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RISKCON 2022

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Assessing Risk in Your Favor

12 CEUs | 2 Tracks/14 Sessions | Virtual Only | Networking Lunch Hour

Member Pricing : $695

Join us this summer for our virtual risk adjustment conference. This will be a comprehensive deep dive into:

Provider training best practices
Social determinants of health
Reporting and analytics best practices
Vendor solutions
Clinical documentation improvement
Coding for difficult cases
Audit and compliance guidance

The conference is designed to keep risk adjustment coders, administrators, auditors, and payers up to date with industry developments and best practices. You'll come out of it with a solid grasp of assessing risk to greatly benefit your employer and help you thrive in your profession. Join us to expand your learning, enrich your knowhow, expand your network, and earn 12 CEUs while you're at it.

Hope to see you there!

Wednesday, June 22, 2022

General Session

9:00 AM - 10:00 AM, MDT | 1.00 CEUs COC, CPC, CPC-P, CPB, CPPM, CRC

GS1: Payer and Provider Collaboration/Engagement and Best Practices

Kristen Viviano, CPC, CRC, Approved-Instructor

Kick off the conference with an interactive session focusing on collaboration and partnership! The benefits of positive collaboration between payers and their provider partners within risk adjustment are irrefutable. In this session we will discuss common challenges, do's and don'ts, and best practices.

General

10:00 AM - 10:15 AM, MDT

EH1: Break

Breakout Session 1

10:15 AM - 11:30 AM, MDT | 1.25 CEUs COC, CPC, CPC-P, CDEI, CDEO, CEMC, CFPC, CIC, CIMC, CPB, CPEDC, CPPM, CRC

Track - 1A: Chart Dissection - Diabetes

Melissa Kirshner, MPH, AAPC Fellow, CPC, CDEO, CPMA, CRC, CPC-I, CFPC

What do we need in a diabetic patient’s medical record? Do you know all of the ICD-10-CM guidelines? What happens when the documentation and/or coding are not coded to the highest level of specificity? How does that impact our risk adjustment coding and what can we do to help our providers?

10:15 AM - 11:30 AM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CPB, CPPM, CRC

Track - 1B: Levels of Risk Contracts Considerations – Value-Based Payments Versus Risk Adjustment - Panel

Khushwinder Singh, MD, MHA, CDIP, CPC, CPCO, CPMA, CRC; Kristen Viviano, CPC, CRC, Approved-Instructor

Value based reimbursement is a hot topic. VBR goes far beyond just risk adjustment. Join this engaging panel to learn the importance of knowing what type of risk contract your organization is part of. Whether your organization is just preparing to enter risk contracts or you are already deeply invested, this panel will help you understand what you need to know about the different level of risk.

General

11:30 AM - 12:30 PM, MDT

EH2: Lunch Break

Breakout Session 2

12:30 PM - 1:45 PM, MDT | 1.25 CEUs COC, CPC, CPC-P, CPB, CPPM

Track - 2A: Chart Dissection - Cardiology/Vascular

Amy C Pritchett, AAPC Fellow, CPC, CDEO, CPMA, CRC, CPC-I, CANPC, CASCC, CEDC

In this session, we will be dissecting cardiology and vascular procedure records in real-time. We will also discuss the medical necessity and APC components of “getting the code wrong”. We will also discuss new CPT procedure codes for 2022 as related to cardiology and vascular procedures. The participants will be quizzed and be able to respond by polling questions, which will make for a fun and very interactive session!

12:30 PM - 1:45 PM, MDT | 1.25 CEUs COC, CPC, CPC-P, CEMC, CPB, CPPM, CRC

Track - 2B: Patient Centered Risk Adjustment

Gabriel R Aponte, MSHIA, RN, RHIA, CCS, CCS-P, CDIP, CCDS, CCDS-O, COC, CPC, CDEI, CDEO, CIC, CPMA, CRC, CCC, CHONC

The session will kick off with a risk adjustment foundation. Then, the attendees will learn how to apply a holistic risk adjustment approach based on the patient’s conditions. The presenter will review chronic diseases and their potential manifestations and complications. Also, he will discuss the implementation of screening tests in a clinic workflow to identify possible diagnoses based on the patient’s health profile.

