The CMS Final Announcement and OIG Risk Adjustment Data Validation (RADV) Final Rule make it imperative for health plans, providers, and other Value-Based Care entities to take a new approach to Risk Adjustment. In this comprehensive webinar, risk adjustment and compliance experts from Reveleer and FTI Consulting will provide insight on the implications of the new regulations, identifying priority areas of focus for your organization. We discussed:
Mark Van Ert
Managing Director, FTI Consulting
Mark has over 25 years of executive leadership experience with major healthcare organizations and has led initiatives for clients including Medicare Advantage and commercial/ACA payers, health systems and provider groups including specialty providers, providers of in-home care, health services companies and investors. His expertise is focused on risk adjustment, and assisting clients optimize the performance of their risk adjustment operations while maintaining full control of their compliance obligations.
Vice President, Risk Adjustment Strategy and Solutions
Deniese brings more than 18 years of experience in the Medicare/Medicaid industry as well as more than 31 years of healthcare experience as a Registered Nurse and a Geriatric Social Worker. Among many things, Deniese provides gap analysis, assessment, design, and implementation in managed care risk-adjustment activities. Deniese has extended experience across all operational areas of Risk Adjustment for Payors and Providers and provides a unique perspective having worked for both Provider and Payer organizations.
SVP, Operations, Reveleer
Brian has 25 years’ experience in the technology and healthcare industries. He lead the Agile technology transformation of a large PBM through CI/CD, DevOps, and Cloud, and the digital transformation of a leading non-profit health system, creating a clinically and operationally aligned enterprise technology strategy. Today, he is helping to revolutionize healthcare delivery, improving health outcomes through the combination of NLP, data analytic, and advanced interoperability to synthesize disparate clinical data sources to create unified patient intelligence.
The FTI Health Solutions team is well known to and well-respected by corporations, relevant government agencies and regulators, including those at the Centers for Medicare and Medicaid Services; Health and Human Services Office of the Inspector General (OIG); Health and Human Services Office for Civil Rights; the Department of Justice (DOJ); and various U.S. Attorney's Offices.
Their work is regularly scrutinized and relied upon by those regulatory agencies and enforcement bodies as well as state Attorneys General, state Medicaid agencies, and various accreditation bodies, such as the Joint Commission and National Committee for Quality Assurance (NCQA).
Their professionals have served as independent advisors to Boards of Directors and senior management on regulatory compliance issues, testified on matters of healthcare reimbursement and healthcare compliance, and have experience with risk areas, auditing, and compliance program activities that are of high interest to the OIG and other regulators.
Reveleer is a healthcare-focused, technology-driven workflow, data, and analytics company that uses natural language processing (NLP) and artificial intelligence (AI) to empower health plans and risk-bearing providers with control over their Quality Improvement, Risk Adjustment, and Member Management programs.
With one transformative solution, the Reveleer platform allows plans to independently execute and manage every aspect of enrollment, provider outreach, data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute programs that deliver more value and improved outcomes. To learn more about Reveleer, please visit Reveleer.com.