Monday, August 4, 2014

Find out everything you need to know about risk adjustment and how it applies to your plan at this one-of-a-kind event!

 Join me November 17, 2014 at the RISE Risk Adjustment Academy - Risk Adjustment 101 Workshop!

The Risk Adjustment Forum is leading the way in risk adjustment education with a comprehensive main event covering some of today’s thorniest risk adjustment challenges and two concurrent, day-long pre-conference workshops – Risk Adjustment 101 & Risk Adjustment Master Class. 

Find out everything you need to know about risk adjustment and how it applies to your plan at this one-of-a-kind event!
Register for the All-Access Pass to attend your choice of pre-conference workshop AND the main event!
The Risk Adjustment Forum is designed to help your plan meet all of today’s risk adjustment challenges and maintain financial solvency in an uncertain marketplace. Examine RA from Medicare Advantage, Exchange/Non-exchange Commercial Plans, Medicaid & Duals perspectives.  This essential conference is a must–attend for plans who are ready to take their risk adjustment game to the next level!
Highlighted sessions include:
  • Risk Adjustment Schemes across All Lines of Business
  • Connecting the Dots – Applying an Organization-Wide Risk Adjustment Strategy  
  • Medicaid Risk Adjustment – A Bird’s Eye View
  • The New CMS-HCC Model  - Moving from Blended Scores to Full Integration
  • Best Practices for Risk Adjustment Data Validation Audits
  • ACA Risk Mitigation Programs and for Exchange and Non-Exchange Commercial Plans
  • Leveraging Data from New Exchange Enrollees
The RISE Risk Adjustment Academy Pre-Conference Workshops With two separate all-day workshops with expert faculty, this is your opportunity to train your newly hired staff at the same time as your expert coding and documentation crew.  Be prepared for jam-packed and intensive learning.  These workshops are held the day prior to our Risk Adjustment Forum—attend one or the other to gain a solid foundation for the main conference to follow!
Highlights Include:
  • Learn the CMS payment model and risk adjustment methodology
  • Understand the purpose of risk adjustment and intended applications
  • Learn about RADV audits – what they are about, the perils and the work involved
  • Appreciate the linkage to HEDIS, Medicare Stars and care management
  • Understand the differences in FFS versus Risk-Adjusted payment from the provider perspective
  • Learn about the legal and compliance risks – documentation is the crucial skill set
  • Understand what the changes are in documentation using ICD-9 and -10 code sets
  • Learn lessons from the experts - Common mistakes and pitfalls in documentation
This program is eligible for up to 18 CPE credits in the Specialized Knowledge and Applications field of study for the workshop plus main conference.

  • Which fees are LPs especially sensitive to and how should transaction fees and expense allocations be handled?
  • What are some innovative tax-planning strategies that we should be mindful of?
  • What are some effective approaches to the increasing demand for LP co-investments?
  • Can the use of management fee waivers help promote better tax efficiency?
  • How different is the SEC’s routine exam versus the presence exam and how can we be ready for when they pay their visit? 
  • What should we be doing to ensure a stellar, cost-efficient compliance culture?
  • What are the biggest issues on the SEC’s radar and are there any proposed new regulations that we should be aware of?
  • How should we be handling our valuation policies in light of increasing SEC and LP demands?
  • What types of waterfall models are successful funds using and are there any innovative new trends?
  • What are some useful strategies when managing maturing and liquidating funds?
November 17 - 19, 2014

The Westin Colonnade Coral Gables
180 Aragon Avenue
Coral Gables, FL 33134

We have a block of rooms reserved at a special rate of $199/night. This rate expires on October 27, 2014. Book early - we expect the block to sell out prior to this date. Mention the “Risk Adjustment Forum” when placing your room reservation to receive the negotiated rate. Upon sell out of the block room rate and availability will be at the hotel’s discretion. Please call 305-441-2600 to book your room.
  • Get comprehensive and up to date information on risk adjustment
  • Define the difference between prospective and retrospective/concurrent assessments and how they apply to your risk adjustment program
  • Get tips to help you avoid transfer payments
  • Learn the about the differences and similarities between MA, Medicaid, and commercial risk adjustment models
  • Discover best practices for CMS RADV audits
  • Acquire a business-based context on how risk adjustment contributes to the viability of the organization, including RADV and legal risk management
  • Discover how diagnostic coding for FFS differs from risk-based programs, including how E&M procedures are treated
  • Learn how optimal documentation is the most bullet-proof strategy for minimizing RADV audit risks
This conference is designed for: Medicare Advantage, Medicaid managed care, and exchange and non-exchange commercial plan executives and providers operating at-risk from the following areas:
  • Risk Adjustment
  • HCC
  • Actuarial staff
  • Pricing & valuation
  • Compliance & audit personnel
  • Plan design
  • Provider engagement & education
  • Finance/Revenue
  • Medicare/Government Programs
As well as:
  • Provider groups
  • State/Government Agencies
  • Risk Adjustment & Predictive Modeling vendors
  • Actuarial and consulting firms
Register Now: Space is Limited!
For more information and to register, contact Whitney Betts at 704-341-2445 or Group Discounts Available!

