17th Risk Adjustment Forum

Jun 25, 2021 ‐ Jul 1, 2021



Sessions

Workshop A: Risk Adjustment Practitioner

Jun 25, 2021 10:00am ‐ Jun 25, 2021 4:00pm

Identification: FRI01A

• 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

Speaker(s):
  • Deborah Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA, Manager, Risk Adjustment, ProMedica
  • Scott Weiner, CRC, CMA, CFM, MBA, Director, Government Programs, Sentara Health Plan

Workshop B: Advanced HCC Auditor

Jun 25, 2021 10:00am ‐ Jun 25, 2021 4:00pm

Identification: FRI01B

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 notetaking.
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)

Speaker(s):
  • Donna Malone, CPC, CRC, CRC-I, AAPC Approved Instructor, Director Ambulatory CDQI, Mount Sinai Hospital System
  • Colleen Gianatasio, Director, Ambulatory CDQI, Devoted Health

Virtual Networking ReceptionVirtual Networking Reception

Preview Available

Virtual Networking Reception

Jun 25, 2021 4:00pm ‐ Jun 25, 2021 5:00pm

Identification: VNL1

Turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of your home to access those hallway conversations we’ve all been missing.


Morning Networking ReceptionMorning Networking Reception

Preview Available

Morning Networking Reception

Jun 30, 2021 9:00am ‐ Jun 30, 2021 10:00am

Identification: VNL2

In-person attendees will enjoy a socially distanced reception, compliant with CDC guidelines, providing networking opportunities among other in-person attendees, speakers, and solutions providers. For virtual attendees, turn on your camera and join us in the virtual networking lobby for face-to-face networking with other attendees that are joining us from the comfort of their home. No matter how you join, you’ll have access to those hallway conversations we’ve all been missing.


Welcome Remarks and Deep Dive: An In-Depth Discussion on the Impact of the Pandemic on Risk Adjustment

Jun 30, 2021 10:00am ‐ Jun 30, 2021 10:55am

Identification: WED001


Welcome RemarksWelcome Remarks

Preview Available

Welcome Remarks

Jun 30, 2021 10:00am ‐ Jun 30, 2021 10:10am

Identification: WED01

Speaker(s):
  • Deborah Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA, Manager, Risk Adjustment, ProMedica
  • Laura Sheriff, RN, MSN, CPC, CRC, National Director, Risk Adjustment, Molina Healthcare, Inc.

Keynote Address: Deep Dive: An In-Depth Discussion on the Impact of the Pandemic on Risk Adjustment

Jun 30, 2021 10:10am ‐ Jun 30, 2021 10:55am

Identification: WED02

• Analyze the overall impact on claims data and risk score to identify how the ripple effect may damage your plan for 2022 and onwards
• Discuss CMS flexibility options to enable relief from oncoming industry set back due to COVID
• Strategies to be best prepared to tackle 2022 and 2023 to ensure efficiency and achieve targeted goals
• Examine the importance of member education surrounding the COVID Vaccine to encourage them to participate and enable them to return to scheduled physician appointments

Speaker(s):

Review of the 2022 HHS Notice of Benefit and Payment Parameters and Upcoming 2021 Benefit Year

Jun 30, 2021 11:10am ‐ Jun 30, 2021 12:05pm

Identification: WED03

• Analyze the 2022 HHS Notice of Benefit and Payment Parameters
• Discuss the operational and process changes for 2021, including any guidelines impacting telehealth
• Assess the changes to RADV Audits and schedules for the upcoming 12 months and organize your team to be ready to achieve a successful audit

Speaker(s):
  • Terry Ward, Senior Vice President, Solutions, Apixo
  • Elizabeth Parish, Group Director of Payment Policy and Financial Management Group, Centers for Medicare & Medicaid Services Consumer Information and Insurance Oversight
  • Adrianne Patterson, Director, Division of Policy & Analysis in the Payment Policy and Financial Management Group, Centers for Medicare & Medicaid Services Consumer Information and Insurance Oversight
  • Milan Shah, Director, Division of Reinsurance Operations in the Payment Policy and Financial Management Group, Centers for Medicare & Medicaid Services Consumer Information and Insurance Oversight

Tools and Technology Spotlight

Jun 30, 2021 11:55am ‐ Jun 30, 2021 12:05pm

Identification: TT1

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

Speaker(s):
  • Rita Young, Senior Vice President Clinical Innovations, Reveleer

Seen One Managed Medicaid Program, You’ve Seen….

Jun 30, 2021 12:20pm ‐ Jun 30, 2021 1:05pm

Identification: WED04

Exactly One Managed Medicaid Program. With six different grouper models, regional contracts within each state, quality bonuses, withholds, or penalties… no two state programs are exactly alike! 1,115 Waivers, SDOH, members moving in and out – there’s just so much to manage! The good news is that there are multiple helpful analytic tools and technologies to make sense of it all.
• Discover the fundamental and nuanced differences between different Medicaid and Medicare programs
• Understand the repercussions of COVID-19 in the 2020 market and what they mean for you
• Discuss best practices and strategies to reach Medicaid members and close chronic risk gaps

Speaker(s):
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