Rise

Track A: Financial Strategies

Protecting Your Revenue: Strengthening Auditing Programs for Financial Stability

• Examine the evolving challenges in revenue protection, including the impact of shifting reimbursement models and regulatory scrutiny 

• Identify key strategies for implementing robust internal auditing programs to ensure revenue integrity and compliance 

• Develop proactive measures to detect and prevent revenue leakage through improved documentation and coding accuracy 

Jenni Monfils, CPC, CDEO, CRC | AVP, Risk Adjustment Coding and Compliance 

Molina HealthCare   

Track B: Member Engagement & Care

Engaging Members, Enhancing Risk Adjustment: The Power of a Patient-Centered Approach

• Analyze the connection between member engagement, risk score accuracy, and financial sustainability  

• Identify strategies to close gaps in care through proactive outreach, chronic disease management, and preventive screenings 

• Evaluate how addressing Social Determinants of Health (SDOH) impacts risk scores and improves patient adherence to treatment plans 

Eric Hansen, DO, FAAFP, Physician  
Hansen Medical 

Kei Shao Tikkanen, Senior Manager, BoI Strategic Initiatives 
Cityblock Health 

Amy Jack, RHIA, CRC, CCA, Director of Risk Adjustment 
Select Health

Track A: Financial Strategies

Tools & Technology Spotlights Presented by Biomedix

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.

Chris Trygstad, Vice President, Product 
Biomedix 

Track B: Member Engagement & 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 A: Financial Strategies

Maximizing Resource Allocation and Team Dynamics: Tactics to Stay Efficient and Effective

• Analyze how budget constraints impact education efforts and identify cost-effective alternatives to maintain engagement 

• Identify best practices for optimizing team roles and workflows to ensure efficiency despite workforce limitations 

• Evaluate how small health plans can leverage technology and automation to enhance productivity and minimize manual workload 

Jeannine Bumford, Director, Risk Adjustment Operations 
Christus Health 

Matt Ringler, Finance Manager, Health Plans 
Christus Health 

Track B: Member Engagement & Care

Enhancing Care Management for High-Risk Populations

• Examine the impact of home-based care programs on risk scores, compliance, and patient outcomes 

• Evaluate how leading organizations are integrating home health services, remote patient monitoring, and in-home assessments into their risk adjustment models 

• Discuss best practices for leveraging AI, predictive analytics, and data-sharing technologies to improve documentation accuracy 

Hemanshu Patel, MD, CMO, CMtO,   
CareMD Inc 

Track : Financial Strategies

Strengthening Payment Integrity in Value-Based Care Models

• Develop best practices for ensuring payment integrity through proactive audits, provider education, and data-driven oversight 

• Identify common risks associated with over coding and improper payments and explore strategies to mitigate fraud, waste, and abuse 

• Evaluate the impact of payment integrity efforts on financial sustainability, regulatory compliance, and overall program success 

Colleen Gianatasio, Director Clinical Documentation Integrity and Coding Compliance 

Capital District Physician’s Health Plan (CDPHP) 

Track B: Member Engagement & Care

Operational Excellence in Risk Adjustment: Strategies for Success

• Implement effective workflows and best practices to streamline operations and enhance efficiency 

• Leverage technology and data analytics to improve accuracy in coding and documentation 

• Apply practical solutions to common operational challenges, ensuring scalability and long-term sustainability 

Moderator 

Jimmy Liu, VP Analytics and MRR Solutions

Advantmed   

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

Ava Johnson, Associate Director, Ambulatory CDQI  

Mount Sinai Hospital, NYC 

Track A: Financial Strategies

RADV Preparedness: Strategies for Compliance and Risk Mitigation

• Examine the impact of the recently released CY 2018 RADV audits, highlighting the necessity of reconciling risk adjustment data  

• Analyze how the new RADV extrapolation methodology will be applied and what it means for future MA audits 

• Develop best practices for proactive internal audits, provider education, and documentation improvement 

