Log in/Register

Return to search

Risk Adjustment Value Visit 2017

Event Date: 2/15/2017 - 2/17/2017

Event Overview

2017 Risk Adjustment Value Visit in Orlando, FL

Access the Risk Adjustment Toolkit

Visit the documents tab to access the event podcasts, presentations and shared resources from the Risk Adjustment Value Visit (department org charts, job descriptions and best practices).

Have a resource you would like to share?
Share a resource

The defining operational and strategic issue for any health plan serving government sponsored beneficiaries is risk adjustment. Join us February 15-17 for a deep dive into documentation, operational, and strategic issues related to risk adjustment.

 

Who should attend?

  • Chief Financial Officers
  • Risk adjustment leaders
  • Clinical analysts and population health stakeholders
  • Government program leaders with responsibility for Medicare Advantage, Medicaid, or the marketplace
  • Certified coders and/or those who manage certified coders


Event highlights

  • EDPS and RAPs reconciliation: How member plans are mitigating risks, managing the process in house, or identifying vendor partners to help them succeed
  • Case Study from Community Health Options (Maine): Translating risk adjustment intel meaningfully into product design
  • Case Study from Health First (Florida): How this plan is capitalizing on its investment in the risk adjustment to extend the program's value

 

Coding Work Group: Live broadcast (in-person and online)

Wednesday, February 15  |  8:30 AM ET  |  90 minutes

A collection of case studies from Alliance member plans, with a focus on appropriate documentation. To join the online broadcast, register for the Value Visit as a virtual attendee and you will receive the dial-in information. (NOTE: CEU earning opportunity*)

 

CEU Earning Opportunities*

This event has been approved for 3.5 CEUs by AAPC and AHIMA.  Individuals who attend the live broadcast of the coding workshop are eligible to earn 1.5 AAPC CEUs and 1.5 AHIMA CEUs for that session and individuals who attend the whole Value Visit in Orlando are eligible to earn 3.5 CEUs from both organizations.

This program has been approved for 3.5 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. 

 

Thank you to our Sponsors

SILVER SPONSORS

 

     

BRONZE SPONSORS

 

 

     

OTHER SPONSORS

                   


 
 
Functions

Wednesday, February 15, 2017

6:30 - 8:30 pm Networking dinner for event delegates at The Rusty Spoon

 

Thursday, February 16, 2017

6:30 - 8:30 pm Networking dinner for event delegates at 310 Lakeside

 
Agenda

AGENDA AT A GLANCE*   (Full agenda can be found in the Documents tab)

*note: this is a working agenda and will be updated as sessions changed a/or speakers are confirmed

**We have been approved for AAPC and AHIMA CEUs 

WED, FEB 15

Documentation, department structure and data management

8:30am

Coding workshop: Case study examples and best practices review (CEU opp)

10:15am

Best practices for a smooth and effective IVA process (CEU opp)

11:15am

RADV: risk mitigation, audit preparation and lessons learned (CEU opp)

12:15pm

Lunch and Learn: Roundtable discussions

1:15pm

Understanding and managing the risks of overpayment

3:15pm

Flash case studies: EDPS and RAPs reconciliation – homegrown solutions

4:15pm

Case study recap: Alliance member plans take RAPID-M for a test drive

THURS, FEB 16

The political environment and strategies for survival

8:30am

Understanding the political environment and the anticipated impact on risk adjustment

10:30am

The fringe impact: How to surf the public exchange risk adjustment wave

1:00pm

Case study: The lifecycle of beginning a new vendor relationship

2:50pm

Case study: Translating risk adjustment intel meaningfully to product design

4:00pm

Case study line up: Working with providers for effective risk adjustment communication and intervention

FRI, FEB 17

Expanding the value prop of risk adjustment

8:00am

Breakfast break outs: Roundtable discussions

8:45am

Department structures and policy and procedure show and tell

9:30am

Case study: An Alliance member health plan capitalizes on their risk adjustment department’s value proposition

 


Venue

Grand Bohemian Hotel in Orlando, FL

Grand Bohemian Hotel
325 S Orange Avenue
Orlando, FL 32801
407.313.9000

Our room rate is $209 plus taxes/fees. Internet access in the guest rooms is complimentary. This rate may be available three days prior and three days after our meeting dates, depending on the hotel's availability. You should call the reservations department at 866-663-0024 and ask for the Health Plan Alliance (HPA) room rate or click here to book your room online. You must call the hotel by January 23, 2017 in order to receive our group room rate. Should you call after this deadline, you will not be guaranteed to receive our group room rate or the hotel may be sold out. Please note that the group block could sell out before this date.