General

1:45 PM - 2:15 PM, MDT

EH3: Break

Breakout Session 3

2:15 PM - 3:30 PM, MDT | 1.25 CEUs COC, CPC, CPC-P, CDEI, CDEO, CFPC, CIC, CIMC, CPB, CPPM, CRC

Track - 3A: Chart Dissection - Potpourri

Gabriel R Aponte, MSHIA, RN, RHIA, CCS, CCS-P, CDIP, CCDS, CCDS-O, COC, CPC, CDEI, CDEO, CIC, CPMA, CRC, CCC, CHONC

The learning objectives would be participants of this session will: 1. learn that risk adjustment opportunities appear in all types of charts 2. identify where to look in a medical record for common areas of missed opportunity 3. understand how to look for areas of possible conflict in a record and how to address those with providers

2:15 PM - 3:30 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CPB, CPCO, CPPM, CRC

Track - 3B: Payer Audit Findings

Khushwinder Singh, MD, MHA, CDIP, CPC, CPCO, CPMA, CRC; Sheri Poe Bernard, COC, CPC, CDEO, CRC, CPC-I

Many Medicare Advantage organizations may have become complacent in the lull of RADV suspension during the public health crisis. But the DOJ and OIG are working overtime to keep compliance at the forefront, and there are plenty of whistleblowers, too. What can we learn from all their legal focus? This session will explore past and current lawsuits, and what you can do to protect your organization from poor audit results.

General

3:30 PM - 4:00 PM, MDT

EH4: Break

Breakout Session 4

4:00 PM - 5:15 PM, MDT | 1.25 CEUs COC, CPC, CPC-P, CDEI, CDEO, CPB, CPPM, CRC

Track - 4A: Risk Adjustment and CDI PANEL

Sheri Poe Bernard, COC, CPC, CDEO, CRC, CPC-I; Gabriel R Aponte, COC, CPC, CDEI, CDEO, CIC, CPMA, CRC, CCC, CHONC; Colleen Gianatasio, CPC, CPCO, CPC-P, CDEO, CPMA, CRC, CPC-I; Khushwinder Singh, MD, MHA, CDIP, CPC, CPCO, CPMA, CRC

In this session we will review value-based care beyond the revenue. Identifying the benefits to capturing the patient’s accurate clinical story for the patient, provider system and payer. Here are some bullet points of what will be covered: - The Importance of Capturing Accurate Patient Complexity - Review the impact to the patient - what is our responsibility to the patient? (E.g., Program eligibility, value of health plan usage, care management) - Documentation and Coding for Value-Based Care - Review the impact of the model when accuracy of complexity is stated and not stated.

4:00 PM - 5:15 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CDEI, CDEO, CPB, CPCO, CPPM, CRC

Track - 4B: Risk Adjustment Vendor Selection - How to Screen, Select, Audit, and Maintain a Partnership

Todd Husty, D.O., F.A.C.E.P.

Capturing all of the risk diagnoses for all patients through risk for optimization is enticing because there is a huge amount of revenue that is possible. But doing so, without regard to looking for proper documentation to support all diagnoses that are submitted, is potentially and likely to be harmful. The presentation will provide real-world audit data and discuss the current related actions taken by CMS and other government agencies. We will discuss what you need from a risk adjustment vendor and how to evaluate their ability to provide that.

Thursday, June 23, 2022

General Session

9:00 AM - 10:15 AM, MDT | 1.25 CEUs COC, CPC, CPC-P, CPB, CPPM, CRC

GS2: Social Determinants of Health

Jacob Swartzwelder, CPC, CRC, CEMC, Approved-Instructor

Attendees will walk through the basics of Social Determinates of Health, how they impact healthcare and revenue cycle, and how to implement meaningful change in documentation and coding practices. Attendees will leave with an understanding of Social Determinates of Health and a roadmap to maximize documentation and Social Determinates of Health reporting.

