The Risk Adjustment Peer-to-Peer Exchange


November 16-17, 2020 | Austin, Texas
#RiskAdjustmentIEN

This event was rescheduled from the original dates of April 27-28, 2020

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16

November 2020

Monday

Day One

  • 7:00 AM
    Registration & Networking Breakfast
  • 8:00 AM
    Welcome and Chairperson’s Opening Remarks
  • 8:15 AM

    Practical & Implementable Techniques to Boost Plan-Provider Collaboration

    • • What has worked and what hasn’t when incentivizing providers?
    • • How to provide better analytics to your providers based on the members they’re serving
    • • Practical tips and strategies to improve your providers’ coding and documentation in accordance with compliance regulations
    • • How to incorporate your Medical Directors into the discussion to boost engagement

    Randi Escobedo, MS, West Region Director of Strategic Programs
    UNITED HEALTHCARE

  • 10:00 AM

    PCP vs. Specialty: A Discussion of Best Practices and Untapped Opportunities to Capture Costly Member Conditions

    • • Evaluating pros and cons of prioritizing preventative care opportunities for risk capture
    • • Examples of why specialists may be an untapped resource for capturing your members’ costliest conditions
    • • Proven methods for collaborating more effectively with specialists to ensure sufficient documentation

    Neeta Shah, MD, FACP, FFSMB, Senior Vice President, Quality and Risk Adjustment
    HEALTHCARE PARTNERS, MSO

  • 10:45 AM
    Morning Networking Break
  • 11:00 AM

    Panel Discussion: Best Practices & Lessons Learned from Aligning Risk, Quality and Medical Management

    • • Examining organization structures before, during and after integrating operations
    • • What were your greatest challenges to streamlining risk and quality programs?
    • • Top lessons learned and examples of what should have been done differently
    • • What improvements and outcomes have come from your integration initiatives?

    Moderator:
    Jennifer Pereur, Vice President of Solutions
    APIXIO

    Panelists:
    Payal Kumar, MD, MBA, Director, Risk Adjustment and Quality Operations
    SUPERIOR HEALTH PLAN

    Tamara Matos, Stars Operations Director-Florida
    CIGNA

    Linda Farrington, CPC, CPMA, CPC-I, CRC, AAPC, Associate Director, MCAIP Integrated Field Operations
    UNITED HEALTHCARE MEDICARE & RETIREMENT

  • 12:15 PM
    Networking Luncheon
  • 1:15 PM

    Taking the Pulse of Interoperability and its Impact on Chart and Data Retrieval

    • • What is the current and future status of interoperability requirements?
    • • How are other plans approaching challenging CMS’ interoperability requirements?
    • • What will be the impact to chart and data retrieval?
    • • How are you collaborating with your providers to secure buy-in to your tools?

    Panelists:
    W. Todd Gibson, MHA, Health Data Integrity and Risk Adjustment Compliance Lead
    GEISINGER HEALTH PLAN

    Beth Galt-Salsamendi, Senior Clinical Consultant
    BLUE CROSS BLUE SHIELD OF FLORIDA

  • 2:15 PM

    Proven Methods to Optimize RAPS & EDPS Data Management and Submissions

    • • What systems and tools are you using to manage your risk adjustment data?
    • • Steps to more effectively navigate vague guidance to apply filters more appropriately
    • • Which data should be reported through RAPS and which data in EDPS? Techniques to more effectively identify and correct submission errors
    • • What alternative submission options are available to ensure all diagnoses are accounted for?

    Sarah Dixon, Director of Healthcare Finance
    KELSEYCARE ADVANTAGE

  • 3:15 PM
    Afternoon Networking Break
  • 3:30 PM

    Optimizing Risk Adjustment Compliance Monitoring Oversight

    • • Practical tips to more effectively perform compliance training for providers
    • • Best practices for developing and conducting an efficient mock audit program
    • • Key considerations when conducting compliance training for:
      • o Coding
      • o Contracting and Network Management
      • o IT

    Lisa Garret, RN, BSN, CPC, CPC-I, CPC-P, CRC, Risk Adjustment Manager
    OPTIMA HEALTH PLAN

  • 4:45 PM

    Networking Roundtables

    Take a deep dive with your colleagues into these topical roundtables, an informal opportunity to roll-up your sleeves and participate in in-depth topical discussions. Choose your topic.

