Three representatives from the Centers for Medicare & Medicaid Services (CMS) will speak at the 24th Risk Adjustment Forum, the premier event for risk adjustment and quality specialists held November 17-19 in Louisville, Ky.
The regional risk adjustment event for Medicare Advantage, Medicaid managed care, and Affordable Care Act (ACA) plan executives will feature more than 25 industry experts, 26 educational sessions, three preconference workshops, and several networking opportunities.
The first day of the main conference will kick-off with an update from CMS representatives, Kelly Drury, senior advisor, payment policy and financial management group; Leanne Scott, health insurance specialist; and Cathy Anderson, director, division of risk adjustment operations.
During the session, Drury, Scott, and Anderson will discuss HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) updates applicable to the individual and small group markets. Their conversation will include an overview of the proposed policy changes to risk adjustment and HHS-RADV in the 2026 Payment Notice proposed rule and an overview of current 2024 risk adjustment and 2023 HHS-RADV requirements and deadlines.
Sessions following the CMS update will also focus on RADV and Office of Inspector General audits including changes to extrapolation, the benefits of conducting health care in the home, and opportunities to identify coding discrepancies.
Here’s an inside look at a few of the other hot-button updates attendees will hear throughout the three-day event:
The 2024 election outcome and its impact on health plans, policy, and the people: Jenn Kerfoot, chief strategy & growth officer, DUOS, and Leah Hannum, director, government funding operations, Blue Cross of Idaho, will discuss the potential policy changes expected as a result of the election and their direct impact on health payers, strategies for adapting to new regulations and maintaining financial stability, and how shifts in health care policy could affect member access and satisfaction.
ACA risk adjustment update and projections: This session will cover the challenges and changes to ACA risk adjustment for 2025 and 2026, how states can compensate for inaccurate or inadequate risk adjustment transfers, the issues with the ACA RADV process and how to fix them, and new ideas to better understand and explain the differences between ACA and Medicare Advantage risk adjustment. J. Gabriel McGlamery J.D., director of commercial market strategic integration, Florida Blue, will lead the session.
RADV extrapolation changes impacting audits: Donna Malone, CPC, CRC, AAPC approved instructor, AHCCA, RAP, director risk capture, population health management, Mass General Brigham, will examine the changes to extrapolation and how they can financially damage your organization; CMS’ approach to RADV audits and how they calculate an extrapolated amount to be reimbursed; and how to create and implement documentation review to identify potential costly errors prior to being selected for a RADV audit.
OIG audit review and preparation tactics: The session will explore recent findings from OIG audits to identify common fraudulent activities that are being identified to mitigate risk, the OIG toolkit and how it can help prepare organizations to better understand OIG’s objectives, and how to educate your audit response team to understand what to expect when experiencing an OIG audit. Colleen Gianatasio, director clinical documentation integrity and coding compliance, Capital District Physician’s Health Plan (CDPHP), and Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, chief operating officer, First Class Solutions, Inc., will present the session.
As always, the conference will also provide plenty of networking opportunities over breakfasts, lunches, and cocktail receptions with drinks and hors d’oeuvres for all attendees on Sunday, November 17 and Monday, November 18.
The Risk Adjustment Forum will take place November 17-19 in Louisville, Ky. Click here for the complete list of speakers, preconference workshops, the agenda, and how to register for the program.