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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.

 

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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.
Attendees

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

  • Renee Kimm
  • ALLIANCE GUEST
  • Compliance at Central Health Plan of California
  • Gay Ball
  • ALLIANCE MEMBER
  • MRA Project Manager at Cone Health
  • Nicole Beadle
  • ALLIANCE MEMBER
  • Manager, Medicare Compliance at Paramount Health Care
  • DeeEl Brovetto
  • ALLIANCE MEMBER
  • Risk Adjustment Auditor II at Scott & White Health Plan
  • Ngoc Bui-Tong
  • ALLIANCE MEMBER
  • Director of Health Care Economics at Santa Clara Family Health Plan
  • Deb Curry
  • ALLIANCE MEMBER
  • Risk Adjustment Manager at Paramount Health Care
  • Crystal Djordjevic
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Consultant at Health Alliance Medical Plans
  • Rebecca Downing
  • ALLIANCE MEMBER
  • Chief Legal Officer at Western Health Advantage
  • Teya Enerson
  • ALLIANCE MEMBER
  • Sr. Claims Coding Associate Pop Health - Risk Adjustment at Indiana University Health Plans
  • Kelli Fisher
  • ALLIANCE MEMBER
  • Risk Adjustment Auditor at Paramount Health Care
  • Lisa Garrett
  • ALLIANCE MEMBER
  • Risk Adjustment Manager at Sentara Health Plans (Optima)
  • Deanna Homer
  • ALLIANCE MEMBER
  • Vice President, Pharmacy Operations and Quality Programs at HealthTeam Advantage
  • Kaitlin Knapik
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Auditor at Mount Carmel Health System
  • Daniel Morrissey
  • ALLIANCE MEMBER
  • Assistant Coordinator at Paramount Health Care
  • Cathy Nagy
  • ALLIANCE MEMBER
  • Manager, Risk Adjustment Coding and Education at Health Alliance Plan (HAP)
  • Jean Rao
  • ALLIANCE MEMBER
  • Pharmacy Manager at Chinese Community Health Plan
  • Dean Ratzlaff
  • ALLIANCE MEMBER
  • Actuary at Sentara Health Plans (Optima)
  • Monday Reynolds
  • ALLIANCE MEMBER
  • Certified Coder at Santa Clara Family Health Plan
  • Rita Ruecker
  • ALLIANCE MEMBER
  • Chief Financial Officer at Western Health Advantage
  • Wesley Sanders
  • ALLIANCE MEMBER
  • Director of Finance at Alliant Health Plans
  • Sarah Schultz
  • ALLIANCE MEMBER
  • Internal Auditor at CommunityCare
  • Kristy Stephens
  • ALLIANCE MEMBER
  • Director of Proposal Development at Fluent Health
  • Josh Weisbrod
  • ALLIANCE MEMBER
  • VP Risk Adjustment at Network Health
  • Joan Wilberg
  • ALLIANCE MEMBER
  • Manager, Healthcare Economics at Indiana University Health Plans
  • Teresa Younkin
  • ALLIANCE MEMBER
  • Lead Analyst at Geisinger Health Plan
  • Jason Christ
  • SPEAKER
  • Member of the Firm at Epstein Becker Green (EBG)
  • Teresa Mason
  • SPEAKER
  • Senior Counsel at Epstein Becker Green (EBG)
Speakers