Agenda
Explore the full schedule of sessions at the virtual Member Accounting & Reconciliation Summit
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Tuesday - May 19, 2026
10:00 AM
10:00 AM – 10:05 AM
Welcome and Opening Remarks
10:05 AM
10:05 AM – 10:50 AM
Navigating the Evolving Landscape: Upcoming Legislation, Regulatory Activity, and Impact on MA Programs
- Review the current legislative and regulatory landscape, including recent actions and their potential impact on MA programs
- Examine the CY 2027 MA/Part D Final Rule and CY 2027 Final Rate Notice to understand finalized changes and their implications
- Gain insights into what to expect in the near future and how to prepare for upcoming changes
Speaker
Aldiana Krizanovic
Senior Health Policy Consultant, Federal Government Relations at GuideWell & Florida Blue
10:50 AM
10:50 AM – 11:00 AM
Break
11:00 AM
11:00 AM – 11:50 AM
Reconciling CMS Payments: What Every MA Plan Gets Wrong
- Break down CMS payment mechanics, including MMR, PPR, and timing of adjustments
- Identify common sources of discrepancies between CMS and plan financial records
- Prioritize actions to improve payment accuracy and reduce reconciliation gaps
Speaker
Prince Baawauh
DrPH, MPH, CSM, Founder / Chief Tutor | Former Health Insurance Specialist at The HEALS Academy | CMS
11:50 AM
11:50 AM – 12:00 PM
Break
12:00 PM
12:00 PM – 12:50 PM
Risk Adjustment Meets Finance: Reconciling RAF Scores to Revenue
- Translate risk scores into expected revenue and payment outcomes
- Reconcile variances between coding, RAF scores, and CMS payments
- Align finance and risk teams to improve revenue accuracy
12:50 PM
12:50 PM – 1:30 PM
Lunch Break
1:30 PM
1:30 PM – 2:15 PM
Retroactivity Nightmares: Managing Backdated Enrollment & Payment Corrections
- Assess the financial impact of retroactive enrollment and disenrollment changes
- Reconcile prior-period adjustments and payment corrections
- Reduce operational burden through structured retroactivity workflows
2:15 PM
2:15 PM – 2:25 PM
Break
2:25 PM
2:25 PM – 3:10 PM
Aligning Enrollment, Billing & Finance: Fixing Data Disconnects
- Compare data across enrollment, billing, and finance systems to identify inconsistencies
- Resolve member-level discrepancies that impact reconciliation accuracy
- Establish governance to maintain a single source of truth
3:10 PM
3:10 PM – 3:20 PM
Break
3:20 PM
3:20 PM – 4:10 PM
Where the Money Goes Missing: Identifying Revenue Leakage in MA
- Quantify sources of revenue leakage across enrollment, risk adjustment, and billing workflows
- Detect patterns that lead to missed or incorrect payments
- Implement processes to recover revenue and prevent future losses
Speaker
Shannon Decker
CEO at VBC One
4:10 PM
4:10 PM – 4:15 PM
Closing Remarks
Wednesday - May 20, 2026
10:00 AM
10:00 AM – 10:10 AM
Opening Remarks and Day One Takeaways
10:10 AM
10:10 AM – 10:55 AM
Audit-Ready Accounting: Preparing for RADV and CMS Financial Scrutiny
- Identify key audit requirements related to member accounting and reconciliation
- Align financial records with documentation required for RADV and CMS audits
- Mitigate risk by addressing common audit findings and gaps
10:55 AM
10:55 AM – 11:05 AM
Break
11:05 AM
11:05 AM – 11:50 AM
Revenue Integrity in MA: Preventing Overpayments and Underpayments
- Evaluate internal controls that ensure payment accuracy
- Detect anomalies that signal overpayments or underpayments
- Strengthen processes to reduce financial and compliance risk
11:50 AM
11:50 AM – 12:00 PM
Break
12:00 PM
12:00 PM – 12:50 PM
Fixing Contract, Claims, and Subsidy Gaps
- Identify gaps across contract, claims, and subsidy processes that drive discrepancies
- Align systems, data, and workflows to improve reconciliation accuracy
- Strengthen controls and governance to reduce errors and support audit readiness
12:50 PM
12:50 PM – 1:00 PM
Closing Remarks
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