Wynda Clayton  
Specialist, Risk Adjustment  

Martha Goodlin, Senior Director, Risk Adjustment 
Rebellis Group 

Track B: Member Engagement & Care

Optimizing Clinical Documentation Integrity: Avoiding Errors and Maximizing Compliance

• Identify common documentation gaps and coding errors that affect risk scores and develop strategies to address them 

• Evaluate the evolving regulatory landscape and compliance requirements to ensure CDI programs align with industry standards and payer expectations 

• Utilize technology, AI-driven tools, and data analytics to improve documentation accuracy and streamline workflows 

Moderator  
Thomas Shankle, Vice President of Payer Strategy & Success 
Virtix Health 

Emily Crooks, APRN, FNP-C, Director, Population Health 
Affinity Health Group, LLC 

Track A:  Mastering Compliance

Navigating Compliance in the Age of AI: Balancing Innovation and Regulation

• Examine the evolving regulatory landscape surrounding AI and emerging technologies in compliance 

• Design effective approaches for integrating AI while ensuring adherence to compliance standards 

• Support the optimization of quality metrics and other key provider organization needs through AI-driven solutions 

Track B: Strengthening Partnerships

Empowering Providers Through Education: A Blueprint for Success

• Assess organizational needs and identify opportunities to enhance provider education through technology, AI/NLP tools, staffing, and advanced analytics 

• Outline the essential building blocks of an effective provider education program, using a structured approach  

• Measure and refine the success of provider education programs through key performance indicators (KPIs) and ongoing evaluation methods  

Jeannine Bumford, Director, Risk Adjustment Operations 

Christus Health 

Rafael J. Gonzalez MD, Director of Clinical Coding & Clinical Documentation Integrity  

Leon Medical Centers/Leon Health

Track A:  Mastering Compliance

Compliance at the Core: Mitigating Fraud, Waste, and Abuse

• Identify the most common fraud, waste, and abuse (FWA) risks, including upcoding, duplicate claims, and unsupported diagnoses 

• Explore best practices for engaging executive leadership in compliance efforts, fostering a culture of risk management and accountability 

• Examine recent DOJ enforcement actions and CMS compliance initiatives to understand how regulatory bodies are targeting FWA 

Mary Inman, Partner   
Whistleblower Partners 

Annie Shieh, AVP, Compliance 
Molina Healthcare, Inc. 

Colleen Gianatasio, Vice President of Compliance 
CoventBridge Group 

Track B: Strengthening Partnerships

Breaking Down Silos in Risk Adjustment

• Evaluate the connection between risk adjustment, Star Ratings, and quality measures, and how collaboration can improve both financial and clinical outcomes 

• Implement a framework for cross-functional collaboration, leveraging AI-driven analytics, internal auditing, and care coordination to optimize RA performance 

• Develop strategies for integrating data, analytics, and reporting across risk adjustment, finance, and compliance teams  

Moderator  

Ryan Dodson, CRC, Risk Adjustment Consultant 

Choice Medical Group 

Hemanshu Patel, MD, CMO, CMtO,   

CareMD Inc 

Track A:  Mastering Compliance

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: Strengthening Partnerships

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 A:  Mastering Compliance

V28 in Full Effect: Evaluating the Financial and Clinical Impact of the Fully Blended Model

• Analyze the current landscape of the V28 transition, assessing where payers and providers have landed  

• Evaluate whether the rollout of V28 met expectations or presented unforeseen challenges, including coding shifts and risk score fluctuations 

• Examine the disease states most affected by V28 and their impact on different Medicare Advantage plan types, including C-SNPs, D-SNPs, and standard MA plans  

Moderator 
LaNae Coffey, AVP of Sales,  
Veradigm 

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP 
Director Clinical Documentation and Quality Improvement (CDQI) 

Rafael J. Gonzalez MD, Director of Clinical Coding & Clinical Documentation Integrity  
Leon Medical Centers/Leon Health 

Track B: Strengthening Partnerships

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