General

10:15 AM - 10:30 AM, MDT

EH5: Break

Breakout Session 5

10:30 AM - 11:45 AM, MDT | 1.25 CEUs COC, CPC, CPC-P, CDEI, CDEO, CEMC, CPB, CPPM, CRC

Track - 5A: Risk Adjustment for Beginners

Sherrie Lynne Thevel, CPC, CPPM, CRC, CPC-I

This session will provide an overview of what risk adjustment (RA) is, as well as a deep dive into the background of RA, types of models, how physician documentation is crucial, common diagnoses left off the table, and common diseases that risk adjust.

10:30 AM - 11:45 AM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CPB, CPPM, CRC

Track - 5B: Difference Between Models ACA, CMS, and Medicaid - Panel

Kristen Viviano, CPC, CRC, Approved-Instructor; Kelly A Shew, RHIA, CPC, CPCO, CDEO, CPB, CPMA, CPPM, CRC, Approved-Instructor

Did you know there’s more than just one Risk Adjustment model used by insurance companies? Or are you confused about the differences between them? Join us as we review the variables between each model and when each one is used. Bring your RA model questions for the panel to answer!

General Session

11:45 AM - 12:45 PM, MDT | 1.00 CEUs COC, CPC, CPC-P, CPB, CPPM

GS3: Networking Lunch

Join us for Networking Lunch while we give out some great prizes!

Breakout Session 6

12:45 PM - 2:00 PM, MDT | 1.25 CEUs COC, CPC, CPC-P, CPB, CPPM

Track - 6A: Career Opportunities - Panel

Jennifer Hill, CPC, CIC, CPMA, CRC; Kelly A Shew, RHIA, CPC, CPCO, CDEO, CPB, CPMA, CPPM, CRC, Approved-Instructor; Colleen Gianatasio, CPC, CPCO, CPC-P, CPMA, CRC, CPC-I

In this session, speakers will do a live Q&A with the audience on career pathways and job opportunities for risk adjustment.

12:45 PM - 2:00 PM, MDT | 1.25 CEUs COC, CPC, CPC-P, CIC, CPB, CPPM, CRC

Track - 6B: RA Score Computations - How it Gets from Demographic to Individual Risk Score PANEL

Christine Hall, CPC, CPB, CPMA, CRC, CPC-I; Melissa Kirshner, MPH, AAPC Fellow, CPC, CDEO, CPMA, CRC, CPC-I, CFPC

In this session we will walk through the CMS HCC model components to show how a risk score is built. In addition, we will explore the impact of when the complete patient story is not stated. Here are some bullet points of what will be covered: - Introduction to Value-Based Care - Review the components of the CMS Model - Overview of the business of Medicine

General

2:00 PM - 2:30 PM, MDT

EH6: Break

Breakout Session 7

2:30 PM - 3:45 PM, MDT | 1.25 CEUs COC, CPC, CPC-P, CPB, CPPM, CRC

Track - 7A: Technology Solutions for Risk Adjustment (AI, NLP) - Why Coders Will Always Be Important - Panel

Kelly A Shew, RHIA, CPC, CPCO, CDEO, CPB, CPMA, CPPM, CRC, Approved-Instructor; Jacob Swartzwelder, CPC, CRC, CEMC, Approved-Instructor

In this session, speakers will do a live Q&A with the audience on coder roles and their impact on the use of technology solutions for risk adjustment.

2:30 PM - 3:45 PM, MDT | 1.25 CEUs CPMA, COC, CPC, CPC-P, CDEO, CEMC, CPB, CPCO, CPPM, CRC

Track - 7B: Compliant Provider Queries

Colleen Gianatasio, CPC, CPCO, CPC-P, CPMA, CRC, CPC-I

Queries are communication tools used to clarify documentation in a medical record. With the increase of queries in the outpatient setting it is crucial to understand the guidelines for a compliant query. This interactive session will help you understand the guidance and participants will have the opportunity to review samples of compliant and non compliant queries.

