Agenda
Explore the full schedule of sessions, workshops, and networking opportunities planned for October in Orlando
Register to Attend ⭐
Tuesday - October 27, 2026
12:00 PM
12:00 PM – 5:15 PM
Information Desk Open
1:00 PM
1:00 PM – 5:00 PM
Workshop A- RADV Audit Simulation
Break 2:30PM - 3:00PM
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?
Speaker
Donna Malone
Director Risk Capture – Population Health at Mass General Brigham
Speaker
Susan Waterman
Director, Risk Adjustment at Baylor Scott & White
1:00 PM – 5:00 PM
Workshop B- Mastering ACA Risk Adjustment
Break 2:30PM - 3:00PM
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
Speaker
Melissa Soto
CHC, CHIE, CRC, Sr. Director of Advanced Analytics at Florida Blue
Speaker
Christina M. Medrano
CHIE, Sr. Director ACA Risk Adjustment Operations at Florida Blue
5:00 PM
5:00 PM – 7:00 PM
The RISE Risk Adjustment Social & Supper
New this year! We’re extending the evening and elevating your experience. Join fellow attendees for two hours of conversation and connection over a premium open bar and a dinner experience featuring carved steak and turkey, sushi, a fresh raw bar, and more.
We’re taking the RISE networking experience up a notch and if you’ve been to a RISE reception before, you know that’s saying something! Come hungry, grab a drink, and settle in for an evening with your RISE community … no dinner reservations or plans outside the hotel required.
Wednesday - October 28, 2026
8:00 AM
8:00 AM – 6:00 PM
Exhibit Hall Open
8:00 AM
8:00 AM – 4:00 PM
Information Desk Open
8:00 AM
8:00 AM – 9:00 AM
Networking Breakfast
8:45 AM
8:45 AM – 8:50 AM
Welcome Remarks
8:50 AM
8:50 AM – 9:25 AM
Opening Address- Regulatory & Policy Updates from CMS: Preparing for 2027 and Beyond
- Explore the Center for Medicare and Medicaid Innovation's (CMMI) current priorities and strategic direction across payer types and across provider, plan, and drug pricing focused models
- Understand how emerging CMMI models and initiatives may shape regulatory and policy shifts heading into 2027 and beyond, including progress toward improving care delivery
- Identify opportunities for payers and health plans to prepare for and align with CMS's evolving innovation agenda
Speaker
Eliot Fishman
Director of the Policy and Programs Group at CMS Innovation Center
9:25 AM
9:25 AM – 10:10 AM
CMS's Take on RADV's Rapid Rise and How Plans Should Respond
- Examine the scope and pace of CMS's RADV audit acceleration, including audit volume trends to date, to better anticipate what's coming next
- Identify the most common medical record submission errors CMS has observed to reduce the risk of future inquiries and delays
- Develop a proactive audit response strategy, including early submission timelines and resource planning, to avoid bottlenecks when managing multiple simultaneous audits
Moderated Q&A from 9:55AM – 10:10AM
Moderator
Ana Handshuh
Principal at CAT5 Strategies
Speaker
Sophia Autrey
Deputy Director, Division of Medicare Advantage Audits (DMAA) at Centers for Medicare and Medicaid Services (CMS)
10:10 AM
10:10 AM – 11:00 AM
Regulatory and Legislative Priorities for Managed Care Oversight
- Analyze the latest 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 compliance expectation
- Learn about items in OIG’s workplan related to Medicare Advantage
Pending OIG Speaker Confirmation
10:50 AM
10:50 AM – 11:15 AM
Networking Break
11:15 AM
11:15 AM – 12:00 PM
Track A
AI in Risk Adjustment: The Good, the Bad, and the Ugly
- Examine real-world case studies where AI implementation helped and where it created potential compliance exposure
- Identify the guardrails and governance controls needed to keep AI-driven coding and documentation audit-defensible
- Discuss regulatory considerations and how AI is showing up specifically in RADV preparation
Moderator
Rose T. Dunn
MBA, RHIA, CPA, FACHE, FHFMA, Chief Operating Officer at First Class Solutions, Inc.
Speaker
Justin Liu
CEO & Co-Founder at Charta Health
Speaker
Carlos Rodriguez
MD, AHCCA, VP of Risk Adjustment and Clinical Performance at Aegis Medical Group
Speaker
Biodun Kajopaiye
Health Care Operations, Strategy and Data SME at Fit 4 Lyfe Consulting LLC
11:15 AM – 12:00 PM
Track B
RADV Operational Excellence: Data Validation & Extrapolation Basics for Non-Clinical Teams
- Define what a RADV audit is and walk through the validation process in plain language for non-clinical staff
- Explain what extrapolation means, how it's calculated, and why it matters to an audit's financial outcome
- Identify which internal stakeholders should be looped in before a RADV or extrapolation notice arrives
Speaker
Tim Collins
Associate Vice President at Jefferson Health Plans
Speaker
Debbie Conboy
Senior Consultant at Wakely
Speaker
Joe Flaks
Senior Consulting Actuary at Wakely
12:00 PM
12:00 PM – 12:15 PM
Track A
Tools & Technology Spotlight Presented by Milliman
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.
