Rise

/media/5211/rise-logo.png

RISE Risk Adjustment Forum
October 21-23, 2025
Tampa, FL

Agenda

Tuesday - October 21, 2025

8:30 AM 9:30 AM

7:30 AM 8:30 AM

6:30 AM 7:30 AM

5:30 AM 6:30 AM

Networking Breakfast

8:30 AM 4:00 PM

7:30 AM 3:00 PM

6:30 AM 2:00 PM

5:30 AM 1:00 PM

Registration Desk Open

9:00 AM 5:00 PM

8:00 AM 4:00 PM

7:00 AM 3:00 PM

6:00 AM 2:00 PM

Workshop A: RADV Audit Simulation

This Audit simulation workshop is designed for audit professionals from managed care health plans to successfully manage the various types of audits, but with a particular focus on RADV Audits. Join us for an introduction to best practices, the opportunity to work through case examples, and to share experiences with your peers. This workshop will zero-in on regulatory compliance while teaching you how to optimize the accuracy of the information gathered and submitted at the practice level. Please note: Attendees are encouraged to bring questions to pose to our expert workshop facilitators. You will not need coding manuals, but most people bring a laptop or a tablet, for notetaking. Benefit from a closed-door, confidential exchange of ideas, where peers can freely discuss strategies, insights, and experiences to drive innovation and improvement.

  • Review of Basic Rules of Audit  
  • Explore Chart Retrieval and Review  
  • Initial steps for preparing for Audits  
  • Which staff is essential to overseeing your audit prep?  
  • Staying ahead – key items to monitor well in advance of an actual audit  

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 
Director Risk Capture, Population Health Management  
Mass General Brigham 

Susan L Waterman, RHIT, CCS, CPC, CRC, AHIMA ICD-10-CM/PCS Trainer
Director, Risk Adjustment
Baylor Scott and White Healthcare 

Laura Sheriff, RN, MSN, CPC, CRC, Risk Adjustment Industry Expert

9:00 AM 1:00 PM

8:00 AM 12:00 PM

7:00 AM 11:00 AM

6:00 AM 10:00 AM

Workshop B: Risk Adjustment Practitioner

  • The essentials of and differences between Medicare Advantage, Commercial and Medicaid risk adjustment  
  • Understanding how risk scores are calculated  
  • Making sense of varying payment models  
  • An intro into using data and predictive analytics to optimize your risk adjustment practices  
  • Tools for achieving data accuracy  
  • Where do we stand with the transition from RAPS to EDS? The latest in a long journey  
  • Provider engagement strategies that will impact your risk adjustment initiatives  
  • Risk adjustment vendor selection and management  
  • Determining whether you need RA vendors  
  • How do you effectively vet potential vendors and ultimately select them?  
  • Strategies for on-going, thorough vendor management  
  • The future of risk adjustment – what you need to know to stay ahead of possible changes  
  • Initial steps for preparing for a RADV audit  
  • Which staff is essential to overseeing your RADV audit prep?  
  • Staying ahead – key items to monitor well in advance of an actual audit  

Ava Johnson, Associate Director, Ambulatory CDQI
Mount Sinai Hospital, NYC

Colleen Gianatasio, Clinical Documentation Integrity and Coding Compliance Specialist

1:00 PM 5:00 PM

12:00 PM 4:00 PM

11:00 AM 3:00 PM

10:00 AM 2:00 PM

Workshop C: Mastering ACA Risk Adjustment

This interactive workshop will provide a comprehensive understanding of ACA risk adjustment, its financial implications, and best practices for accurate data submission and compliance. Attendees will gain actionable insights into risk score optimization, audit preparedness, and regulatory updates to ensure their organizations effectively navigate ACA risk adjustment requirements. 