Amy Pritchett, CPC, CDEO, CPMA, CRC, CPC-I, CANPC, CASCC, CEDC

Amy Pritchett, CPC, CDEO, CPMA, CRC, CPC-I, CANPC, CASCC, CEDC, has over 20 years of experience in medical billing and coding, high-level auditing, project management, and directing several coders across multiple facility locations. Her background also includes educating, applying, and presenting to her coding staff and quality assurance managers. Pritchett holds several certifications ranging from coding specialist to ICD instructor.

Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC, CPCO

Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, CRC, CPCO, has over 20 years of experience in all aspects of the business of healthcare. As director of ambulatory CDQI for Mount Sinai Health Partners, she is responsible for provider engagement and clinical documentation improvement for accurate coding. Gianatasio specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation, and auditing classes. Gianatasio currently serves as president of the AAPC National Advisory Board for the 2022-2025 term.

Donna Malone, CPC, CRC, Approved Instructor

Donna Malone, CPC, CRC, Approved Instructor, has been in the value-based care space for 15 years and has been coding for over 20 years. She is currently director of enterprise risk adjustment at Tufts Health Plan. She is also an adjunct professor and advisor at MassBay Community College in the Medical Coding and Medical Administration programs and has been teaching for more than 16 years. Malone is a member of the 2022-2025 AAPC National Advisory Board, has served as president of the Watertown, Mass., local chapter since 2017, and was the chapter’s education officer in 2016.

Gabriel R. Aponte, MSHIA, RN, RHIA, CPC, COC, CIC, CRC, CPMA, CDEO, CDEI, CCC, CHONC, CCS, CCS-P, CDIP, CCDS, CCDS-O

Gabriel R. Aponte, MSHIA, RN, RHIA, CPC, COC, CIC, CRC, CPMA, CDEO, CDEI, CCC, CHONC, CCS, CCS-P, CDIP, CCDS, CCDS-O, has been working in the risk adjustment arena since 2007, with more than a decade of managing Risk Adjustment Data Validation (RADV) audits. He has been in charge of coding departments and teams responsible for risk adjustment mock audits and educational material promoting correct coding and accurate risk scores in healthcare provider networks. Aponte has also worked with vendors responsible for chart retrievals and retrospective coding. Besides working with payers, he has worked with large medical practices and health systems, which has provided him with a broad understanding of different payment models and workflows. Aponte is currently an outpatient CDI senior consultant for United Audit Systems, INC (UASI) and a member of the AAPC's National Advisory Board.

Jennifer Hill, CPC, CPMA, CRCO

Jennifer Hill, CPC, CPMA, CRC, is a risk adjustment specialist who has worked on a variety of client projects, both big and small, for Medicare and private insurance companies. Hill currently serves as director of client engagement for AAPC Services, where she uses her passion for project management, coding, and auditing to develop curriculum and provide quality education and training to coders, auditors, and providers across the country.

Jacob Swartzwelder, CPC, CRC, CEMC, Approved-Instructor

Jacob Swartzwelder, CPC, CRC, CEMC, Approved-Instructor, got an unexpected start in medical coding when his office manager identified him as their newest coder! Having worked both for well-known hospitals and international coding companies, Swartzwelder specializes in E/M auditing, Risk Adjustment, operational risk reduction, and leadership development. He has maintained (CPC) certification since 2010, later earning his CRC and CEMC certifications.

Kelly Shew, RHIA, CPC, CPCO, CDEO, CPB, CRC, AAPC Approved Instructor

Kelly Shew, RHIA, CPC, CPCO, CDEO, CPB, CRC, AAPC Approved Instructor, made the switch to healthcare about 12 years ago. Since then, she’s spent some time billing, coding, and auditing, but her happiest places are in education and risk adjustment. Shew is a member of the AAPC Documentation Advisory Committee and currently serves as the education officer for the Ann Arbor, Mich., local chapter.