DRESS
Business casual attire is appropriate for the meeting.  Remember that the hotel meeting room temperatures vary, so we recommend that you layer clothing to be comfortable in case the room becomes either hot or cold.

GROUND TRANSPORTATION
The hotel is about 13 miles from Orlando International Airport (MCO) and is approximately a 25 minute drive. Taxi service is available for an estimated $45 one way.  Valet parking is $26 overnight and $16 if not staying overnight. 

ORLANDO WEATHER
Click here for the latest weather forecast.


Documents
Page 4 of 5
First | Previous | Next | Last
2/7/2017

Risk Adjustment Coder
Under minimal supervision using established procedures, abstracts medical information from various sources in the patient medical record for Medicare Advantage Risk Adjustment (MARA) and Healthcare Reform (HCR) Risk Adjustment projects. Designs and works with forms for collection of data and performs surveillance checks to monitor the accuracy of data. Ensure appropriate documentation and data collection according to specific project or audit requirements. Provides for quality assurance activities and coordinates auditing processes with leadership. Work collaboratively with various HAP departments and HAP’s provider community to obtain accurate submission of risk adjustment data through coordinated medical chart review activity. Promote education on the importance of comprehensive medical record documentation and correct coding. Position is responsible for maintaining a culture of integrity through coding compliance and adherence to CMS program guidelines.

2/7/2017

Risk Adjustment Financial Analyst III
Under minimal supervision provide assistance to the Manager of the Medicare Advantage Risk Adjustment. Works closely with the Lead Medicare Advantage Financial Analyst in ensuring the finance responsibilities for the Medicare Advantage program are performed. Assists Lead tasks in the development and coordination of MA risk adjustment projects. Coordinate project start-up for chart review and Audits. Assist with HHS HCR RADV Audits as necessary. Assist with department control procedures, financial and reporting systems to provide specialized information to various users. Under minimal supervision perform analysis, reconciliation and problem solving, and understanding of the complexities of the Medicare Advantage program. Assist Lead in working with Henry Ford Medical Group, information systems, Membership & Billing departments and Altegra Health (Risk System). Coordinate system testing, enhancing data integrity, and work with internal as well as external customers to create and

2/7/2017

Risk Adjustment Health Information Analyst
Retrieves all medical records for CMS Risk Adjustment Data Validation (RADV) audits, Health care Reform (HCR) RADV audits and internal Medicare Advantage Risk adjustment projects as needed. Using excel and /or Access logs, monitors and tracks incoming medical records. Monitor and track what records have been received and which remain outstanding. Works directly with multiple HAP departments to write and approve provider mailings. Works closely with Provider Relations Department to reconcile the correct payment amount for medical record as indicated in provider contracts. Actively communicates with the provider community in order to obtain medical records before deadlines. Processes incoming medical records and performs quality checks to ensure that the correct records are retrieved. Works closely with Medical Record Retrieval vendors to resolve any issues related why records cannot be obtained. Audits medical record vendor invoices to ensure proper payment for services. Perfor

2/7/2017

Risk Adjustment Lead Financial Analyst
Under minimal supervision provide assistance to the Director and Manager of the MA Risk Adjustment Department in ensuring the finance responsibilities for the Medicare Advantage program are performed. Lead all projects and tasks in the development and coordination of MA risk adjustment projects. Leads and coordinates all start up for Medicare Risk Adjustment CMS Audits. Assist with HHS HCR RADV Audits as necessary. Coordination and production of department control procedures, financial and reporting systems to provide specialized information to various users. Under minimal supervision perform analysis, reconciliation and problem solving, and understanding of the complexities of the Medicare Advantage program. Act as a liaison between Henry Ford Medical Group, information systems, Membership & Billing departments and Altegra Health (Risk System). Coordinate system testing, enhancing data integrity, and work with internal as well as external customers to create and maintain the Me

2/7/2017

Risk Adjustment Financial Analyst II
Under limited supervision assists the FA III Analyst and/ or Lead Analyst with all Medicare Advantage Risk Adjustment project work including project start up, tracking and summarization. Project work consists of creation of project descriptions and detailed instruction on startup sample selection. In addition support maintenance of the Altegra Health Risk view system by assisting with testing of new release and monthly load as well as monitor new requests for enhancements to the system and/or submission of trouble tickets to Altegra Health Support team.

