View Agenda | Medicare Advantage Member Accounting & Reconciliation Summit

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The Medicare Advantage Member Accounting and Reconciliation Summit
June 17-18, 2025
A Virtual Event

Past Agenda

Tuesday - June 17, 2025

10:00 AM 10:10 AM

9:00 AM 9:10 AM

8:00 AM 8:10 AM

7:00 AM 7:10 AM

Day One Opening Remarks

Shannon Decker PhD, MBA, MBA, MEd, MEd, Founder & CEO 
VBC One 

10:10 AM 10:55 AM

9:10 AM 9:55 AM

8:10 AM 8:55 AM

7:10 AM 7:55 AM

OIG Keynote Address: Understanding OIG’s Current Oversight of Managed Care Risk Adjustment Priorities

Join RISE for a special keynote with Ann Maxwell, HHS OIG's Deputy Inspector General for Evaluation and Inspections, to understand OIG’s current oversight priorities in risk adjustment, quality performance, and managed care operations. 

Ann Maxwell, Deputy Inspector General for Evaluation and Inspections 
HHS Office of Inspector General 

 

10:55 AM 11:00 AM

9:55 AM 10:00 AM

8:55 AM 9:00 AM

7:55 AM 8:00 AM

Break

11:00 AM 11:50 AM

10:00 AM 10:50 AM

9:00 AM 9:50 AM

8:00 AM 8:50 AM

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, Principal
Cogent Advisors

 

11:50 AM 12:10 PM

10:50 AM 11:10 AM

9:50 AM 10:10 AM

8:50 AM 9:10 AM

Break

12:10 PM 1:00 PM

11:10 AM 12:00 PM

10:10 AM 11:00 AM

9:10 AM 10:00 AM

Upcoming Legislation, Regulatory Activity, and Post-Election Impact on MA Programs

  • Examine the current state of legislation, regulation, and policy, and identify what to expect in the near future. 
  • Review the latest updates and actions from Congress affecting Medicare Advantage programs.
  • Analyze the CY 2026 MA/Part D Final Rule and CY 2026 Final Rate Notice to understand what has been finalized. 

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

1:00 PM 2:00 PM

12:00 PM 1:00 PM

11:00 AM 12:00 PM

10:00 AM 11:00 AM

Lunch

2:00 PM 2:45 PM

1:00 PM 1:45 PM

12:00 PM 12:45 PM

11:00 AM 11:45 AM

From Billing to Payment: Strengthening Provider Financial Reconciliation in Medicare Advantage

  • Review strategies to align risk-sharing agreements and value-based payments with Medicare reconciliation cycles 
  • Outline common misalignments between provider contracts, fee schedules, and actual claim reimbursements  
  • Identify the financial impact of capitated vs fee-for-service provider arrangements on reconciliation efforts 

Shannon Decker PhD, MBA, MBA, MEd, MEd, Founder & CEO 
VBC One 

Rafi Cices, Head of BOI, Coding & Billing 
Cityblock Health 

2:45 PM 2:50 PM

1:45 PM 1:50 PM

12:45 PM 12:50 PM

11:45 AM 11:50 AM

Break

2:50 PM 3:40 PM

1:50 PM 2:40 PM

12:50 PM 1:40 PM

11:50 AM 12:40 PM

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

Moderator:  
David DeHommel, VP Payer Strategies 
Reveleer 

Suzanne Barone, Clinical Manager, Risk Adjustment and Quality 
VNSHealth 

Taylor Lawrence, Supervisor, Risk Adjustment Data Validation and Stars 
Louisiana Blue 

3:40 PM 4:00 PM

2:40 PM 3:00 PM

1:40 PM 2:00 PM

12:40 PM 1:00 PM

Break

4:00 PM 4:50 PM

3:00 PM 3:50 PM

2:00 PM 2:50 PM

1:00 PM 1:50 PM

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, PhD, MBA, MBA, MEd, MEd, Founder & CEO
VBC One

Miranda Miller, Director of Value Based Performance 
Samaritan Health Services 

Syed Rizvi, Director of Risk Adjustment and Vendor Operations 
Southwestern Health Resources 

4:50 PM 4:55 PM

3:50 PM 3:55 PM

2:50 PM 2:55 PM

1:50 PM 1:55 PM

Day One Closing Remarks

Shannon Decker PhD, MBA, MBA, MEd, MEd, Founder & CEO 
VBC One 

Wednesday - June 18, 2025

10:00 AM 10:10 AM

9:00 AM 9:10 AM

8:00 AM 8:10 AM

7:00 AM 7:10 AM

Day Two Opening Remarks and Day One Takeaways

Shannon Decker PhD, MBA, MBA, MEd, MEd, Founder & CEO 
VBC One 

10:10 AM 10:55 AM

9:10 AM 9:55 AM

8:10 AM 8:55 AM

7:10 AM 7:55 AM

Elevating Data Quality to Drive Reconciliation Success

  • Review best practices for ensuring data accuracy in member-level submissions 
  • Highlight solutions for managing large-scale data corrections in risk adjustment and claims 
  • Discuss data validation protocols to mitigate CMS compliance risk

Penny Jefferson, Manager of Coding and Clinical Documentation 
University of California Davis Medical Center 

Brittany Poche, Manager RADV and Stars Strategy Operations 
LA Blue 

 

10:55 AM 11:00 AM

9:55 AM 10:00 AM

8:55 AM 9:00 AM

7:55 AM 8:00 AM

Break

11:00 AM 11:50 AM

10:00 AM 10:50 AM

9:00 AM 9:50 AM

8:00 AM 8:50 AM

Revenue Optimization Through Proactive Payment Error Identification

  • Discover common sources of payment discrepancies across MA plans 
  • Review predictive analytics tools that help forecast and mitigate financial shortfalls 
  • Examine strategies for building a cross-functional reconciliation task force to address revenue risks proactively 

Ekaette Joseph-Isang, MD, MPH, CPHQ, Principal Consultant, Health Care Executive
RiteBridge Consultants 

Prince Baawah, DrPH, MPH, CSM, Founder, Chief Tutor 
The HEALS Academy 

11:50 AM 11:55 AM

10:50 AM 10:55 AM

9:50 AM 9:55 AM

8:50 AM 8:55 AM

Break

11:55 AM 12:45 PM

10:55 AM 11:45 AM

9:55 AM 10:45 AM

8:55 AM 9:45 AM

Managing Dual-Eligible Risk: Reconciling Medicare and Medicaid Data for Financial Accuracy

  • Highlight strategies for aligning Medicaid and Medicare data to prevent financial inaccuracies 
  • Discuss the evolving role of state Medicaid agencies 
  • Examine common reconciliation challenges including misclassified dual-eligible status, LIS payment discrepancies, and incorrect subsidy applications 

Shannon Turner, Senior Manager
UPMC

Kelly Aber, AVP, Enrollment & COB Services 
UPMC Health Plan 

12:45 PM 1:00 PM

11:45 AM 12:00 PM

10:45 AM 11:00 AM

9:45 AM 10:00 AM

Closing Remarks

Shannon Decker PhD, MBA, MBA, MEd, MEd, Founder & CEO 
VBC One