In this on-demand webinar, hear from Avalere and Inovalon risk adjustment experts to get a deep understanding of the latest regulatory changes from the Centers for Medicare & Medicaid Services (CMS).
Free webinar – now available on demand!
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Evolving risk adjustment models and regulations have made it even more important for health plans to resolve challenges like lack of transparency into member data and risk scores, inefficient and disjointed processes, inadequate expertise, and program customization capabilities.
CMS believes that “9.5 percent of payments to Medicare Advantage (MA) organizations are improper mainly due to unsupported diagnoses submitted by MA organizations. Prior OIG reviews have shown that some diagnoses are more at risk than others to be unsupported by medical record documentation”1 – heightening the need for health plans to have a robust risk program that can address all the different regulatory requirements.
In this webinar, industry experts from Avalere and Inovalon discuss the impact of recent federal regulatory changes including the RADV Rule and Final Call Letter, and share best practices for how health plans can manage their risk adjustment processes more efficiently and effectively.
Understand the latest updates in risk adjustment and learn how you can adapt your health plan’s programs to remain compliant in the ever-evolving risk landscape.
Learn about the model, impact, and changes expected in the coming year and hear about best practices your health plan can implement to create a smarter, faster, and more efficient risk adjustment process.
Get a first-hand look at how Inovalon is empowering health plans to improve their processes, prepare, and remain ahead of regulatory changes with compliant, cloud-based software.
*Benefit 4 Desc
Evolving risk adjustment models and regulations have made it even more important for health plans to resolve challenges like lack of transparency into member data and risk scores, inefficient and disjointed processes, inadequate expertise, and program customization capabilities.
CMS believes that “9.5 percent of payments to Medicare Advantage (MA) organizations are improper mainly due to unsupported diagnoses submitted by MA organizations. Prior OIG reviews have shown that some diagnoses are more at risk than others to be unsupported by medical record documentation”1 – heightening the need for health plans to have a robust risk program that can address all the different regulatory requirements.
In this webinar, industry experts from Avalere and Inovalon discuss the impact of recent federal regulatory changes including the RADV Rule and Final Call Letter, and share best practices for how health plans can manage their risk adjustment processes more efficiently and effectively.
Understand the latest updates in risk adjustment and learn how you can adapt your health plan’s programs to remain compliant in the ever-evolving risk landscape.
Learn about the model, impact, and changes expected in the coming year and hear about best practices your health plan can implement to create a smarter, faster, and more efficient risk adjustment process.
Get a first-hand look at how Inovalon is empowering health plans to improve their processes, prepare, and remain ahead of regulatory changes with compliant, cloud-based software.
The ScriptMed Cloud software solution is an industry leader, serving six of the top ten specialty pharmacies, and 35% of specialty pharmacy patients nationally
Revenue Cycle Expert
Kem is an Innovative Healthcare Leader with a passion for practice transformation through best practices, technology & education. She is the founder and president of Medical Revenue Cycle Specialists, a boutique medical revenue cycle consulting firm, which improves workflow and practice revenues for small to mid-size physician practices, allowing them to focus on patient care.
Over her career of over 20 years, Kem has earned a reputation as a transformational healthcare leader. She is currently also serving as the President of the Hyattsville/Prince George’s County Chapter of the American Academy of Professional Coders (AAPC). In this interview, Kem talks to me about overcoming challenges during the COVID pandemic and her experience as an author
Revenue Cycle Expert
Kem is an Innovative Healthcare Leader with a passion for practice transformation through best practices, technology & education. She is the founder and president of Medical Revenue Cycle Specialists, a boutique medical revenue cycle consulting firm, which improves workflow and practice revenues for small to mid-size physician practices, allowing them to focus on patient care.
Over her career of over 20 years, Kem has earned a reputation as a transformational healthcare leader. She is currently also serving as the President of the Hyattsville/Prince George’s County Chapter of the American Academy of Professional Coders (AAPC). In this interview, Kem talks to me about overcoming challenges during the COVID pandemic and her experience as an author
Revenue Cycle Expert
Kem is an Innovative Healthcare Leader with a passion for practice transformation through best practices, technology & education. She is the founder and president of Medical Revenue Cycle Specialists, a boutique medical revenue cycle consulting firm, which improves workflow and practice revenues for small to mid-size physician practices, allowing them to focus on patient care.
