Federal Enforcement impact on Risk Adjustment MA Landscape: Key Legal and Compliance Considerations

Wednesday, February 13, 2019
11:00AM CT – 12:30PM CT (90 minutes)

This event is hosted on our ReadyTalk platform

Government interest and enforcement involving the Medicare Advantage (MA) Program risk adjustment payment system no longer is focused solely on Medicare Advantage Organizations. This presentation is an overview of the potential legal pitfalls and current enforcement landscape in Medicare Advantage associated with risk adjustment. We will provide an overview of the risk adjustment payment methodology, how providers influence payment, key risk and enforcement areas, and best practices moving forward.

Medicare Advantage Risk Adjustment 

• Background on Payment Methodology – provide an overview of the Medicare Advantage program and how risk adjustment works 
• Government Interest – explain why the government is interested 
• Regulatory Landscape – discuss regulations and sub-regulatory guidance relevant to MA and payment (MA Overpayment Rule, False Claims Act, Anti-kickback Statute, MA compliance regulations, sub-regulatory CMS guidance ) 

Emerging Risk Areas, Enforcement Landscape and Considerations: this section will discuss the following five risk areas, recent government interest and considerations in practice 

• Documentation and Coding – Practice and Guidance – discuss common issues with documentation and coding practices and guidance that affect payment 
• Retrospective Chart Reviews – overview of retrospective chart reviews, recent activity and considerations in practice
• In-Home Assessments – overview of in-home assessments, recent activity, CMS issued best practices and other considerations
• Filtering Logic – analysis of data submission errors
• Internal Auditing and Monitoring – overview of common practices and pitfalls, provider related cases and best practices in ensuring compliance with the MA program
   

Audience

Leaders in risk adjustment, compliance, legal, and fraud, waste & abuse will find this content invaluable.

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