Speaker
Josh Brezovar
Sr. Actuarial Analyst at Milliman
12:00 PM – 12:15 PM
Track B
Tools & Technology Spotlight Presented by Stellar Health
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.
Speaker
Austin Bostock
Director, Enterprise Sales at Stellar Health
12:15 PM
12:15 PM – 1:15 PM
Networking Lunch
1:15 PM
1:15 PM – 2:00 PM
Track A
Strengthening Risk Adjustment Accuracy Before the Audit Ever Starts
- Engage providers as true partners in capturing accurate, complete documentation at the point of care
- Leverage AI and analytics tools to flag documentation and coding gaps prospectively, before claims are submitted
- Explore how a forward-looking risk adjustment strategy can reduce reliance on reactive audit defense down the line
Speaker
David DeHommel
SVP, General Manager of Payer Solutions at Reveleer
Speaker
Aleesha King
Managing Director, Risk Adjustment Operations at Blue Cross Blue Shield of Michigan
Speaker
Donna Malone
Director Risk Capture – Population Health at Mass General Brigham
1:15 PM – 2:00 PM
Track B
Prospective CDI: Laying the Foundation for Accurate Risk Adjustment in a Post-Final-Rule Landscape
- Understand why recent final rule changes are accelerating the shift from retrospective to prospective outpatient CDI - and what that means for your program
- Learn how pre-visit planning, chart prep, and point-of-care documentation reviews drive accurate HCC capture and protect risk score integrity before submission
- Discover how AI-powered suspecting and forecasting models are reshaping prospective risk adjustment strategies
Speaker
Dawn Carter
Senior Director, Health Policy and Regulatory Affairs at Centauri Health Solutions
Speaker
Jenni Monfils
AVP, Risk Adjustment Coding and CDI at Molina Healthcare
Speaker
Ava Johnson
Director, Ambulatory CDQI at Mount Sinai Hospital, NYC
2:00 PM
2:00 PM – 2:05 PM
Session Transition
2:05 PM
2:05 PM – 2:50 PM
Track A
Safeguarding Revenue and Compliance: Building an Audit-Ready Operating Model
- Build an audit-ready risk adjustment infrastructure, including reliable, efficient medical record retrieval, that holds up year-round
- Close ownership gaps between actuarial, compliance, care management, and operations teams to prevent retrieval delays and documentation blind spots
- Strengthen audit defensibility with version control, decision tracking, and record-retrieval practices that can withstand CMS scrutiny
Moderator
Jeannie Hennum
General Manager of Value Based Care at Verisma
Speaker
Kwame Appiah-Yeboah
Director, Risk Adjustment at Johns Hopkins Health Plans
Speaker
Monica Modha
Manager, Medical Risk Adjustment, VBC Operations at Orlando Health
Speaker
Patricia Burgos
Director of Risk Adjustment and Performance at Innovacare Health
2:05 PM – 2:50 PM
Track B
Building the Risk Adjustment Workflow: People, Process & Technology
- Identify the staffing and skill mix required to run a modern risk adjustment operation
- Map the technology layer, from coding tools to submission systems, needed to support that workflow
- Compare staffing benchmarks and workforce-planning approaches across health plans
Moderator
Ryan Dodson
CRC, Risk Adjustment Consultant at Choice Medical Group
Speaker
Michael Zeli
Executive Director, Clinical Documentation Integrity at AdventHealth
Speaker
Kenny Misir
VP, Payment Integrity & Provider Risk Strategies at Virtix Health
Speaker
Adam Flores
Risk Adjustment Medical Coder at Blue Cross & Blue Shield of RI
2:50 PM
2:50 PM – 3:15 PM
Networking Break
3:15 PM
3:15 PM – 4:00 PM
Track A
ACA / HHS RADV: Recalibration, Edge Data & the Appeals Gap
- Examine how HHS has recalibrated its ACA risk adjustment models using edge data and revised HHS RADV error calculations for the 2027 benefit year
- Identify why HHS RADV appeals get far less discussion than MA RADV appeals, and what that gap means in practice for ACA plans
- Break down the methodology shift in HHS's recalibration process and what plans should watch for in their own risk score trends
Speaker
Katy Davis
Education Director, Coding and Regulatory Compliance at Scanning Sherpas
Speaker
Susan Waterman
Director, Risk Adjustment at Baylor Scott & White
Speaker
Amy Jack
Director of Risk Adjustment at Select Health
3:15 PM – 4:00 PM
Track B
Medical Loss Ratio Management: A Three-Dimensional View
- Examine how MLR strategy connects revenue capture and expense reduction across both medical and pharmacy spend
- Evaluate which population-health interventions deliver measurable ROI and which ones don't
- Discuss engagement models, from direct member outreach to value-based arrangements, that move the MLR needle