  • Understand the Purpose and Mechanics of ACA Risk Adjustment 
  • Interpret Risk Adjustment Methodologies and Payment Transfers 
  • Ensure Compliance with ACA Risk Adjustment Data Requirements 
  • Enhance Risk Adjustment Data Integrity and Submission Accuracy 
  • Prepare for RADV Audits 
  • Develop an internal audit readiness plan to mitigate compliance risks 
  • Stay Ahead of Policy Changes and Future Regulatory Updates 

Wynda Clayton 
Specialist, Risk Adjustment

 

5:00 PM 6:00 PM

4:00 PM 5:00 PM

3:00 PM 4:00 PM

2:00 PM 3:00 PM

Networking Cocktail Reception

Join us for drinks, hors d’oeuvres, and face-to-face networking with peers.  

Wednesday - October 22, 2025

8:00 AM 8:50 AM

7:00 AM 7:50 AM

6:00 AM 6:50 AM

5:00 AM 5:50 AM

Networking Breakfast

8:00 AM 4:00 AM

7:00 AM 3:00 AM

6:00 AM 2:00 AM

5:00 AM 1:00 AM

Registration Desk Open

7:50 AM 6:15 PM

6:50 AM 5:15 PM

5:50 AM 4:15 PM

4:50 AM 3:15 PM

Exhibit Hall Open

9:00 AM 9:05 AM

8:00 AM 8:05 AM

7:00 AM 7:05 AM

6:00 AM 6:05 AM

Welcome Remarks

9:05 AM 10:10 AM

8:05 AM 9:10 AM

7:05 AM 8:10 AM

6:05 AM 7:10 AM

Keynote Address

Meridith Elliott Powell
Acclaimed Motivational Speaker, Author, and Business Growth Expert

10:10 AM 11:10 AM

9:10 AM 10:10 AM

8:10 AM 9:10 AM

7:10 AM 8:10 AM

Regulatory Priorities: Navigating Changes and Uncertainty

  • Analyze the latest OIG findings and recommendations related to risk adjustment, including common compliance risks and areas of heightened scrutiny 
  • Implement best practices for proactive fraud, waste, and abuse (FWA) prevention, ensuring alignment with OIG compliance expectation 
  • Develop proactive strategies for adapting to risk adjustment changes while optimizing plan performance and revenue integrity 

11:10 AM 11:40 AM

10:10 AM 10:40 AM

9:10 AM 9:40 AM

8:10 AM 8:40 AM

Networking Break

Concurrent Session 11:40 AM - 12:25 PM 10:40 AM - 11:25 AM 9:40 AM - 10:25 AM 8:40 AM - 9:25 AM

Track A: Audit Readiness

Track B: Risk Adjustment Safeguards

Track Chairs:

11:40 AM 12:25 PM

10:40 AM 11:25 AM

9:40 AM 10:25 AM

8:40 AM 9:25 AM

Track A: Audit Readiness

Ready or Not: RADV Audit Ramp-Up

  • Understand the full scope of CMS’s RADV plan—including larger data sample sizes, and a more aggressive audit timeline targeting all MA plans  
  • Discover strategies to minimize operational disruption through self-auditing, proactive data reconciliation, and payment integrity   
  • Hear real-world examples on audit preparation, workflow alignment, and cross-functional coordination that help your plan audit-resilient 

Deb Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA,
Risk Adjustment Programs Director
Medical Mutual  

11:40 AM 12:25 PM

10:40 AM 11:25 AM

9:40 AM 10:25 AM

8:40 AM 9:25 AM

Track B: Risk Adjustment Safeguards

Build a Foundation: Compliance Essentials for Every Role

  • Define the core principles of compliance in risk adjustment and why they matter across all roles 
  • Recognize key fraud, waste, and abuse risks such as improper coding, unsupported diagnoses, and billing inconsistencies 
  • Gain practical tips for building compliance confidence, especially for professionals in new or non-traditional roles  

Gabrielena (Gaby) Alcalá, Founder and CEO
MAPA Healthcare

Prince Baawuah, DrPH, MPH, CSM, Founder / Chief Tutor,
The HEALS Academy
Former Health Insurance Specialist, CMS

 

Concurrent Session 12:25 PM - 12:40 PM 11:25 AM - 11:40 AM 10:25 AM - 10:40 AM 9:25 AM - 9:40 AM
Track Chairs:

12:25 PM 12:40 PM

11:25 AM 11:40 AM

10:25 AM 10:40 AM

9:25 AM 9:40 AM

Track A: Audit Readiness

Tools & Technology Spotlight

Leading service providers will showcase their offerings in a quick-pitch setting. Evaluate the latest and greatest tech tools to bring back to your organization. 