    • Roundtable A: Risk and Quality Integration

    Jessica Turcotte, CPC, CRC, Director, Medicare and Commercial Risk Adjustment
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS

    • Roundtable B: Chart Retrieval and Review

    Ryan Dodson, CRC, Director of Operations
    CHOICE PHYSICIANS GROUP

    • Roundtable C: RADV and Compliance

    Lori Asmus, CRC, Director of Risk Adjustment
    NETWORK HEALTH

  • 5:30 PM
    Networking Reception
  • 6:00 PM
    End of Day

17

November 2020

Tuesday

Day Two

  • 7:00 AM
    Networking Breakfast
  • 8:00 AM
    Chairperson’s Recap of Day One
  • 8:10 AM

    Unlocking the Secrets of Medicaid Risk Adjustment

    With a focus on proven methods and best practices, this session will focus on techniques to overcome the most significant challenges related to risk adjustment within Medicaid, from member engagement to balancing state and federal requirements.

  • 9:00 AM

    Panel Discussion: We Went Through a RADV and All We Got was this Lousy T-Shirt

    • • What audit preparedness tools and techniques had we implemented prior to the audit—and did they help?
    • • Examining resource allocation throughout the RADV audit
    • • Considerations to make when outsourcing audit support
    • • How do you ensure the accuracy of your third-party coders’ efforts?
    • • What to do with RADV results and why you should approach provider errors differently when they are based on RADV outcomes

    Jessica Turcotte, CPC, CRC, Director, Medicare and Commercial Risk Adjustment
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS

    Jenni Monfils, CPC, CRC, Risk Adjustment Compliance Coding Manager
    UCARE

    Lori Asmus, Director of Risk Adjustment
    NETWORK HEALTH

  • 10:00 AM
    Morning Networking Break
  • 10:15 AM

    Advanced Strategies and Methods to Enhance Chart Reviews, HCC Coding, and Clinical Documentation Improvement

    • • Best practices to improve your chart reviews across each line of business
    • • Enhanced tips to more effectively mine PCP charts to improve code capture
    • • Understanding how hospital charts are different and how to conduct CDI on them
    • • How to use CDI efforts to educate providers about billing

    Wynda Clayton, MS, RHIT, Risk Adjustment Manager
    PROVIDENCE HEALTH PLAN

    Ryan Dodson, CRC, Director of Operations
    CHOICE PHYSICIANS GROUP

  • 11:00 AM

    Networking Roundtables

    • Roundtable A: RAPS/EDPS

    Facilitator: TBD

    • Roundtable B: Plan-Provider Collaboration

    Ryan Dodson, CRC, Director of Operations
    CHOICE PHYSICIANS GROUP

    • Roundtable C: Coding and CDI Efforts

    Jenni Monfils, CPC, CRC, Risk Adjustment Compliance Coding Manager
    UCARE

  • 12:00 PM
    Networking Luncheon
  • 1:00 PM

    Boosting Operational Oversight of Your Risk-Related Vendors to Mitigate Downstream Compliance Problems

    • • Vendor oversight best practices to improve transparency and response timeliness
    • • What to look for and how to identify possible instances of non-compliant vendor operations
    • • How do you take corrective actions if you suspect instances of non- compliance

    Osato Chitou, Esq. MPH, Founder & Principal
    COMPLI BY OSATO

  • 2:00 PM

    Innovative Plan and Provider Programs Improving Member/Patient Engagement

    • • Examining common behavioral traits of members in MA, Medicaid, and ACA exchange plans
    • • Tips and strategies to optimize member engagement in the respective lines of business
    • • Examples of member incentive programs that have yielded positive results
  • 2:45 PM
    Summit Wrap-Up & Conclusion
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