Over her career of over 20 years, Kem has earned a reputation as a transformational healthcare leader. She is currently also serving as the President of the Hyattsville/Prince George’s County Chapter of the American Academy of Professional Coders (AAPC). In this interview, Kem talks to me about overcoming challenges during the COVID pandemic and her experience as an author
Presenter wrap-up call to action
Revenue Cycle Expert
Kem is an Innovative Healthcare Leader with a passion for practice transformation through best practices, technology & education. She is the founder and president of Medical Revenue Cycle Specialists, a boutique medical revenue cycle consulting firm, which improves workflow and practice revenues for small to mid-size physician practices, allowing them to focus on patient care.
Over her career of over 20 years, Kem has earned a reputation as a transformational healthcare leader. She is currently also serving as the President of the Hyattsville/Prince George’s County Chapter of the American Academy of Professional Coders (AAPC). In this interview, Kem talks to me about overcoming challenges during the COVID pandemic and her experience as an author
Revenue Cycle Expert
Kem is an Innovative Healthcare Leader with a passion for practice transformation through best practices, technology & education. She is the founder and president of Medical Revenue Cycle Specialists, a boutique medical revenue cycle consulting firm, which improves workflow and practice revenues for small to mid-size physician practices, allowing them to focus on patient care.
Over her career of over 20 years, Kem has earned a reputation as a transformational healthcare leader. She is currently also serving as the President of the Hyattsville/Prince George’s County Chapter of the American Academy of Professional Coders (AAPC). In this interview, Kem talks to me about overcoming challenges during the COVID pandemic and her experience as an author
Revenue Cycle Expert
Kem is an Innovative Healthcare Leader with a passion for practice transformation through best practices, technology & education. She is the founder and president of Medical Revenue Cycle Specialists, a boutique medical revenue cycle consulting firm, which improves workflow and practice revenues for small to mid-size physician practices, allowing them to focus on patient care.
Over her career of over 20 years, Kem has earned a reputation as a transformational healthcare leader. She is currently also serving as the President of the Hyattsville/Prince George’s County Chapter of the American Academy of Professional Coders (AAPC). In this interview, Kem talks to me about overcoming challenges during the COVID pandemic and her experience as an author
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Managing Director, Avalere
Sean serves in Avalere’s Policy practice, focusing on Medicare Advantage (MA) and Part D reform, risk adjustment, and analysis of healthcare quality and utilization. In recent projects, Sean has helped MA plans obtain regulatory flexibility linked to enhanced benefits for members, access medical loss ratio flexibilities during the pandemic, improve bid gain/loss margin rules, and rationalize network requirements for dialysis centers. He led successful policy discussions with the Centers for Medicare & Medicaid Services (CMS) aimed at maintaining high quality of care for patients with end-stage renal disease while also reducing dialysis center network adequacy requirements, which restricted provider competition. Sean has also helped MA plans safeguard patient access by negotiating line-of-business requirements with CMS’s Office of the Actuary.
VP, Clinical Quality, Training, Oversight and Innovation, Inovalon
Kathleen is a registered nurse with over 20 years of experience and a deep dedication to improving healthcare quality through education. An expert trainer in clinical quality, coding and abstraction, and utilization management, Kate oversees clinical quality and training for all Inovalon’s clinical review staff.
VP, Data Analytics, Inovalon
Lalith is a seasoned executive with over 20 years of experience in healthcare technology. He is responsible for overseeing the product management and analytics of risk adjustment solutions for Medicare, Medicaid, and commercial risk adjustment products.
Business Development Director, Inovalon
Patrick has spent his career dedicated to healthcare technologies and payer solutions. For the last 10 years, he has worked on developing, executing, and understanding risk adjustment and risk score accuracy solutions. He leveraged that experience as and knowledge to be a Principal Solutions Engineer for over 6 years support the education and onboarding of customers for Inovalon solutions. Currently, Patrick works as a Director of Business Development for National accounts.
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We know that OIG is paying attention to this, we know that DOJ is paying attention and that they're both putting increased stress on CMS to do so as well and potentially even change their sampling methodology and frequency. Another thing I think was important and not to cause fear is they (OIG) also said, ‘at some point an error rate becomes fraud even without intent because failure to detect errors when they (health plans) should have had a process to do so is so very impactful.
No longer can you keep your head in the sand. This is not, ‘hopefully I won’t be chosen this year,’ this is really impacting everyone. Plans really can’t do that any longer seeing this increased scrutiny.
VP, Clinical Quality, Training, Oversight and Innovation, Inovalon
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Medical Software Specialist