Complete & accurate coding & documentation post-pandemic is more important than ever as the volume of data has declined dramatically since March of this year. To prevent a cataclysmic fall in risk adjustment performance, and to optimize appropriate reimbursement, plans must work more efficiently and effectively inter-departmentally 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, at the Inaugural Medicare Advantage Risk Adjustment & Revenue Management Innovations National Forum.

The role of the risk adjustment department demands attention to constantly changing CMS regulations and market conditions to allow out of the box thinking and lightening speed reactions. And, 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. This is the only Risk Adjustment & Revenue Management event 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.
2020 All-Star Speakers
SCAN Health Plan

Antonette Buenavides

Dir. Risk Adjustment Programs & Audit
Capital District Physicians’ Health Plan

Puneet Budhiraja

Senior Vice President, Chief Actuary
Harvard Pilgrim Health Care

Gaurishankar Chandrashekhar

Director of Revenue Management
Providence Health Plan

Wynda Clayton, MS, RHIT

Risk Adjustment Manager

Jen Hayes

Manager of Quality, HEDIS & Coding
Florida Blue

Aldiana Krizanovic

Senior Health Policy Consultant, Federal Government Relations
Gorman Health Group

Jeff De Los Reyes

Senior Vice President, Healthcare Analytics and Risk Adjustment Solutions
Health Alliance

Zoe Lutes

Director of Utilization Management & Risk Adjustment
Tufts Health Plan

Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP

AAPC Approved Instructor, Director Coding & Provider Education (CDI), Enterprise Risk Adjustment
Martin's Point Health Care

Dawn Peterson

Director of Risk Adjustment
UPMC Health Plan

Tim Plank

Director, Government Revenue Risk Adjustment, Insurance Services Division
Pareto Intelligence

Brandon Soloman

Vice President, Client Advisory & Business Development
UPMC Enterprises

Dr. Adele Towers

Director of Risk Adjustment
Gateway Health

Dan Weaver

Vice President, Stars, Quality & Risk Adjustment
Network Health

Josh Weisbrod

Vice President, Risk Adjustment

Michael Zeli

Director of Risk Adjustment and Quality
  • Disease Management by Population Segment to Boost Performance Scores, Increase Care Quality & Minimize Risk
  • Disease Management by Population Segment to Boost Performance Scores, Increase Care Quality & Minimize Risk
  • Disease Management by Population Segment to Boost Performance Scores, Increase Care Quality & Minimize Risk
  • Disease Management by Population Segment to Boost Performance Scores, Increase Care Quality & Minimize Risk

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