real life case studies and practical takeaways:

  • Examples on how to improve outcomes and reduce utilization
  • Identify risk adjustment opportunities
  • Best practices for addressing quality care gaps
  • Discuss which activities can be performed successfully via telemedicine versus face-to-face
  • How to leverage technology to meet care delivery expectations

  • Kyle Mendez, MBA, Senior Director, Revenue Management, Landmark Health
  • Michael Le, MD, Chief Medical Officer, Landmark Health

Workshop D: Life During Wartime – Continuing Improvement and Success for Your Programs After 2020

Mar 26, 2021 1:00pm ‐ Mar 26, 2021 4:00pm

Identification: FRI04

Join us for a comprehensive review of 2020 and the changes to Risk Adjustment and Quality that impact your plan. Hear from experts and peers on how each of them navigated the uncharted waters of COVID-19 and how they were able to adapt to the new guidelines and restrictions without sacrificing care. Finally, discover the key to keep up success and improve growth in 2021 and beyond.

  • What’s Happened to Risk Adjustment?
  • How Have Quality Programs Suffered?
  • The Key: EMR Integration and the Future of the Health care Industry


Welcome Cocktail Reception in Networking Lobby – All Conference Attendees Invited

Mar 26, 2021 4:00pm ‐ Mar 26, 2021 5:00pm

Identification: VNL01

Keynote Interview with:
Tara Lipinski
Olympic Gold Medalist
Figure Skating Analyst for NBC Sports Group

Conference Chair:
Ana Handshuh, Principal
CAT5 Strategies

Internationally Acclaimed Figure Skater and Olympic Gold Medalist, Tara Lipinski, discusses her career and how she has overcome the many obstacles that have stood in her path. Through anecdotes and inspirational life lessons about overcoming adversity to her storied career in figure skating, people of all ages can expect to leave feeling inspired and entertained.

Turn on your camera and join us in the networking lobby for that face-to-face networking experience we’ve all been missing. Mimicking hallway chats, this is your opportunity to connect with other attendees, speakers, and solutions providers in risk adjustment, quality, social determinants of health, and more. Networking has never been easier – join a small group of up to 8 people, hop around to different tables with just a click, and enjoy saying hello to familiar faces and taking part in relevant industry discussions. We’ll see you in the lobby!


Opening Remarks iconOpening Remarks

Preview Available

Opening Remarks

Mar 29, 2021 9:00am ‐ Mar 29, 2021 9:10am

Identification: MON01


Centers for Medicare & Medicaid Services (CMS) Policy Update

Mar 29, 2021 9:10am ‐ Mar 29, 2021 10:05am

Identification: MON02

Join CMS representatives as they discuss the Proposed Model Specification Changes in the 2022 Payment Notice, 2021 RA model changes, and RADV Final Rule. They will also address operations update on 2019 and 2020 RADV and EDGE LDS.

The conversation will continue with risk adjustment updates for the Medicare Advantage and Part D programs, reviewing the policies in the 2022 Rate Announcement, including updates to the risk adjustment models, overview of model design, and data used for risk score calculation.

  • Erin Sutton, Deputy Director, Payment Policy and Financial Management Group, Centers for Medicare & Medicaid Services (CMS)
  • Allison Yadsko, RADV Policy Team Lead, Centers for Medicare & Medicaid Services (CMS)
  • Catherine Anderson, Acting Director, Division of Risk Adjustment Operations, Centers for Medicare & Medicaid Services (CMS)
  • Rebecca Paul, Deputy Director, Medicare Plan Payment Group, Centers for Medicare & Medicaid Services (CMS)

The Future Direction of the American Health Care System

Mar 29, 2021 10:05am ‐ Mar 29, 2021 11:00am

Identification: MON03

Dr. Emanuel shares practical, concrete steps that payers and providers, as well as businesses and government, can take in order to adapt to the major shifts happening within health care, and to transform the American health care system to provide consistently higher-quality and lower-cost care.

  • Ezekiel J. Emanuel, M.D., Vice Provost of Global Initiatives & Levy University Professor Perelman School of Medicine and The Wharton School, University of Pennsylvania, Special Advisor to the Director General , The World Health Organization

RISE Policy Committee: 2021 Regulatory Overview and Industry Impact

Mar 29, 2021 11:15am ‐ Mar 29, 2021 12:00pm

Identification: MON04

Join experts as they discuss today’s political climate and its trickle effect in health care. They will delve into topics such as the new administration’s priorities, impact of 2020 data as we move forward, and challenges to the revenue and bottom line in upcoming years. They will also discuss key issues regarding budget reconciliation, CMS recently released rules, risk adjustment changes affecting MA and commercial plans, and what plans should keep an eye on for 2021 and beyond.


Connecting the Dots: Transforming Social Determinants of Health Data into Big Picture Results

Mar 29, 2021 12:15pm ‐ Mar 29, 2021 1:00pm

Identification: MON08

  • Capturing and utilizing available information to improve whole-person care
  • Collaborating with stakeholders and community-based organizations to close gaps
  • Enhancing care without overburdening providers or encroaching on patients’ privacy or trust