BULLETIN for current and past at

Using Member Evalutions to Stay Compliant

Early studies from the beginning of risk adjustment implementation suggest that as many as 40% of claims based submissions could not be supported by charts. Thus, plans have come to view retrospective chart review as both a revenue enhancing and a revenue protection activity, done as much to ensure compliance as to capture any missed diagnoses codes.

What many plans miss is that a well-designed prospective risk adjustment program can better ensure compliance by working to ensure 100% documentation behind claims based submissions, and by initiating any necessary chart review during the service year, rather than retrospectively.

This webinar presentation focuses on the often-overlooked compliance component of an intelligent prospective risk adjustment program. Setting aside the long list of benefits prospective evaluations offer to the plan in both the finance and medical management departments, this far reaching activity also protects compliance. We will take a close look at a plan's must-have compliance factors, and how this program works to meet those needs. This webinar is advanced, but highly practical and designed to offer tangible take aways.

Participants will be able to:

Ensure they have the one, best medical record: A simple step that goes a long way
Understand the need for stratifying their claim database: How stratifying your claims-based codes by confidence impacts your care continuum.
Identify positive action steps to revamp their chart review process: Making retrospective literally a thing of the past
Engage in interactive learning through online question submission, attendee feedback and opportunity for follow up questions, and networking with attendees, faculty and other professionals through dedicated LinkedIn group

Interested attendees would include:

Medicare Executives and Staff
Risk Adjustment Executives and Staff
Case Management Executives and Staff
Quality Improvement Executives and Staff
Revenue Management Executives and Staff
STARS Program Staff

Attendees would represent organizations including:

Health Plans
Provider Networks
Government Agencies
Solutions Providers
Associations, Institutes and Research Organizations
Media
Other Interested Parties

Individual Registration Fee: $195. Web Summit CD-ROM: $40 for attendees; $285 for non-attendees after the event. Corporate Site licensing also available. Click here to register or call 209.577.4888 We look forward to your participation in this event!