Home - Medicare Advantage Risk Adjustment & Revenue Management Innovations

A successful risk adjustment department must be instantly responsive to changing CMS regulations and market conditions while innovating out-of-the-box solutions that deliver competitive advantage. Are you utilizing the best practices and procedures to optimize reimbursement? Join us at the 2nd Medicare Risk Adjustment & Revenue Management Innovations Summit designed exclusively for the unique needs of MA health plans, with a strong emphasis on actual health plan Best Practice Case Studies, in addition to vendor solutions. As the technology landscape evolves, plans are challenged to augment their coding programs with NLP and other AI tools. Hear from top MA health plans to find out how to minimize the impact of the pandemic by preserving quality and sustaining data volume, building strong provider incentive programs and ensuring compliance.

To optimize appropriate reimbursement, plans must work more efficiently and effectively within their organizations and with the provider community to ensure Data Quality & CMS compliance. Find out how MA health plan risk adjustment leaders are diligently working on reeducating providers on telehealth guidelines, flagging SDoH conditions, assisting providers on prioritizing member needs, and helping technology-challenged vulnerable members access care. For your safety, all SSN events are now virtual until the all-clear. These live-streaming events, which we have successfully delivered since April of last year, have received rave reviews in response to the unmatched content and faculty. And, our state-of-the art virtual platform allows for great networking and interaction through riveting general sessions, all designed to make your experience as real as if you were there in person. Plus, there are multiple chat rooms designed to connect you one-on-one (on camera if you choose) with the people you want to meet!

Hear how industry leaders have excelled beyond traditional performance levels. Speakers will drill down into the granular solutions that you can take home and implement to transform your plan's performance.

2021 All-Star Speakers

SCAN Health Plan

Antonette Buenavides

Dir. Risk Adjustment Programs & Audit

Centauri Health Solutions

Dawn Carter

Director Product Strategy

Providence Health Plan

Wynda Clayton, MS, RHIT

Risk Adjustment Manager

Paramount Health Care

Deb Curry, MBA, RHIA, CCS-P, CRC

Manager, Risk Adjustment

Network Health

Diane Gabrielsen

Vice President, IS Delivery

Highmark

Jen Hayes

Manager of Quality, HEDIS & Coding

Network Health

Bruce Kissinger

Solution Architect Director

Cybexys, Inc.

Raul Kivatinetz

CEO

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Florida Blue

Aldiana Krizanovic

Senior Health Policy Consultant, Federal Government Relations

Allina Health Aetna

Shawn Larsen, RN

Director of Stars Strategy & Risk Adjustment, Medicare

Capital District Physicians’ Health Plan

Tom Nasadoski, MBA

Director, Risk Adjustment and Recovery

Centers for Medicare & Medicaid Services (CMS)

Rebecca Paul

Deputy Director of the Medicare Plan Payment Group, Center for Medicare

Martin's Point Health Care

Dawn Peterson

Director of Risk Adjustment

Ciox Health

Matt Peterson

Executive Vice President, Client Success & Growth

GHG Advisors

Patrick Petty

Consultant, Risk Adjustment, Formerly, Gorman Health Group

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AmericasHealth Plan

Wendy Schmerse, CPC

Risk Adjustment Program Manager

Highmark

Amy Slafka

Medicare Advantage Risk Adjustment Program Manager

Ameridial

Craig Vretas

Vice President, Healthcare Solutions

Gateway Health

Dan Weaver

Vice President, Stars, Quality & Risk Adjustment

Network Health

Josh Weisbrod

Vice President, Risk Adjustment

PLATINUM SPONSOR

Disease Management by Population Segment to Boost Performance Scores, Increase Care Quality & Minimize Risk

GOLD SPONSOR

SILVER SPONSOR

Join Decision Makers to Exchange Ideas and Network

Regulations, Policy, Audit and Compliance

CMS & NCQA Policy - What's Working (and not working) for 2020 and Preparing for the Future
Compliance with Evolving Risk Adjustment Regulations

Auditing for RADV compliance - New Procedures Post Pandemic
Impact of COVID-19 - Forecasting for 2021 Based on 2020
From RAPS to EDPS

Provider Collaborations for Data Capture and Coding

Provider Engagement Strategies to Capture Data for both Risk Adjustment and Clinical Data
Coding Accuracy - What Visits to Include, Restructuring Existing Processes, What's New?
Risk Adjustment for Value-based Contracts

Refocus Provider Incentives on Chronic Condition and Problem Visits
Flag Social Determinants of Health to Ensure Chronic Conditions are Supported

AI, NLP, Telehealth & Other Technology Innovations

Telehealth Risk Revenue Strategies to Optimize Reimbursement
Telehealth Risk Adjustment Reconciliation - Data Submission/Substantiation

Augmenting Coding with AI and NLP to Exponentially Increase Efficiency & Minimize Outsourcing

Revenue Reconciliation & Financial Analysis

Interdepartmental Communications to Reduce Redundancies -- Aligning Quality, Stars & Risk to Boost Performance Scores
How Risk Adjustment Can Boost Star Ratings through Closing Gaps In Care
Turning Diagnosis Codes into Dollars: From Claims to HCC to Risk Score

Working with Financial Analysts to Ensure Financial Reconciliation of Recapture For Both Telehealth and In-Person Visits Using CMS Reporting
Choosing The Best Vendor Tools
Outcomes Of Annual Bids - What Will Plans be Doing in September and Going Forward

Who Should Attend:

From Medicare Advantage Health Plans:

Medicare Advantage Health Plans, ACOs, Medical & Provider Groups, IPAs, MSOs

Executives Responsible for:

Risk Adjustment
Risk Analytics
HCC Coding
Documentation
Audit

Finance/Actuarial
Vendor Performance
Data Analytics
Strategic Initiatives
Compliance

Also of interest to:

Quality Improvement
HEDIS and Stars