Don’t miss the opportunity to join RISE this fall for the 22nd Risk Adjustment Forum, the premier event for risk adjustment and quality specialists.
The regional risk adjustment event for Medicare Advantage, Medicaid managed care, and Affordable Care Act (ACA) plan executives seeking updated best practices and strategies for coding accuracy and education success, will feature more than 25 industry experts, 25 educational sessions, two brand-new preconference workshops, and several networking opportunities.
Here's a sneak peek at what’s planned so far:
Preconference workshops
Two full-day and two half-day workshops will take place on Monday, November 27.
Workshop A will focus on the Risk Adjustment Practitioner. Instructors will go over the essentials of and differences between Medicare Advantage, commercial, and Medicaid risk adjustment; the calculations of risk scores; different payment models; the use of data and predictive analytics; tools for data accuracy; the transition from RAPS to EDS; provider engagement strategies; risk adjustment vendor selection and ongoing management; RADV audit preparation; and potential changes to risk adjustment. The session will take place 9:30 a.m. to 5 p.m. Instructors include Susan Waterman, RHIT, CCS, CPC, CRC, director of risk adjustment, Baylor Scott and White Healthcare; Ava Johnson, associate director, ambulatory CDQI, Mount Sinai Hospital, NYC; and Donna Malone, CPC, CRC, AAPC approved instructor, AHCCA, RAP, director clinical documentation and quality improvement (CDQI), Mount Sinai Hospital System.
Workshop B: Advanced HCC Auditor will also take place 9:30 a.m. to 5 p.m. This popular workshop focuses on HCC coding accuracy and is designed for those who are directly involved in HCC coding work as well as finance and analytics professionals. Instructors will introduce best practices and case examples. Participants will leave with an understanding of how HCC codes map 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), and clinical documentation barriers for risk adjustment purposes (data validation audit risks). Instructors include Deb Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA, director risk adjustment and recoveries, Paramount Healthcare/ProMedica Health System; Colleen Gianatasio, clinical documentation integrity and coding compliance, Capital District Physician’s Health Plan (CDPHP); and Laura Sheriff, RN, MSN, CPC, CRC, risk adjustment consultant, vice president, risk adjustment, South Western Health Resources.
Workshop C: RADV Audit Preparation for Success is a new half-day preconference session (9:30 a.m. to 1 p.m.) that examines the changes to RADV extrapolation, which stakeholders are needed when preparing for an audit, sample audits for team preparation, and explore the differences in preparation for small, medium, and larger organizations. Instructor is Donna Malone, CPC, CRC, AAPC approved instructor, AHCCA, RAP, director clinical documentation and quality improvement (CDQI), Mount Sinai Hospital System.
The new half-day workshop D: Risk Adjustment 101- An Overview of Risk Adjustment Processes and Terminology will take place 1 p.m. to 5 p.m. Instructors will go over risk adjustment’s purpose, participants, and best practices; the role of the provider; commonly used terms and acronyms associated with risk adjustment the RADV audit process, including team structure, timelines, Centers for Medicare & Medicaid Services (CMS) expectations, and best practices for audit preparation. Instructors include Jenni Monfils, CPC, CDEO, CRC, assistant vice president, risk adjustment coding and compliance, Bright Healthcare; Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, chief operating officer, First Class Solutions, Inc.; and Ekaette Joseph-Isang MD, MBA, MPH, senior director, CDI & quality, Honest Medical Group.
General sessions
CMS regulation update: Donna Malone, CPC, CRC, AAPC approved instructor, AHCCA, RAP, director clinical documentation and quality improvement (CDQI), Mount Sinai Hospital System, will review the upcoming changes in the CMS Final Rule and their impact on risk adjustment. She will also review the potential effect of the bipartisan bill impacting Medicare Advantage risk adjustment related to upcoding and discuss the key changes to the RADV audit process and best practices to prepare.
ACA risk adjustment update: J. Gabriel McGlamery, J.D., director of commercial market strategic integration, Florida Blue, will assess the impact of risk adjustment on competition in the ACA marketplace; review the biggest risk adjustment issues and how they are warping the market; adopt new strategies to communicate and explain ACA risk adjustment to senior leadership; and discuss ACA RADV audits and how best to prepare for them.
HCC Model V28 education and preparation: This panel session will examine the two-year breakdown of transition between HCC Model V24 and HCC Model V28 and how to prepare for accurate coding and submission. Instructors will review the educational opportunities for all stakeholders and discuss coding opportunities and the true revenue impact the model will have on your organization. Deb Curry will moderate the discussion. Panelists will include Rafael J Gonzalez M.D., director of clinical coding and CDI, Leon Medical Centers & Leon Health, and Khush Singh, MD, MHA, CRC, CPMA, CPCO, CDIP, consultant, risk adjustment and value-based care, program operations and compliance, Granite Consulting.
Culture of collaboration: Diversifying your engagement strategy: Explore ways to create a multi-channel strategy that engages patients and providers alike with speakers Meghan West, senior manager product management, Veradigm; Amanda Banister, senior manager of provider engagement, Veradigm; and Jessica Barnett, CHC, COC, CPC, CRC, manager, risk programs and audit, Blue Cross and Blue Shield of Kansas City.
State of the industry: Generating success in an evolving risk adjustment landscape: Panelists will discuss changes to ensure your organization is prepared for the transition from HCC Model V24 to HCC Model V28, the importance of preparation for a CMS audits, provider education, and key takeaways for your risk adjustment program. Deb Curry will return to the stage to moderate the discussion. Panelists include Dr. Joseph-Isang and Adele L. Towers, M.D., MPH, FACP, CRC, director of risk adjustment, UPMC Enterprises, and associate professor of medicine, Division of Geriatric Medicine, University of Pittsburgh; and Dr. Carlos Rodriguez, IMG, AHCCA, director of risk adjustment, Innovacare Health (invited).
Track sessions
Each day of the main conference will feature sessions within two tracks.
Track A will include sessions on the following topics:
- Automated technologies positive impact on risk adjustment
- Strategies to mitigate downstream financial impacts of V28 through technology and analytics
- Vendor oversite, communication, and management
- Tactics to close gaps in care utilizing data analytics
- Tools and technology spotlights
- Complete capture: Coding for risk adjustment and quality
- Advanced illness and frailty training for providers
- Provider education for CMS risk score run preparation for success
Track B will include sessions on the following topics:
- Strategies to increase coding precision
- Internal education for coders for transition to HCC Model V28
- Strengthen your OP CDI program by focusing on utilization and access
- Coding productivity improvement techniques
- Tools and technology spotlights
- Audit survival skills
- Recently audited plans experience
- An industry overview of recent audit findings
Networking opportunities
In addition to networking breakfasts and lunches during the two days of the main conference, RISE will host cocktail receptions with drinks and hors d’oeuvres for all attendees 5 to 6 p.m. Monday, November 27 and 5:30 to 6:30 p.m., Tuesday, November 28.
The Risk Adjustment Forum will take place November 27-29, 2023, at the Fairmont Dallas. Click here for the complete list of speakers, preconference workshops, the agenda, and how to register for the program.