risk adjustment user group
DESCRIPTION
Risk Adjustment User Group. June 2010. Welcome to the June 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
June 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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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:– [email protected] for Payment
Operations– [email protected] 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.
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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 – [email protected]– 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) [email protected]
• Henry Thomas (Training, Project Officer) [email protected]
• Louis Johnson (FERAS,GTL) [email protected]
• Chanda McNeal (RAS Payment) [email protected]
• Jennifer Harlow (RADV) [email protected]
• Lateefah Hughes (RADV)[email protected]
• Mary Guy (RADV) [email protected]
• Payment Research [email protected]• RADV Questions [email protected] • CSSC www.csscoperations.com • LTC www.tarsc.info
RESOURCES