This conference has concluded.

The Risk Adjustment Peer-to-Peer Exchange


November 16-18, 2020 | Virtual Conference
#RiskAdjustmentIEN

Schedule


16

November 2020

Monday

Day One

  • **All times EST**
  • 11:00 AM

    Interactive Lunch ‘n Learn Session

    Prospective Risk Adjustment Interventions Health Plans are Using to Improve Capture of Complete, Accurate and Timely Data

    Welcome to 2020’s version of a working lunch meeting. Grab your lunch (or brunch) and join the conversation! This moderated session will be a hybrid of a presentation and meeting, giving you an opportunity to turn your cams and mics on and discuss this critical topic with your peers and colleagues.

    • • Understand the current challenges of prospective risk programs
    • • Learn how to implement an effective prospective program that leverages AI
    • • Identify areas of improvement for complete, accurate, and timely risk capture
    • • Discuss these challenges in a moderated format with other health plans and risk-bearing provider groups

    Facilitator:
    Bryan Lee, Vice President of Payer Solutions
    APIXIO

  • 12:00 PM

    Welcome & Chair’s Opening Remarks

    Ryan Dodson, CRC, Regional manager, Risk Adjustment
    MOLINA HEALTHCARE INC

  • 12:05 PM

    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

  • 12:45 PM
    Break
  • 1:00 PM

    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 HEALTHPLAN

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

  • 2:00 PM

    Interactive Networking Meet & Greet Breakouts

    “Pull up a chair,” turn on your mic and camera, and engage with fellow risk adjustment professionals from around the country. Discuss shared challenges, and exchange contact information to build your professional network. A facilitator will be on hand to get things started.

  • 2:20 PM
    Break
  • 2:45 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:
      • • Coding
      • • Contracting and Network Management
      • • IT

    Ryan Dodson, CRC, Regional manager, Risk Adjustment
    MOLINA HEALTHCARE INC

  • 3:30 PM
    Break
  • 3:45 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

  • 4:30 PM
    End of Day One

17

November 2020

Tuesday

Day Two

  • **All times EST**
  • 12:00 PM

    Welcome and Opening Remarks

    Ryan Dodson, CRC, Regional manager, Risk Adjustment
    MOLINA HEALTHCARE INC

  • 12:05 PM

    Case Study: Sentara Healthcare’s Experience Initiating Provider Engagement

    • • Examining top-level strategy considerations as we set off to improve provider engagement programs
      • • How we approached collaboration with network management, value-based contracting, and quality
      • • Our 3 Ts of Implementation – Train, track, targeted actions
      • • COVID-19 implications for PE
    • • Walking through key resources and implementation workflows for:
      • • Targeting members for current year gap closure
      • • Prospective gap closure support
    • • How we’re approaching data, analytics and attribution

    Lisa Garrett, RN, BSN, CPC, CPC-I, CPC-P, CRC, Risk Adjustment Manager
    SENTARA HEALTH PLANS

    Kwame Appiah-Yeboah, Ph.D., CRC, Director, Financial and Risk Management
    SENTARA HEALTH PLANS

  • 1:00 PM
    Break
  • 1:10 PM

    Special Feature: Content-Driven Interactive Breakouts

    Join fellow attendees for a special guided discussion. Share lessons learned and get answers to your own questions.

    • 1:10 – 1:35 Interactive Discussion: Prospective Risk Programs
      Terry Ward, SVP of Payer Solutions
      APIXIO

    • 1:35 – 2:00 Interactive Discussion: Retrospective Risk Programs
      Andy Kumar, VP of Product Strategy
      CIOX
  • 2:00 PM
    Break
  • 2:30 PM

    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, Regional manager, Risk Adjustment
    MOLINA HEALTHCARE INC

  • 3:30 PM
    Break
  • 3:45 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

  • 4:30 PM

    End of Day Two


18

November 2020

Wednesday

Day Three

  • **All times EST**
  • 12:00 PM

    Welcome Back and Opening Remarks

    Ryan Dodson, CRC, Regional manager, Risk Adjustment
    MOLINA HEALTHCARE INC

  • 12:05 PM

    Risk Adjustment Coding and Reducing Cost Using NLP with Machine Learning

    • • Examining traditional concerns with NLP and where the technological advancements stand in regard to risk adjustment
    • • Exploring use cases for deploying NLP technology coupled with human interaction, including:
      • • NLP for 2nd or 3rd level review
      • • Coders for 1st level review and NLP for audit
    • • COVID impact—the additional reconciliation run for CMS PY2020 risk adjustment data submission

    Carey Ketelsen, Senior Vice President of Risk Adjustment Coding Operation
    CIOX

    Andy Kumar, Vice President of Product Strategy
    CIOX

  • 12:45 PM
    Break
  • 1:00 PM

    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 do you do with your findings?
    • • How do you approach provider errors?

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

    Deborah Curry, MBA, RHIA, CCS-P, CRC, Manager, Risk Adjustment
    PROMEDICA

  • 2:00 PM

    End of Conference

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