risk adjustment user group
DESCRIPTION
Risk Adjustment User Group. April 2009. Welcome to the April User Group. Introduction Payment Process Data Validation Operations Update Questions and Answers Closing. INTRODUCTION. INTRODUCTION. User Group Process. All attendees must pre-register It is only necessary to register once - PowerPoint PPT PresentationTRANSCRIPT
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Risk Adjustment User Group
April 2009
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Welcome to the AprilUser Group
• Introduction
• Payment Process
• Data Validation
• Operations Update
• Questions and Answers
• Closing
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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 2008 monthly Risk Adjustment User Group Q & A and Notes documents are posted at 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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PAYMENT PROCESS
• Prior to transition– 38% response rate
• Post transition – 73% resolved in March– 67% resolved in February
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PAYMENT PROCESS
Question 1
Where can plans locate the coefficients for the CMS-HCC End-Stage Renal Disease Model, the CMS-HCC Community Model, and the CMS-HCC Institutional Model for payment years 2008 and 2009?
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PAYMENT PROCESS
Question 2
What does the risk score mean on the Part C Risk Adjustment Model Output Report (MOR) for a given month?
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PAYMENT PROCESS
2010 Advanced Notice
•Frailty Adjustment •Normalization Factors•Budget Neutrality•Adjustment for MA Coding Pattern Differences•ESRD Payments•IME Phase Out•Network Areas for PFFS Plans in Plan Year
2011•Continuation of Clinical Trial Policy•Adjustment to FFS Per Capita Costs for VA-DOD
costs•Calculation and Source of MSP Factors
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PAYMENT PROCESS
Notices:
• Final (April 7, 2008): http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2009.pdf
• Advance (February 20, 2009): http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/Downloads/Advance2010.pdf
• Expected release 2010 Final Notice April 2009
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DATA VALIDATION
• CY 2007
– Pilot RADV (notified June 20, 2008)• Analyses in progress
– Targeted RADV (notified Nov. 10, 2008)• Instructions Packet to be distributed• Selected plans to be notified via email when packet
is released• Plans will have 12 weeks to submit medical records
– Random RADV• To be implemented
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DATA VALIDATION
• CY 2007 (cont’d) – National Sample (notified December 3, 2008)
• Medical record submission deadline was Friday, February 27th
• A plan-specific Tracking Report that confirms medical records and coversheets received has been released to plan-designated contacts
• Please review the Tracking Report for inconsistencies and notify HMS as instructed
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DATA VALIDATION
• CY 2007 (cont’d)– Submit your RADV-related questions to
Ann Marshall on the RADV team at [email protected]
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Operations: Reports Overview
• Reports
FERAS - Provides the status of accepted or rejected of submitted files, and identifies the rationale for the rejections.
RAPS Return File - Contains the entire submitted transactions, and identifies the 300, 400, and 500 level errors.
RAPS Transaction Error Report - Identifies errors found in CCC records during the RAPS processing cycle. Displays only 300, 400, and 500 level error codes
RAPS Transaction Summary Report - Summarizes all transaction submitted.
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Operations: Reports Overview
• Reports cont. RAPS Monthly Plan Activity Report – Provides
the monthly summary of submitted transactions, which are stratified by Submitter ID and Plan Number.
RAPS Cumulative Plan Activity Report - Contains monthly cumulative list of transactions, which are stratified by Submitter ID and Plan Number
RAPS Monthly Error Frequency Report – Provides the monthly summary of all errors in the files that were submitted in test and/or production.
RAPS Quarterly Error Frequency Report - Provides the quarterly summary of all errors on all files that were submitted within a 3-month period
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TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting
May 20, 2009
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RESOURCES
• Sean Creighton (Director, Division Risk Adjustment Operations) [email protected]
• Henry Thomas (Training, Project Officer) [email protected]
• Louis Johnson (FERAS,GTL) [email protected]
• Payment Research [email protected]• Lateefah Hughes (RADV)
[email protected]• Ann Marshall (RADV) [email protected] • LTC www.tarsc.info • CSSC www.csscoperations.com