2/7/2017

Risk Adjustment Medical Coder Lead
Oversight of daily output of chart reviews for Medicare Advantage Risk Adjustment (MARA) and Healthcare Reform (HCR) Risk Adjustment projects. Assist coders with routine coding questions and monitors the quality and quantity of daily coded output. Research coding questions using Coding Clinic and other resources as necessary. Assists with documentation of processes, thorough written policies and procedures including writing, reviewing, updating and storage. Perform coding and abstracting on routine and special projects. Build a strong knowledge of the systems and assist Financial Analyst with testing of new releases.

2/7/2017

Risk Adjustment Manager
Responsible for development and execution of projects concentrated on complete and accurate reporting of the health status of HAP’s Medicare Advantage (MA) and Commercial Qualified Health Plan (QHP) membership to CMS. Coordinate various HAP/HFHS departments and HAP’s provider community to obtain accurate submission of risk adjustment data through coordinated medical chart review activity. Promote education on the importance of comprehensive medical record documentation and correct coding. Position is responsible for achieving results which contribute to HAP’s financial goals by optimizing MA and QHP premium revenue while simultaneously maintaining a culture of integrity through coding compliance and adherence to CMS program guidelines.

2/7/2017

Coding Workshop: Case Study Examples and Best Practices Review
This session is designed for individuals within Health Plan Alliance member health plans who are certified coders a/or supervising certified coders, and who have responsibility for coding, documentation and other activities related to RADV audits for MA and/or the ACA products.

2/6/2017

Risk Adjustment Department Best Practices
Risk Adjustment Best Practices Summary document for Health New England. Contains information around Policies, Procedures, Tools and Roles in the Health New England Risk Adjustment department.

2/2/2017

Risk Adjustment Organizational Chart
Organizational Chart showing the location of the Risk Adjustment department at Health New England.