Learn More:

What can mHealth Games do for your Managed Care Organization?

 Kameron Gifford, CPC

Staff Training

Automate and track all frontline training and development initiatives with one easy-to-use solution.

  • Reduce your Organization’s ICD-10 Training costs up to 88%.
  • Build custom learning plans and automate HIPPA, HITECH and FWA Training.
  • Manage multiple certifications, including renewal and expiration processing.
  • Audit proof your education programs with the xAPI and prove mastery.
  • Build a virtual learning environment (VLE) to launch fun and interactive learning programs.

Clinical Documentation Improvement

Clinical Documentation Improvement or CDI — a process in which care providers receive feedback from specialists who review clinical documents —   delivers clinical and financial benefits for healthcare organizations.  

·       Fill the gaps in care including those found in documentation, coding, quality, and many other aspects involved with the overall care management of a patient.

·       Improve processes, eliminate errors, reduce costs, and increase revenue.

Risk Adjustment Education

·       Identify gaps in coding and documentation that lead to inaccurate risk profiles.

·       Utilize multiple sources of information to transition providers into a prospective system.

·       Provide education and training specific to the needs of each individual practice.

·       Implement and monitor improvement plans to ensure 95% accuracy of claims.

·       Design and initiate compliance plans to ensure protection against state and federal penalties.

·       Analyze, collect and improve HEDIS measurements across every practice.

·       Increase member awareness and understanding of chronic diseases through outreach programs.

·       Documentation and revenue risk assessments proceeding transition into ICD-10.

·       Provide comprehensive ICD-10 transition services that include planning, education, implementation and monitoring

·       Average return on investment is 300+%

Patient Generated Health Data (PGHD)

Patient engagement is one of the five goals of the federal government's meaningful use program. PGHD is just one tool in the spectrum of care for patients and caregivers.  PGHD can be a powerful tool in the efforts to achieve the Triple Aim.

·       Work collaboratively with providers, care teams, patients and caregivers to bring PGHD into the care plan.

·       Create tools to improve the patient experience, improve population health and lower health care costs.

·       Utilize innovative methods such as personality assessments to assign members to Primary Care Physicians.

Contact mHealth Games today!

Clinical Documentation Improvement Helps Providers with ICD-10 Transition

July 14, 2014, 10:41:56 AM
Katie Sullivan, MA
Most providers associate clinical documentation improvement (CDI) with the transition to ICD-10 coding, however, CDI — a process in which care providers receive feedback from specialists who review clinical documents — may also deliver clinical and financial benefits for healthcare organizations.

The main benefit of CDI is the feedback loop that it creates. It can fill the gaps in care including those found in documentation, coding, quality, and many other aspects involved with the overall care management of a patient.

Georges Feghali, MD, Chief Medical Officer and Chief Quality Officer at TriHealth Medical health system, said that his organization adopted CDI to develop consistency between the clinical and coding language that physicians use.

“The problem is that when physicians write in clinical terms that they understand, they assume everybody else understands those terms.  But they don’t. For example, 1 term that is very commonly used is urosepsis. What urosepsis means to a physician is that somebody’s septic and the origin of the sepsis is urinary. But the coding interpretation of urosepsis is a urinary tract infection. With a urinary tract infection, you treat the patient with antibiotics for a couple of days and the problem is gone. No big deal. But actual urosepsis has a 25% mortality rate to it,” said Dr Feghali. “So in the physician and clinician’s mind, this translates to a very, very sick patient that’s in the ICU and has a 1 out of 4 chance of dying, and the coders are interpreting that as somebody who has a bladder infection, and walking around and should take 2 days of antibiotics. On 1 hand, you have somebody that looks like they should be in the outpatient setting. On the other hand, somebody’s going to die. If you end up measuring them in the same way, you’re left with wondering why our patients are dying when they look like they’re very healthy 20-year-olds.”

They found that correctly coding urosepsis and UTIs also saved money — an estimated cost difference of $7,000 when they conditions were appropriately coded.

For many physicians, though, the transition to ICD-10 can seem burdensome. They translate the additional or new codes as extra work and documentation.  CDI specialists can serve an important role in training physicians because they can show providers how they can integrate coding into their work flows.

“As a physician, I don’t want too many things when it comes to documentation. Don’t make me lie; don’t make me do it for financial purposes. Tell me why we do it, and I will change the behavior,” said Dr Feghali. “I don’t think there’s a physician on earth who is going to say, ‘I don’t care how I look, so I’m going to keep writing it the wrong way.’”