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Risk Adjustment User Group

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

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Risk Adjustment User Group

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  1. Risk Adjustment User Group June 2010

  2. Welcome to the JuneUser Group • Introduction • Payment Process • Data Validation • Operations Update • Questions and Answers • Closing

  3. INTRODUCTION

  4. INTRODUCTION User Group Process • 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

  5. 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

  6. 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

  7. PAYMENT PROCESS

  8. PAYMENT PROCESS • Post transition • 100% resolved in March 2010 • 100% resolved in April 2010 • 90% resolved in May 2010

  9. PAYMENT PROCESS • Mid-Year Model Run for 2010 • Payment in July 2010 • Covers Dates of Service • 1/1/09 – 12/31/09 • Final Reconciliation for 2009 • Payment in August 2010 • Covers Dates of Service • 1/1/08 – 12/31/08

  10. PAYMENT PROCESSFAQ Question – How often does CMS update the beneficiary Risk Adjustment Factor Type (RAFT) and during what timeframes annually?

  11. DATA VALIDATION

  12. 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.

  13. DATA VALIDATION • CY 2008 National Sample • MAOs 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 OMB • A key component of the Part C payment error rate is payment error identified under RADV • Medical Record Receipt Report • Released 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 review • Is nearing completion, and CMS will analyze data.

  14. 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

  15. 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

  16. OPERATIONS UPDATES

  17. 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..

  18. 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.

  19. TECHNICAL ASSISTANCE UPDATES

  20. TECHNICAL ASSISTANCE UPDATES • Next User Group Meeting • July 21, 2010 • New participants can register to attend the UG session from the www.TARSC.info

  21. QUESTIONS & ANSWERS

  22. CLOSING

  23. RESOURCES • 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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