Federal Enforcement impact on Risk Adjustment MA Landscape: Key Legal and Compliance Considerations

Event Date: 2/13/2019

Event Overview

Wednesday, February 13, 2019
11:00AM CT – 12:30PM CT (90 minutes)

This event is hosted on our ReadyTalk platform

Government interest and enforcement involving the Medicare Advantage (MA) Program risk adjustment payment system no longer is focused solely on Medicare Advantage Organizations. This presentation is an overview of the potential legal pitfalls and current enforcement landscape in Medicare Advantage associated with risk adjustment. We will provide an overview of the risk adjustment payment methodology, how providers influence payment, key risk and enforcement areas, and best practices moving forward.

Medicare Advantage Risk Adjustment

Background on Payment Methodology – provide an overview of the Medicare Advantage program and how risk adjustment works
Government Interest – explain why the government is interested
Regulatory Landscape – discuss regulations and sub-regulatory guidance relevant to MA and payment (MA Overpayment Rule, False Claims Act, Anti-kickback Statute, MA compliance regulations, sub-regulatory CMS guidance )

Emerging Risk Areas, Enforcement Landscape and Considerations: this section will discuss the following five risk areas, recent government interest and considerations in practice

Documentation and Coding – Practice and Guidance – discuss common issues with documentation and coding practices and guidance that affect payment
Retrospective Chart Reviews – overview of retrospective chart reviews, recent activity and considerations in practice
In-Home Assessments – overview of in-home assessments, recent activity, CMS issued best practices and other considerations
Filtering Logic – analysis of data submission errors
Internal Auditing and Monitoring – overview of common practices and pitfalls, provider related cases and best practices in ensuring compliance with the MA program

Audience

Leaders in risk adjustment, compliance, legal, and fraud, waste & abuse will find this content invaluable.

Other recommended events

Register now for these upcoming events

Discuss strategies DSNP plans may have for engaging members to complete an HRA | Braindate | 04/30/2024
Transforming Healthcare Analytics: Strategies & Tools for Actionable Insights and Improved Outcomes | Vendor Spotlight | 05/01/2024
Care Management Model Roundtable Call | Webinar | 05/01/2024

View the presentation materials from these recent events

Mastering Integrated Payments + Communications | Vendor Spotlight | 04/23/2024
Machine Readable File and Treatment Cost Calculator Compliance | Braindate | 04/22/2024
Risk Adjustment and HCC capture: CDI and previsit planning | Braindate | 04/22/2024

Documents

2/13/2019

Presentation: Federal Enforcement impact on Risk Adjustment MA Landscape - Key Legal and Compliance Considerations
Government interest and enforcement involving the Medicare Advantage (MA) Program risk adjustment payment system no longer is focused solely on Medicare Advantage Organizations. This presentation is an overview of the potential legal pitfalls and current enforcement landscape in Medicare Advantage associated with risk adjustment. We will provide an overview of the risk adjustment payment methodology, how providers influence payment, key risk and enforcement areas, and best practices

2/12/2019

Federal Enforce Impacts on RA MA Landscape
An overview from Epstein Becker Green of the potential pitfalls and current enforcement landscape in Medicare Advantage associated with risk adjustment. Included are the risk adjustment payment methodology, how providers influence payment, key risk and enforcement areas, and best practices.