Description: CPT, NCCI, ICD, CCI, DRG, APC, PTP – understanding healthcare claims involve a dizzying array of code sets and payment methodologies, and yet the claim form is the intersection of health plan affordability, provider payment, and data analysis. This webcast will cover: • The code sets used in medical coding • Types of correct coding policies implemented by CMS and commercial payers • Payment integrity strategies to drive health plan affordability • Data analytics approaches leveraging medical coding knowledge

Description: This session explores the far-reaching changes to how clinical data will be sourced, processed and consumed in many payer use cases including risk adjustment, quality measurement, care management, claims adjudication, prior authorizations, and other payer functions. Robust, interoperable data exchange is a prerequisite for value-based care. Clinical data will be increasingly accessible to augment administrative (claims) data via standardized Fast Health Interoperability Resources (FHIR, pronounced 'fire'), at a fraction of the cost of a accessing a traditional medical record and in real-time. On May 1, 2020, HHS issued a final rule implementing interoperability and the patient access provisions of the 21st Century Cures Act of 2016, although enforcement has been delayed into 2021 because of the COVID-19 pandemic. The new regulations promote, “HHS’s vision and strategy for achieving a health information ecosystem within which all individuals, their personal representatives, their health care providers, and their payers are able to send, receive, find, and use electronic health information in a manner that is appropriate, secure, timely, and reliable to support the health and wellness of individuals through informed, shared decision-making, as well as to support consumer choice of payers and providers.”Once enforcement begins, CMS and the Office of the National Coordinator for Health Information Technology (ONC), have the authority to mandate adoption of interoperability requirements, and also penalize payers and providers for non-compliance or the delay and withholding of data.This ‘digital transformation’ of the clinical data ecosystem has far-reaching implications for enabling technologies including Natural Language Processing (NLP) and entire segments of services and vendors. It will eliminate many departmental barriers, duplication and error sources for health plans and impact every department and the underlying economics of delivering and managing care.

Description: Explore how certain actuarial roles should be reserved under defined benefit plans for more than 50 years during the Reserved Roles for Actuaries in Defined Contribution Plans webcast. This online event will be focused on actuaries and defined contribution (DC) plan actuaries and how they have been spotlighted by the pension industry due to their roles. Join us to discover which roles under DC plans could be reserved for actuaries by plan sponsors or through legislation.

Description: Explore the value and cost of prescription drugs, how they should be defined and measured and the effects various stakeholders in the pharmacy ecosystem can have on these factors in the latest webcast. You'll investigate the impact of coverage, formulary and rebate negotiations and related benefit design. Find out how actuaries can answer questions related to the prescription drug industry, in addition to improving the access, quality and affordability of prescription drugs in the United States. Join us for this webcast and come learn about value-based contract design, negotiations, implementation and administration for prescription drugs.

Description: As the size of the life reinsurance market in Bermuda has grown to over half a trillion dollars at the end of 2021, more and more actuaries are getting involved with this 21 square mile North Atlantic island in one way or the other. Come explore a fundamental understanding of the Bermuda solvency framework and an overview of its upcoming changes.

Description: "Through both informed policy debate and opinionated social media, there are many current event health topics actively discussed and debated. The question remains... how does one separate out subjective information, seek objective analysis, and at the same time consider where there might be more research needed to come to conclusions? This session will use several current event topicsas examples and discover insights as to where research has been performed, what it may or may not cover, and also note where lines are still blurred and may need further details to be studied. Topics that may be discussed include: How valuable and exact is the use of risk-adjustment for Medicare Advantage What is the health and mortality impact of receiving COVID-19 vaccinations"

Description: Investigate the importance of collaboration with accounting, underwriting, sales, marketing and other professions as an actuary when you attend this webcast. Cross-functional positions can cause unique challenges to arise, like various experts attempting to balance growth and profitability. Discover an opportunity to learn about relevant ASOPs and dive deeper into contemporary examples that highlight specific professionalism issues that can develop.

Description: As the size of the life reinsurance market in Bermuda has grown to over half a trillion dollars at the end of 2021, more and more actuaries are getting involved with this 21 square mile North Atlantic island in one way or the other. Come explore a fundamental understanding of the Bermuda solvency framework and an overview of its upcoming changes.

Description: Join us for the Pandemics & Paradigm Shifts: ERM in an Intensely Dynamic World panel discussion, where industry and regulatory perspectives will help provide insight into a number of topics. Expect interactive dialogue opportunities based on the conversation between the panelists and the audience. Key topics that will be conversed about, but the panel is not limited to, include a brief review of historical paradigm shifts and subsequent insurer failures, best practices and an outlook on the ultra-dynamic world of today and consideration of a company's enterprise risk management framework as it affects ratings and insurance department examinations.