Agenda
Explore the full schedule of sessions at The Audit Readiness Master Class
Thursday - January 15, 2026
10:00 AM
10:00 AM – 10:05 AM
Welcome and Opening Remarks
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
10:05 AM
10:05 AM – 10:50 AM
Keynote Address
Keynote Address: Decoding the Latest CMS Audit & Enforcement Report
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
10:50 AM
10:50 AM – 11:00 AM
Break
11:00 AM
11:00 AM – 11:50 AM
Part 1: Your Audit Chances Are Guaranteed: How to Prepare
- Being proactive vs reactive
- Building a team for trusted documentation and vendor partners
- Training providers and vendors to better standardize charting criteria
- Establishing feedback loops and understanding what could get rejected
- Update contracts to clarify liability and retrieval obligations
- Form a RADV “SWAT Team”
- Require self-audits and reporting oversight, as well as rapid response drills
- Establish internal controls and compliance processes for CMS review
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
11:50 AM
11:50 AM – 12:00 PM
Break
12:00 PM
12:00 PM – 12:50 PM
Part 2: You’ve Been Selected for a RADV Audit, What’s Next?
- Notify all internal stakeholders right away and make sure everyone is aligned
- Review which enrollees and HCCs are being audited and cross-check against your internal mock audit results-flagging any high risk charts
- Begin medical record retrievals and ensure records are accurate and signed and annotated
- Have coding team review every chart and add any additional color or clarifications within CMS rules
- Engage legal counsel early to begin your appeals strategy
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
12:50 PM
12:50 PM – 1:30 PM
Lunch Break
1:30 PM
1:30 PM – 2:15 PM
Part 3: Navigating Chart Retrieval at Scale
- Centralize record storage and retrieval workflows
- Establish standardizations for dates, signatures and clinical notes to support diagnoses
- Educate your team on common pitfalls and potential penalties
- Validate completeness and quality with vendors before submissions
- Exploring common errors in the chart retrieval process that can be costly during an audit
Speaker
Mary Inman
Partner at Whistleblower Partners, LLP
2:15 PM
2:15 PM – 2:25 PM
Break
2:25 PM
2:25 PM – 3:10 PM
Part 4: Defending Your Case: The Legal Impact of Non-Compliance
- The importance of knowing the rules of the audit year
- Validate all information and ensure all signatures and credentials are correct.
- Submit addenda or to resolve any ambiguities
- Assume that any missing elements or information are automatic denials, so plan to find any and all information you can.
- Maintain an audit trail and keep records of all versions of submissions
- Audit your policies and ensure they align with the latest CMS coding rules
- Ensure full cooperation on retrievals and sharing with all vendors and partners
- Pre-build appeals arguments and establish expert resources in the case of litigation
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
Speaker
Jeannie Hennum
General Manager of Value Based Care at Verisma
3:10 PM
3:10 PM – 3:20 PM
Break
3:20 PM
3:20 PM – 4:05 PM
Mock Audit: Preparing for the Inevitable and Learning Under Pressure
What happens when CMS comes knocking? In this interactive session, we’ll walk through a simulated RADV audit, from the engagement letter, to record submission. This mock audit is a safe space to stress-test your readiness and highlight the weak spot, to better learn from the mistakes you’d rather not make under CMS scrutiny.
Key Takeaways from this session:
- Understanding each step of the RADV audit process
- Gaining tools to reduce risk through self-audits
- Building confidence in documentation and chart retrievals
- Practicing coordinating providers, vendors and coders under tight timelines
- Identifying gaps in trainings, delegations and oversight
- Learn strategies to keep documentation audit-ready year-round
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
Speaker
Wynda Clayton
MS, RHIT, Risk Adjustment Specialist
4:05 PM
4:05 PM – 4:10 PM
Closing Remarks
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
Friday - January 16, 2026
10:00 AM
10:00 AM – 10:10 AM
Chairperson’s Opening Remarks and Day One Takeaways
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
10:10 AM
10:10 AM – 11:00 AM
Boardroom Briefings: Talking to the C-Suite and the Board about RADV Risk
- Get buy-in and support on the drastic importance this has for organizations
- Express the importance of tightening oversight with all partners
- Updating contracts, clarifying liability, and retrieval obligations
- Discuss the importance of Investing in the latest technology and support
- Establish quarterly check-ins on the most up to date compliance requirements
- Quantify the potential risk through scenario planning
- Discuss cross-functional team planning and the need for executive-level visibility should an audit occur
Speaker
Deb Curry
MBA, RHIA, CDIP, CCS-P, CRC, Mgr, Risk Adjustment Coding Quality & Operations at Medical Mutual
Speaker
Heather Bullock
Director of Risk Adjustment Operations and Process Improvement at Horizon Blue Cross Blue Shield of New Jersey
Speaker
Jeannie Hennum
General Manager of Value Based Care at Verisma
11:00 AM
11:00 AM – 11:10 AM
Break
11:10 AM
11:10 AM – 11:55 AM
Surviving a Medicare Programmatic Audit
- Know your scope–does your process match the latest regulations?
- Assign team leads for each audited domain
- Practice mock program audits and rehearse roles and identify any weakness before CMS arrives
- Maintain audit-ready case files that are centralized and easily accessible
- Establish a document request respond process
- Be transparent and communicate about any corrective actions
- Brief leadership on any potential exposures, financial impacts and reputational risks
- Prepare internal and external communications strategies
11:55 AM
11:55 AM – 12:05 PM
Break
12:05 PM
12:05 PM – 12:50 PM
From Data to Defense: Balancing Vendor Relationships
- Do your due diligence! Ask about their experience and documentation standards
- Be sure to get references and case studies
- Confirm their technology capabilities and prioritize those which dashboards and audit trails
- Ensure that all compliance framework is up to date
- Modifying and managing regular contract reviews and updating agreements to the latest findings
- Establishing Service-Level Agreements, which include metrics, turnaround times and tolerance for errors
- Building out an oversight committee
- Understanding where liability stands and delegating risk
- Maintain backup vendors or contingency plans
Speaker
Ava Johnson
Director, Ambulatory CDQI at Mount Sinai Hospital, NYC
Speaker
Deb Curry
MBA, RHIA, CDIP, CCS-P, CRC, Mgr, Risk Adjustment Coding Quality & Operations at Medical Mutual
12:50 PM
12:50 PM – 1:30 PM
Lunch Break
1:30 PM
1:30 PM – 2:15 PM
The Future of Medicare Advantage Oversight: What RADV’s Expansion Tells Us about where CMS and OIG Are Headed Next
Oversight is no longer episodic! It’s universal and continuous and will only continue to scale. This session decodes what RADV’s expansion signals about the next phase of Medicare Advantage oversight. There will be tighter delegation accountability, quicker timelines, data-driven targeting, and a lower tolerance for documentation gaps. In this session we’ll learn how to move from reactive to proactive to ensure audit readiness is embedded into daily operations
Speaker
Ava Johnson
Director, Ambulatory CDQI at Mount Sinai Hospital, NYC
Speaker
Danielle Bagnell
CPC, CDEO, CPMA, CRC, CVBA, Virtual Instructor and Subject Matter Expert at AAPC
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
2:15 PM
2:15 PM – 2:25 PM
Chairperson’s Closing Remarks
Speaker
Donna Malone
CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, Director Risk Capture, Population Health Management at Mass General Brigham
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