Page 4 of 5
First | Previous | Next | Last
Attendees

Below is a list of all delegates registered to date for this event

  • Rick Alexsonshk
  • ALLIANCE MEMBER
  • Director ACA Risk Adjustment at SummaCare
  • Terri Bowers
  • ALLIANCE MEMBER
  • HCC Risk Adjustment Analyst at Providence Health Plan
  • Joe Caldwell
  • ALLIANCE MEMBER
  • Chief Finance Officer at Denver Health Medical Plan
  • Wynda Clayton
  • ALLIANCE MEMBER
  • Risk Adjustment Manager at Providence Health Plan
  • Rudy Dominguez
  • ALLIANCE MEMBER
  • Population Health Managment Process Specialist at Community Health Plan of Washington
  • April Dos Santos
  • ALLIANCE MEMBER
  • Plan Development Specialist at Alliant Health Plans
  • Jessica Dupont
  • ALLIANCE MEMBER
  • Vice President of Government Programs at Alliant Health Plans
  • Chris Frederickson
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment Data Analytics at Network Health
  • Sara Hansen
  • ALLIANCE MEMBER
  • Senior Director, Population Health & Clinical Operations at Avera Health Plans
  • Amber Harris
  • ALLIANCE MEMBER
  • Director Risk Adjustment at MediGold
  • Susan Herbert
  • ALLIANCE MEMBER
  • Director, Health Plan Integration & Development at AdventHealth (FHHS)
  • Jennifer Hunt
  • ALLIANCE MEMBER
  • AVP Actuarial Services at Paramount Health Care
  • Karen Jensen
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment and SIU at Quartz Health Solutions
  • Luce Lohier
  • ALLIANCE MEMBER
  • Director, Government Programs Reimbursement at AvMed
  • Rachel Musacchio
  • ALLIANCE MEMBER
  • Director of Value Capture at Health First Health Plans
  • Daniel O'Connell
  • ALLIANCE MEMBER
  • Vice President of Health Services at Cox HealthPlans
  • Michelle Peake
  • ALLIANCE MEMBER
  • Manager Analytics Risk Adjustment and HEDIS at Health First Health Plans
  • Kylie Rasmussen
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Auditor at SelectHealth
  • Dean Ratzlaff
  • ALLIANCE MEMBER
  • Director, Actuary/Revenue Management at Sentara Health Plans (Optima)
  • David Seal
  • ALLIANCE MEMBER
  • Executive Director Provider Outreach and Engagement at AdventHealth (FHHS)
  • Jennifer Wilson
  • ALLIANCE MEMBER
  • Director, Risk Adjustment at Community Health Options
  • Julia Lambert
  • SPEAKER
  • Principal & Senior Consulting Actuary at Wakely Consulting Group
  • Alexis Levy
  • SPEAKER
  • Managing Director at HealthScape Advisors, LLC
  • Alison Pool
  • SPEAKER
  • Sr. Consulting Actuary at Wakely Consulting Group
  • Karan Rustagi
  • SPEAKER
  • Senior Consulting Actuary at Wakely Consulting Group
  • David Smith
  • SPEAKER
  • Founder at Third Horizons Strategies
  • Abdo Abdo
  • SPONSOR
  • Vice President, Business Development at Talix
  • Becky Erbe
  • SPONSOR
  • Chief Business Development Officer at hunterAI
  • Michael Nemeth
  • SPONSOR
  • Director of Revenue Management Strategy at DST Health Solutions
  • Lisa Alexander
  • VIRTUAL ATTENDEE - MEMBER
  • Point of Service Coding Analyst at Health Alliance Medical Plans
  • Dania Alvarez
  • VIRTUAL ATTENDEE - MEMBER
  • BI Systems Analyst III at AvMed
  • Jane Andersen
  • VIRTUAL ATTENDEE - MEMBER
  • Senior Risk Adjustment Analyst at Community Health Options
  • Julie Bartels
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Analyst at Quartz Health Solutions
  • Robin Bibler
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Analyst at Providence Health Plan
  • Dalene Brandenburg
  • VIRTUAL ATTENDEE - MEMBER
  • Data Analytics Coordinator at Health Alliance Medical Plans
  • Sarah Burke
  • VIRTUAL ATTENDEE - MEMBER
  • Lead Quality Auditor at Health First Health Plans
  • Yang Cao
  • VIRTUAL ATTENDEE - MEMBER
  • Actuary at Fidelis Care New York
  • Charniece Carter
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Operations Supervisor at Health First Health Plans
  • Zhuo Chen
  • VIRTUAL ATTENDEE - MEMBER
  • Actuary at Fidelis Care New York
  • Colleen Degenhardt
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Analyst at Quartz Health Solutions
  • Doris Ewing
  • VIRTUAL ATTENDEE - MEMBER
  • Coding Analyst at Health Alliance Medical Plans
  • Craig Humphrey
  • VIRTUAL ATTENDEE - MEMBER
  • President & COO at FirstCarolinaCare Insurance Company
  • Amy Jack
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Manager at SelectHealth
  • Morgan Johnson
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor at SelectHealth
  • Erin Kavanagh
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Analyst at Samaritan Health Plans
  • Kaesie Kettinger
  • VIRTUAL ATTENDEE - MEMBER
  • Senior Risk Adjustment Auditor at Paramount Health Care
  • Anji Lefler
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor at SelectHealth
  • Rhonda Long
  • VIRTUAL ATTENDEE - MEMBER
  • Coding Analyst at Health Alliance Medical Plans
  • Stephne Morgan
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Program Manager at Health New England
  • Jaylene Olson
  • VIRTUAL ATTENDEE - MEMBER
  • Point of Service Coding Analyst at Health Alliance Medical Plans
  • Kari Pace
  • VIRTUAL ATTENDEE - MEMBER
  • Clinical Documentation Improvement Nurse-Risk Adjustment/Quality Management at Medical Associates Health Plans
  • Jessica Phillips
  • VIRTUAL ATTENDEE - MEMBER
  • Quality Improvement Specialist at Health New England
  • Jennifer Rohs
  • VIRTUAL ATTENDEE - MEMBER
  • Manager, Documentation and Coding Education at Henry Ford Health System
  • Kristy Russell
  • VIRTUAL ATTENDEE - MEMBER
  • HCC Coding Analyst Supervisor at SelectHealth
  • Krista Schonrock
  • VIRTUAL ATTENDEE - MEMBER
  • AVP, Senior Medical Director Physician Review at SelectHealth
  • Stefanie Shelton
  • VIRTUAL ATTENDEE - MEMBER
  • Sr. Claims and Reimbursement Specialist at Community Health Plan of Washington
  • Ashley Stipanovich
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor I at SelectHealth
  • Tana Turner
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor ll at SelectHealth
  • Erin Walsh
  • VIRTUAL ATTENDEE - MEMBER
  • Compliance Manager at IU Health Plans
  • Kimberly Watkins
  • VIRTUAL ATTENDEE - MEMBER
  • Risk Adjustment Coding Auditor Supervisor at Intermountain Healthcare
  • Joan Wilberg
  • VIRTUAL ATTENDEE - MEMBER
  • Manager, Healthcare Economics at IU Health Plans
  • Colin Yi
  • VIRTUAL ATTENDEE - MEMBER
  • Actuary Analyst at Fidelis Care New York
  • Xiaoling Zhang
  • VIRTUAL ATTENDEE - MEMBER
  • Actuary at Fidelis Care New York
Speakers