Rise

Day One Opening Remarks

The Road Ahead: Understanding Policy Changes and Their Financial Impact for Medicare Advantage

• Understand how emerging policies could shift reimbursement models and member care strategies 
• Highlight proactive strategies for MA plans to adapt to regulatory uncertainty 
• Discuss the role of new administration priorities, current legislative agenda, and upcoming regulatory changes in shaping future plan operations and strategy. 

Aldiana Krizanovic
Senior Health Policy Consultant, Federal Government Relations
Florida Blue

Mitigating Financial Risk Through Retrospective Reconciliation

• Discuss strategies to resolve discrepancies between interim and final settlements 
• Review methods to reconcile Part C and Part D payments effectively 
• Uncover how risk corridors influence financial settlements in Medicare Advantage plans 

David Meyer,
RISE Executive Committee

Effective Cost Reporting Strategies for Medicare Advantage Plans

• Examine how accurate cost reporting impacts future capitation rates and risk adjustment 
• Outline key challenges in reconciling MA administrative costs with CMS requirements 
• Understand the implications of inaccurate cost reporting on compliance and revenue 

Managing Part D Payment Reconciliation

• Define the complexities of reconciling direct subsidy, reinsurance, and risk-sharing payments 
• Highlight the role of drug utilization data in accurate Part D reconciliation 
• Discuss how rebate accounting influences final settlement adjustments 

Preparing for Medicare RADV Audits

• Understand the scope and purpose of Risk Adjustment Data Validation audits 
• Discuss common findings in RADV audits and their impact on financial performance 
• Review documentation standards to mitigate risk adjustment audit penalties 

Preparing for Value-Based Contracting and Reconciliation

• Highlight the role of value-based contracts in shaping future Medicare payments 
• Examine reconciliation strategies for shared savings and risk-bearing arrangements 
• Review how provider collaboration impacts value-based payment reconciliation 

Shannon Decker, CEO
VBC One

Day One Closing Remarks