Dr. William Lee Jonakin

Risk Adjustment Data Validation (RADV): Auditing Target Medicare Advantage Plan

Presenter : Dr.William Lee Jonakin, MD, CPC, CRC
Event Date : 05/02/2019
Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT
Duration : 90 Minutes



Product Description

On November 1, 2018, the Federal Register published a proposed rule regarding technical changes to Medicare Advantage. Like most government documents, it was fairly complex in scope and detail, but there were some serious highlights. In particular the document emphasized that Risk Adjustment Data Validation (RADV) audits would have an increased impact on Medicare Advantage plans. In one table, it was noted an expected recoupment of $ 1,000,000,000 dollars of inappropriate funding from Medicare Advantage plans. Yes, one billion dollars.  Subsequent years were expected to net $381,000,000. This should not come as a surprise, as congress has exerted increased scrutiny to CMS’s oversight of these plans.

It is the intent of this webinar to equip payers, networks, and health systems with the policies, procedures and approach to mitigate these very real financial risks. We will discuss the historical background of Medicare Advantage and Risk Adjustment. We will discuss sufficiency of documentation, the foundation of any risk adjustment activity.  We will discuss how much documentation is enough documentation and what are the necessary elements essential to support documentation.

At the conclusion, attendees will have a good basis to formulate the requisite strategies to avoid potentially crippling financial recoupment.

Session Objectives:

At the conclusion of the webinar, attendees will

  1. Have insight into the history of Medicare Advantage
  2. Understand the implications of an inadequate compliance approach
  3. Understand the three-pronged approach for documentation compliance
  4. Understand the difference between an active diagnosis and the “history of” diagnosis
  5. Know what M-E-A-T means and how it applies to documentation
  6. Know the prerequisites for diagnosis submission in Medicare Advantage
  7. Gain insight into how to engage with providers around value-based care
  8. Know the common documentation stumbling blocks

Session Agenda:

  1. Detailed review of the history of Medicare Advantage
  2. Recovery Audit Contractors vs Risk Adjustment Data Validation
  3. Excerpts from the Federal Register
  4. Discuss sufficiency of documentation
  5. Previous OIG findings
  6. Congressional oversight
  7. Investigative reporting on Medicare Advantage
  8. “Gilding the lily”
  9. The cautionary tale of Dr. Isaac Thompson
  10. Components of an adequate compliance plan
  11. Importance of up and down approach
  12. General compliance considerations
  13. Focused compliance considerations
  14. “Tail” compliance considerations
  15. Administrative details
  16. ICD-10
  17. The HCC map
  18. Published RADV audit guidance
  19. In-depth review of OIG published areas of concern
  20. Frequent stumbling blocks
  21. Examples from clinical records
  22. Live Q&A Session
Related Courses:

Suggested Attendees:

  • Coders
  • Auditors
  • Providers
  • Revenue cycle
  • Payers
  • Risk adjustment professionals
  • Network executives

About the Presenter:

Dr.William Lee Jonakin, MD, CPC, CRC, is the Medical Director for Medicare Advantage and Risk Adjustment at St. Luke’s Health Partners, a financially and clinically integrated network in Southwest Idaho. He is also the principal in Clinical Discernment, LLC, a consultancy focused on the accurate representation of the illness burden of a population. He has had a career spanning several areas: Pediatrics, Emergency Medicine, Urgent Care, and General Practice. He has always been interested in the business of medicine, and most recently the shift from volume to value. Dr. Jonakin is board certified in Pediatrics and is also a Certified Professional Coder and Certified Risk Adjustment Coder. 

After Registration

You will receive an email with login information and handouts (presentation slides) 1 day before the live webcast that you can print and share to all participants at your location.

System Requirement

Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

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For more information you can reach out to below contact:
Toll-Free No: 1-302-444-0162
Email: [email protected]

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