Building Stronger, Smarter, More Defensible Risk Adjustment Programs
Risk adjustment revenue is under pressure from both sides: health plans must capture the revenue they have legitimately earned while preparing to defend every diagnosis they submit.
The Risk Adjustment Forum is the leading risk adjustment conference bringing together Medicare Advantage, ACA, and Medicaid professionals for three days of practical strategies to strengthen payment integrity, reduce financial exposure, and build more defensible programs. This is where the people doing the work compare playbooks, pressure-test strategies, and leave with next steps they can put to work immediately.
Top health plans, risk adjustment leaders, and compliance experts met in Orlando to:
- Build Your RADV Defense Before the Notice Arrives: Test your readiness through a live audit simulation and understand validation and extrapolation before a notice arrives.
- Protect Revenue Without Creating New Risk: Strengthen prospective CDI, data integrity, and workflows to capture legitimate revenue without creating compliance risk.
- Anticipate What's Next: Prepare for CMS and OIG oversight, AI scrutiny, ACA changes, and potential new limits on chart-review diagnoses.
Stay tuned for details on next year's event.
What's New. What's Next. Why It Matters.
Defend What You Submit
Tested playbooks for RADV audits, extrapolation exposure, and heightened CMS and OIG scrutiny including the record-retrieval, version-control, and decision-tracking practices that hold up year-round.
Translate Uncertainty Into Action
Turn fast-moving policy and legal developments into near-term operating decisions: the Saving Medicare Act, HHS's ACA risk adjustment recalibration, and the star-ratings litigation raising the stakes for quality and risk alignment.
Grow Where the Market is Going
New frontiers on the program for the first time: dual eligible across Medicare and Medicaid, ACA risk adjustment mechanics, and prospective CDI that protects risk score integrity before submission.
Thinking About Attending? Here's Why You Should
- Sharpen your RADV audit defense. Walk through a live audit simulation and a plain-language breakdown of validation and extrapolation, so your team is prepared long before a notice arrives.
- Get ahead of federal enforcement. Analyze OIG's Medicare Advantage workplan priorities and build proactive fraud, waste, and abuse prevention into your compliance posture.
- Decode HHS's ACA recalibration. Unpack the shift to edge data, revised RADV error calculations, and the appeals gap most ACA plans aren't watching closely enough.
- Prepare for the Saving Medicare Act before it becomes law. Assess how proposed limits on chart-review diagnoses and expanded CMS oversight could reshape MA reimbursement.
- Separate AI's real value from its compliance risk. Examine where AI-driven coding helped and where it created audit exposure, plus the governance guardrails that keep it defensible.
You'll Be in Good Company
Take a look at who you'll be sitting next to. Health plans across Medicare Advantage, Medicaid, D-SNP/SNP, ACA, and commercial lines, plus ACOs, physician practices, hospitals, IDNs, PBMs, pharmaceutical manufacturers, consultants, auditors, and employer groups.
Experienced leaders and newer team members both leave with something: the extrapolation-basics session was built specifically for non-clinical teams who need the audit math in plain language.
Organizations That Attend
- Health Plans: Medicare Advantage, Multi-Line, Commercial, & Medicaid
- Accountable Care Organizations
- Community-Based Organizations, Government Agencies, & Advocacy Groups
- Physician Practices, Medical Groups, & Hospitals
- IPA Management or MSO Companies
- Integrated Delivery Networks
- Not-For-Profit Organizations & Health Care Foundations
- Pharmacy Benefit Managers
- Pharmaceutical Manufacturers
- Prescription Drug Plans
- Consultants & Vendors That Provide Platforms and Solutions
- Auditors
- Academia & Employer Groups
Job Functions You'll Network With
• Risk Adjustment & HCC Coding
• Actuarial
• Revenue & Finance
• Plan Design
• Provider Engagement & Education
• Legal
• Compliance & Auditing
• Client Services
• Member Engagement
• Managed Care
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