risk adjustment user group
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A training initiative presented by
2009
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10 M
on
thly
Risk Adjustment User Group
June 2010
A training initiative
presented by
2010
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Welcome to the JuneUser Group
• Introduction
• Payment Process
• Data Validation
• Operations Update
• Questions and Answers
• Closing
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presented by
2010
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INTRODUCTION
• All attendees must pre-register• It is only necessary to register once• Retain unique PIN for all sessions• Session will last for one hour• Session slides will be available by
the Tuesday before the session • Panel will answer questions during
the Q&A portion of the session
User Group Process
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INTRODUCTION
• The 2010 monthly Risk Adjustment User Group dates are posted on the CSSC Operations website.
• Please continue to review the website for updates to this information.
www.csscoperations.com/new/usergroup/usergroupinfo.html
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INTRODUCTION
Q&A Resources• User Group Calls cover 2 risk adjustment
areas: Payment Operations and Data Validation.
• On the calls, subject matter experts are available from each area to answer questions.
• To submit questions outside of User Group:– Analyst@askriskadjustment.com for Payment
Operations– RADV@cms.hhs.gov for Data Validation
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PAYMENT PROCESS
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• Post transition
• 100% resolved in March 2010
• 100% resolved in April 2010
• 90% resolved in May 2010
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PAYMENT PROCESS
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Mid-Year Model Run for 2010Payment in July 2010Covers Dates of Service 1/1/09 – 12/31/09
Final Reconciliation for 2009Payment in August 2010Covers Dates of Service 1/1/08 – 12/31/08
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PAYMENT PROCESSFAQ
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Question – How often does CMS update the beneficiary Risk Adjustment Factor Type (RAFT) and during what timeframes annually?
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DATA VALIDATION
• CY 2007 Targeted Sample– Technical Assistance Report: will soon be
released• TA Report will identify inconsistencies in date of service
and/or provider type as well as other inconsistencies (e.g., obscured text).
• CMS will hold a teleconference to coincide with the distribution of TA Reports
– CMS will discuss: » Format of the report» Time period and requirements for plan response» Importance of reviewing and reporting any issues to the IMRRC
– Date, time, and dial-in information will be forthcoming.
• TA Reports and teleconference information will be sent by the IMRRC (Healthcare Management Solutions) via email to CY 2007 Targeted Sample plan-designated contacts.
• A Medical Record Receipt Report will also be distributed.
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DATA VALIDATION
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CY 2008 National SampleMAOs were notified of selection on Dec. 14, 2009
Under the Improper Payments Information Act (IPIA), CMS must annually measure and report the Part C payment error rate to OMBA key component of the Part C payment error rate is payment error identified under RADV
Medical Record Receipt ReportReleased on June 3, 2010 to CY 2008 National Sample plan-designated contacts (MCO and primary/secondary contacts)Deadline for response was June 8, 2010.
Medical record reviewIs nearing completion, and CMS will analyze data.
A training initiative
presented by
2010
DATA VALIDATION
• CY 2008 Contract-Level Sample– MA organizations (MAOs) selected
for this sample will be notified– Notification will be sent to MAO
CEO and MCO– Training will be provided—
• In-person at CMS, and• Via Webinar
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DATA VALIDATION
• RADV Mailbox – RADV@cms.hhs.gov– Mailbox recently established – MAOs may submit RADV questions to
this mailbox– Questions will be reviewed by the RADV
team and answered via this mailbox
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Operations
CSSC Can Help With…
• Verification of acceptance on file submissions.
• Technical issues and problems encountered with the submission of risk adjustment data.
• Restoring Risk Adjustment Reports
• Verification of data, addressing problems, offering technical assistance, and developing action plans through the monitoring and review of the plans data..
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Operations
FAQ
Q: Can the reconciliation payment date be included on the Annual Risk Adjustment
Submission Timetable?
A: Future reconciliation payment dates have not been determined; therefore, this information is not included on the submission timetable.
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TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting
July 21, 2010
New participants can register to attend the UG session from the www.TARSC.info
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• Sean Creighton (Director, Division of Risk Adjustment & Payment Policy) Sean.Creighton@cms.hhs.gov
• Henry Thomas (Training, Project Officer) Henry.Thomas@cms.hhs.gov
• Louis Johnson (FERAS,GTL) Louis.Johnson@cms.hhs.gov
• Chanda McNeal (RAS Payment) Chanda.mcneal@cms.hhs.gov
• Jennifer Harlow (RADV) Jennifer.Harlow@cms.hhs.gov
• Lateefah Hughes (RADV)Lateefah.Hughes@cms.hhs.gov
• Mary Guy (RADV) mary.guy@cms.hhs.gov
• Payment Research analyst@askriskadjustment.com• RADV Questions RADV@cms.hhs.gov • CSSC www.csscoperations.com • LTC www.tarsc.info
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