Agenda

• 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

• 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

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. 

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. 

• 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

• 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

• 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

• 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

• 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

• Unpack how D-SNP risk adjustment bridges Medicare and Medicaid and where the two systems' methodologies, timelines, and documentation requirements diverge

• Compare state-level Medicaid variation and what it means for programs operating across multiple state markets

• Explore the regulatory pitfalls behind SNP growth, and where programs get exposed if compliance and documentation don't keep pace