Risk Adjustment Roundtable With the Experts

Take a deep dive into Risk Adjustment with the help and guidance of 4 experts with more than 80 years of combined experience in the business of healthcare. Join presenters Sheri Poe Bernard, Colleen Gianatasio, Donna Malone, Khushwinder Singh in a discussion of topics ranging from the what the focus of risk adjustment regulators is these days to best practices on how to avoid becoming an accomplice in HCC fraud and abuse:

This workshop will consist of 4 sections where the following topics will be discussed:

• Risk Adjustment in the News presented by Sheri Poe Bernard

What's the focus of risk adjustment regulators these days? We can perhaps find answers in the numerous legal actions that the federal government has recently filed against Medicare Advantage plans. Sheri has culled through these multi-billion dollar actions and will describe top compliance issues identified by the OIG and DOJ, and the panel will discuss how these developments should shape our own compliance in 2022.

• Practical Use of Models presented by Donna Malone

Providers have been well educated regarding documentation required to support “what” they did for the patient to capture proper evaluation and management levels, however not much attention has been given over the years to address capturing the true complexity of the patient’s health status. All value-based care models rely on documentation from the patient’s providers stating the specific diagnoses being managed or impacting medical decision-making.

Donna will walk you through a process that is condition focused to assist the provider at the point of care to get credit for the intensity of the patient they are providing at the point of care.

• Intersection of Quality & Risk presented by Colleen Gianatasio

This segment will cover the overlap between risk adjustment and quality. By looking for overlap in risk adjustment and quality measures plans will be able to break down silos within their organization, create efficiencies and help to improve patient outcomes.

• Clinical Validation & Other Risks presented by Khushwinder Singh

Financial incentives tied to HCCs are muddying the waters and damaging clinical integrity in medicine today. Learn about the risks of failing a clinical validation audit when your provider's medical record includes risk-adjusting diagnoses without evidence of diagnostic work-ups, treatments, and/or plans of care associated with those diagnoses. Clinical decision making is not based on diagnosis code—but rather diagnosis codes are based on clinical decision making. There is pressure on clinicians today to recapture previously coded HCCs by other providers, and/or report new HCC capture. Providers may become unwitting accomplices to HCC fraud or abuse when using pre-chosen HCC-linked codes to describe clinical diagnoses.

How much pressure is your organization exerting on providers to capture HCCs? Learn about the risks of these practices and others from a physician who is also a certified risk adjustment coder and documentation integrity specialist.

About The Presenters

Sheri Poe Bernard, COC, CPC, CDEO, CRC, CPC-I


Sheri Poe Bernard is managing consultant at Granite GRC Consulting, where her chief responsibility is risk adjustment auditing, clinical documentation improvement, and training. With 28 years in coding and reimbursement publishing, training, and test development, she is an expert communicator of coding concepts. She is the author of the AMA publication, Risk Adjustment Documentation and Coding, now in its second edition. She served for 15 years as a coding content developer at Optum360. She was a Vice President at AAPC for three years, and on its national advisory board for 8 years.

Colleen Gianatasio, CPC, CPC-P, CPMA, CRC, CPC-I


Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O has over 20 years of experience in all aspects of the business of healthcare. As Director of Ambulatory CDQI for Mount Sinai Health Care Partners she is responsible for provider engagement and clinical documentation improvement for accurate coding. Colleen specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation and auditing classes. Colleen is President - elect of the AAPC National Advisory Board.

Donna Malone, CPC, CRC, Approved Instructor


Donna Malone is President of the AAPC Local Chapter in Watertown, MA. She is currently Director Enterprise Risk Adjustment at Tufts Health Plan. She has been in the value-based care space for 15 years and has been coding for over 20 years. She is also an Adjunct Professor and Advisor at MassBay Community College in the Medical Coding and Medical Administration Programs and has been teaching for 16+ years.

Khushwinder Singh, MD, MHA, CDIP, CPC, CPCO, CPMA, CRC


Khush Singh, MD is a trained clinician and an experienced healthcare management professional, with over 15+ years of Health Information Management (HIM) experience. As a seasoned clinician, Khush is always determined to meet higher goals with a commitment towards improving the health of the patients & helping medical providers in managing the health information coding data, minimizing errors & reducing wastage of healthcare resources, thus improving the overall quality of healthcare delivery to our most deserving patient population.

He is continuously helping to drive the culture of excellence and is committed to improving the quality of healthcare, with a focus on IHI’s Triple Aim. Having a passion for Value-Based Care & Risk Adjustment, Khush believes that ‘Risk adjustment’ is a unique HIM platform where various health information data elements like the diagnoses ICD-10 coding data from its inception as medical records in various EMRs, lab data from EHRs and claims data like CPT/HCPCS codes that move along in the EHRs and other HIM systems provide a measure of quality and value to the healthcare delivery system.