12:25 PM 12:40 PM

11:25 AM 11:40 AM

10:25 AM 10:40 AM

9:25 AM 9:40 AM

Track B: Risk Adjustment Safeguards

Tools & Technology Spotlight

Leading service providers will showcase their offerings in a quick-pitch setting. Evaluate the latest and greatest tech tools to bring back to your organization.

12:40 PM 1:35 PM

11:40 AM 12:35 PM

10:40 AM 11:35 AM

9:40 AM 10:35 AM

Networking Lunch

Concurrent Session 1:35 PM - 2:20 PM 12:35 PM - 1:20 PM 11:35 AM - 12:20 PM 10:35 AM - 11:20 AM
Track Chairs:

1:35 PM 2:20 PM

12:35 PM 1:20 PM

11:35 AM 12:20 PM

10:35 AM 11:20 AM

Track A: Audit Readiness

Facing the Fallout: Understanding and Preparing for Extrapolation Risk

  • Get a practical breakdown of the extrapolation process and how it’s being applied in audits today  
  • Learn how leaders are preparing for the long-term implications of extrapolated findings 
  • Gain cross-functional insights to strengthen your audit readiness strategy and reduce financial and reputational risk 

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 
Director Risk Capture, Population Health Management  
Mass General Brigham 

1:35 PM 2:20 PM

12:35 PM 1:20 PM

11:35 AM 12:20 PM

10:35 AM 11:20 AM

Track B: Risk Adjustment Safeguards

Activate End-to-End Clinical Documentation Integrity CDI

  • Move beyond surface-level coding to uncover documentation gaps that can impact risk scores, quality, and compliance 
  • Clarify how CDI influences the entire risk adjustment lifecycle—from clinical encounter to final submission 
  • Explore strategies to align clinical documentation with regulatory expectations, payer requirements, and evolving industry standards 

2:20 PM 2:25 PM

1:20 PM 1:25 PM

12:20 PM 12:25 PM

11:20 AM 11:25 AM

Session Transition

Concurrent Session 2:25 PM - 3:10 PM 1:25 PM - 2:10 PM 12:25 PM - 1:10 PM 11:25 AM - 12:10 PM
Track Chairs:

2:25 PM 3:10 PM

1:25 PM 2:10 PM

12:25 PM 1:10 PM

11:25 AM 12:10 PM

Track : Audit Readiness

Build a Powerful Internal Audit Team and Stretch Resources

  •  Explore practical strategies for launching or strengthening an internal audit function, even with limited resources 
  • Learn how to prioritize high-impact areas and leverage existing staff, technology, and cross-departmental collaboration to "do more with less" 
  • Hear real-world examples of how organizations have built scalable audit teams that support compliance, risk mitigation, and operational improvement 

Ava Johnson, Associate Director, Ambulatory CDQI
Mount Sinai Hospital, NYC

2:25 PM 3:10 PM

1:25 PM 2:10 PM

12:25 PM 1:10 PM

11:25 AM 12:10 PM

Track B: Risk Adjustment Safeguards

V28 Postmortem: Financial Lessons, Coding Shifts & Who Was Most Affected

  • Take a deep dive into the real-world financial and business impact of V28—why it hit harder than expected and which populations felt it most 
  • Explore postmortem analyses highlighting how coding patterns, documentation strategies, and risk scores shifted under V28 
  • Identify key patient demographics that were disproportionately impacted and what that means for future forecasting, coding education, and payment modeling

3:10 PM 3:35 PM

2:10 PM 2:35 PM

1:10 PM 1:35 PM

12:10 PM 12:35 PM

Networking Break

Concurrent Session 3:35 PM - 4:20 PM 2:35 PM - 3:20 PM 1:35 PM - 2:20 PM 12:35 PM - 1:20 PM
Track Chairs:

3:35 PM 4:20 PM

2:35 PM 3:20 PM

1:35 PM 2:20 PM

12:35 PM 1:20 PM

Track A: Audit Readiness

Life After an OIG Audit: Lessons, Outcomes & What’s Next

  • Hear firsthand experiences from plans that have undergone OIG audits and how they navigated the aftermath 
  • Unpack lessons learned—from documentation pitfalls to gaps in internal controls—and how they led to tangible changes in operations 
  • Explore real-world outcomes, including corrective action plans, financial impacts, and shifts in compliance strategy 

3:35 PM 4:20 PM

2:35 PM 3:20 PM

1:35 PM 2:20 PM

12:35 PM 1:20 PM

Track B: Risk Adjustment Safeguards

Strategic AI Vendor Selection & Partnership Management

  • Identify the right partners in a rapidly consolidating healthcare landscape, ensuring alignment with strategic goals 
  • Implement effective vendor oversight strategies to enhance performance, compliance, and long-term collaboration 
  • Learn how to navigate vendor selection and demos with purpose 

Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, Chief Operating Officer
First Class Solutions, Inc.

4:20 PM 4:25 PM

3:20 PM 3:25 PM

2:20 PM 2:25 PM

1:20 PM 1:25 PM

Session Transition

4:25 PM 5:10 PM

3:25 PM 4:10 PM

2:25 PM 3:10 PM

1:25 PM 2:10 PM

Lead Through Change: Advocating for Risk Adjustment in Uncertain Times

  • Explore practical strategies for leading through industry uncertainty—both upward to senior leadership and downward to support teams on the ground 
  • Learn how to frame the value of risk adjustment in language that resonates with executive decision-makers 
  • Discover techniques for maintaining team engagement and focus during periods of high change, while ensuring operational continuity 

Dr. Shannon Decker, PhD, MBA, MBA, M.Ed., M.Ed, Founder & CEO 
VBC One 

5:10 PM 5:15 PM

4:10 PM 4:15 PM

3:10 PM 3:15 PM

2:10 PM 2:15 PM

Closing Remarks

5:15 PM 6:15 PM

4:15 PM 5:15 PM

3:15 PM 4:15 PM

2:15 PM 3:15 PM

Networking Cocktail Reception

Join us for drinks, hors d’oeuvres, and face-to-face networking with peers.

Thursday - October 23,2025

8:00 AM 9:00 AM

7:00 AM 8:00 AM

6:00 AM 7:00 AM

5:00 AM 6:00 AM

Networking Breakfast

8:00 AM 11:00 AM

7:00 AM 10:00 AM

6:00 AM 9:00 AM

5:00 AM 8:00 AM

Registration Desk Open

8:00 AM 1:15 PM

7:00 AM 12:15 PM

6:00 AM 11:15 AM

5:00 AM 10:15 AM

Exhibit Hall Open

9:00 AM 9:10 AM

8:00 AM 8:10 AM

7:00 AM 7:10 AM

6:00 AM 6:10 AM

Welcome Remarks and Day One Takeaways

9:10 AM 10:00 AM

8:10 AM 9:00 AM

7:10 AM 8:00 AM

6:10 AM 7:00 AM

Analysis of Big, Beautiful Bill: Preparation and Impact for Health Plans

  • Examine the potential impact on risk adjustment workflows, from member data access to real-time encounter data exchange and inter-plan transitions 
  • Identify areas of increased compliance and audit risk, especially around documentation accuracy, HCC capture, and data integrity
  • Learn how risk adjustment teams can proactively collaborate with compliance, IT, and operations to align with upcoming transparency and interoperability mandates

10:10 AM 10:05 AM

9:10 AM 9:05 AM

8:10 AM 8:05 AM

7:10 AM 7:05 AM

Session Transition

Concurrent Session 10:05 AM - 10:55 AM 9:05 AM - 9:55 AM 8:05 AM - 8:55 AM 7:05 AM - 7:55 AM

Track A: Redesigning Care

Track B: Clinical Alignment 

Track Chairs:

10:05 AM 10:55 AM

9:05 AM 9:55 AM

8:05 AM 8:55 AM

7:05 AM 7:55 AM

Track A: Redesigning Care

ACA Risk Adjustment Realities

  • Understand the foundational similarities and critical differences between ACA and Medicare RA models 
  • Learn why identifying and documenting conditions in younger, harder-to-reach populations creates unique compliance hurdles 
  • Discuss the latest regulatory uncertainty—particularly around ACA subsidies—and what it may signal for future program design 

Wynda Clayton 
Specialist, Risk Adjustment

10:05 AM 10:55 AM

9:05 AM 9:55 AM

8:05 AM 8:55 AM

7:05 AM 7:55 AM

Track B: Clinical Alignment

Reimagining Physician Training & Education

  • Identify key physician pain points related to administrative burden and outdated educational models 
  • Design query feedback loops that drive action and improve documentation quality at the point of care 
  • Anticipate how upcoming CMS strategies may impact risk adjustment, coding, and clinical documentation 
Concurrent Session 10:55 AM - 11:10 AM 9:55 AM - 10:10 AM 8:55 AM - 9:10 AM 7:55 AM - 8:10 AM
Track Chairs:

10:55 AM 11:10 AM

9:55 AM 10:10 AM

8:55 AM 9:10 AM

7:55 AM 8:10 AM

Track A: Redesigning Care

Tools & Technology Spotlights

Leading service providers will showcase their offerings in a quick-pitch setting. Evaluate the latest and greatest tech tools to bring back to your organization.

10:55 AM 11:10 AM

9:55 AM 10:10 AM

8:55 AM 9:10 AM

7:55 AM 8:10 AM

Track B: Clinical Alignment

Tools and Tech Spotlight

Leading service providers will showcase their offerings in a quick-pitch setting. Evaluate the latest and greatest tech tools to bring back to your organization.

11:10 AM 11:50 AM

10:10 AM 10:50 AM

9:10 AM 9:50 AM

8:10 AM 8:50 AM

Networking Break

Concurrent Session 11:50 AM - 12:40 PM 10:50 AM - 11:40 AM 9:50 AM - 10:40 AM 8:50 AM - 9:40 AM
Track Chairs:

11:50 AM 12:40 PM

10:50 AM 11:40 AM

9:50 AM 10:40 AM

8:50 AM 9:40 AM

Track A: Redesigning Care

Risk Adjustment in ACOs: Strategies for Financial Sustainability

  • Analyze the role of risk adjustment in ACO payment models, including shared savings, capitation, and full-risk arrangements 
  • Discuss key challenges ACOs face in risk adjustment, including data capture, patient attribution, and provider engagement  
  • Examine how ACO REACH incorporates risk adjustment methodologies and its impact on health equity and financial sustainability 

11:50 AM 12:40 PM

10:50 AM 11:40 AM

9:50 AM 10:40 AM

8:50 AM 9:40 AM

Track B: Clinical Alignment

Impacts of the RxHCC Shift

  • Examine the latest changes to the Part D RA model and how the 2025 RxHCC updates are reshaping revenue strategy, especially for chronic and high-cost conditions  
  • Understand how rising specialty drug spend—and its growing influence on risk scores—requires tighter alignment between medical and pharmacy data 
  • Hear real-world insights into how health plans are adapting their protocols to respond to the new RxHCC landscape 

12:40 PM 12:45 PM

11:40 AM 11:45 AM

10:40 AM 10:45 AM

9:40 AM 9:45 AM

Session Transition

12:45 PM 1:25 PM

11:45 AM 12:25 PM

10:45 AM 11:25 AM

9:45 AM 10:25 AM

Industry Leader Conclusion Panel: Lessons Learned

  • Summarize the most critical takeaways from recent CMS changes, including increased audit activity and evolving guidance 
  • Reflect on real-world lessons learned from implementing AI, analytics, and audit-readiness strategies across risk adjustment programs 
  • Identify practical ways organizations are embedding payment integrity and audit preparedness into operations 

1:25 PM 1:30 PM

12:25 PM 12:30 PM

11:25 AM 11:30 AM

10:25 AM 10:30 AM

Closing Remarks