Rise

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  

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

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. 

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.

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 

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 

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

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

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 

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.

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

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 

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.

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.

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 

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