Speaker
Max Sungurov
Chief Medical Officer at BlueCross BlueShield of South Carolina
4:00 PM
4:00 PM – 4:05 PM
Session Transition
4:05 PM
4:05 PM – 4:55 PM
Quality Meets Risk Adjustment: Building a Synergized Member-Engagement Model
- Identify where quality and risk adjustment teams currently operate from separate member lists and separate outreach — and what's lost in that disconnect
- Design an integrated member-engagement model that closes quality gaps and risk gaps in a single visit or contact
- Discuss why star-ratings litigation is raising the stakes for quality/risk alignment right now
Moderator
Ryan Peterson
Principal at Upward Growth
Speaker
Mark Hassenstab
VP of Stars, Quality, and Risk Adjustment at Curana Health
Speaker
Robyn Bartek
Senior Director, Risk Adjustment and Quality Performance at Orlando Health
Speaker
Amanda Lambert
Director of Quality and Customer Care at Samaritan Health Plan
4:55 PM
4:55 PM – 5:00 PM
Closing Remarks
5:00 PM
5:00 PM – 7:00 PM
The RISE Risk Adjustment Social & Supper
New this year! We’re extending the evening and elevating your experience. Join fellow attendees for two hours of conversation and connection over a premium open bar and a dinner experience featuring carved steak and turkey, sushi, a fresh raw bar, and more.
We’re taking the RISE networking experience up a notch and if you’ve been to a RISE reception before, you know that’s saying something! Come hungry, grab a drink, and settle in for an evening with your RISE community … no dinner reservations or plans outside the hotel required.
Thursday - October 29, 2026
8:00 AM
8:00 AM – 11:15 AM
Exhibit Hall Open
8:00 AM
8:00 AM – 11:00 AM
Information Desk Open
8:00 AM
8:00 AM – 9:00 AM
Networking Breakfast
9:00 AM
9:00 AM – 9:10 AM
Welcome Remarks and Day One Takeaways
9:10 AM
9:10 AM – 10:00 AM
The Saving Medicare Act and the Future of Medicare Risk Adjustment False Claims Act Litigation
- Examine key provisions of the proposed Saving Medicare Act
- Assess how expanded CMS oversight and reduced coding-intensity adjustments could reshape MA reimbursement
- Discuss the history of MA-related FCA litigation, and forecast the impact of the SMA on future FCA litigation
Speaker
Jill Estes
Partner at Morgan Verkamp, LLC
Speaker
Joseph Swanson
Partner at Foley & Lardner LLP
10:00 AM
10:00 AM – 10:50 AM
Leading Edge AI Innovation in Risk Adjustment: What's Coming Next and How to Prepare
- Identify the strategic questions health plan leaders should be asking their own organizations and vendors to evaluate AI readiness, avoid being "flat-footed" as software development costs collapse, and separate durable capability from short-term hype
- Examine how emerging agentic AI and cross-organizational workflow technologies are moving healthcare beyond today's fragmented, point-solution "data exchange" model and what that shift specifically means for RA operations
- Discuss how RA professionals can reposition their teams' value as AI reshapes the work, shifting from executing manual, point-in-time processes to owning the differentiated workflow and subject-matter expertise that AI can't replace
Speaker
Krischa Winright
Chief Executive Officer at peregrine3
10:50 AM
10:50 AM – 11:15 AM
Networking Break
11:15 AM
11:15 AM – 12:05 PM
Prior Authorization APIs: What Payers and Providers Need to Know
- Explain what the January 1 prior-authorization API requirements mean operationally for payers and providers
- Identify how organizations should test their authorization APIs, and who needs to be involved in that testing
- Discuss realistic timelines for getting an organization ready to comply
Moderator
Colleen Gianatasio
Value Based Care expert
Speaker
Dawn Kramer
Clinical Advisor at Samaritan Health Plan
Speaker
Keisha Wilson
Founder & CEO at KW Advanced Consulting, LLC
12:05 PM
12:05 PM – 12:55 PM
Industry Leaders Roundtable: What's Working, What's Not, and What's Next
- Reflect on how this year's regulatory shifts, from final rule changes driving prospective CDI to heightened fraud, waste, and abuse enforcement, are reshaping day-to-day risk adjustment strategy
- Share candid lessons from building audit-ready infrastructure and synergizing quality and risk adjustment teams, including what held up under real-world pressure and what needed rework
- Look ahead to how organizations are preparing their programs, from documentation practices to cross-team ownership, for the next wave of CMS scrutiny
12:55 PM
12:55 PM – 1:00 PM
Closing Remarks
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