Khushwinder Singh, MD, MHA, CDIP, CPC, CPCO, CPMA, CRC

Khushwinder Singh, MD, MHA, CDIP, CPC, CPCO, CPMA, CRC, is a trained clinician and an experienced healthcare management professional, with over 15 years of health information management (HIM) experience. As a seasoned clinician, Singh is always determined to meet higher goals and committed to improving the health of patients and helping medical providers in managing health information coding data, minimizing errors, and reducing wastage of healthcare resources, thus improving the overall quality of healthcare delivery to our most deserving patient populations. He is continuously helping to drive a culture of excellence and is committed to improving the quality of healthcare, with a focus on the Institute for Healthcare Improvement’s Triple Aim. Having a passion for value-based care and risk adjustment, Singh believes that risk adjustment is a unique HIM platform where various health information data elements, such as ICD-10 coding data derived from medical records, lab data, and claims data (e.g., CPT® and HCPCS Level II codes) that move along in the electronic health record and other HIM systems, provide a measure of quality and value to the healthcare delivery system.

Kristen Viviano, MHA, CPC, CRC-I, AAPC Approved Instructor

Kristen Viviano, MHA, CPC, CRC-I, AAPC Approved Instructor, has been working in the healthcare industry for over 10 years. She has experience working interdepartmentally with health plans and provider organizations to foster unique approaches for coding, documentation, and performance improvement strategies. Viviano has experience managing all aspects of risk adjustment and clinical documentation improvement initiatives with diverse teams of experts and turning data into actionable information to improve program outcomes and enhance efficiencies. After recently becoming a certified AAPC instructor, she is eager to share her risk adjustment knowledge with fellow coders and help support newer members of the coding community.

Speaker - Melissa Kirshner, CPC, CDEO, CRC, CPC-I, CFPC, AAPC Fellow

Melissa Kirshner, MPH, CPC, CDEO, CRC, CFPC, CPMA, AAPC Approved Instructor

Melissa Kirshner, MPH, CPC, CDEO, CRC, CFPC, CPMA, AAPC Approved Instructor, AAPC Fellow, has been involved in the healthcare world for over 30 years, with experience in billing, coding, auditing, education, practice management, and risk adjustment. She is a passionate educator for both the AAPC Live Virtual Instructor team as well as for her private Certified Professional Coder (CPC®) students. Kirshner serves on the AAPC Documentation Advisory Committee and is a founding member of the Novi, Mich., local chapter.

Sheri Bernard, COC, CPC, CDEO, CRC, CPC-I

Sheri Bernard, COC, CPC, CDEO, CRC, CPC-I, is managing consultant at Granite GRC Consulting, where her chief responsibilities are risk adjustment auditing, clinical documentation improvement, and training. With 28 years in coding and reimbursement publishing, training, and test development, Bernard is an expert communicator of coding concepts. She is the author of the AMA publication Risk Adjustment Documentation and Coding, now in its second edition, and served as coding content developer at Optum360 for 15 years. Bernard served as vice president at AAPC for three years and was on the AAPC National Advisory Board for eight years.

Sherrie Lynne Thevel, CPC, CPPM, CRC, CPC-I

Sherrie Lynne Thevel, CPC, CPPM, CRC, CPC-I, has 20 years of experience working in the healthcare industry, including managing coding, billing, and compliance, as well as aspects of the revenue cycle. She received a Master of Science in healthcare administration from Lindenwood University and was the recipient of the Mueller Health Care Award. Thevel’s areas of experience include pediatrics, orthopedics, neurology, general coding, and risk adjustment.

Todd Husty, DO, FACEP

Todd Husty, DO, FACEP, is the president/owner of Medical Audit Resource Services, Inc. He graduated from Kansas City College of Osteopathic Medicine in 1980 and worked in several local emergency departments until he opened his company, Medical Audit Resource Services. Husty has spoken at numerous coding and auditing conferences throughout the country.