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Risk Adjustment User Group

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

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Risk Adjustment User Group

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  1. Risk Adjustment User Group April 2009

  2. Welcome to the AprilUser 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 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

  6. PAYMENT PROCESS

  7. PAYMENT PROCESS • Prior to transition • 38% response rate • Post transition • 73% resolved in March • 67% resolved in February

  8. 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? 8

  9. PAYMENT PROCESS Question 2 What does the risk score mean on the Part C Risk Adjustment Model Output Report (MOR) for a given month? 9

  10. 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

  11. 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

  12. DATA VALIDATION

  13. 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

  14. 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

  15. DATA VALIDATION CY 2007 (cont’d) Submit your RADV-related questions to Ann Marshall on the RADV team atann.marshall@cms.hhs.gov 15

  16. OPERATIONS UPDATES

  17. 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.

  18. 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

  19. TECHNICAL ASSISTANCE UPDATES

  20. TECHNICAL ASSISTANCE UPDATES Next User Group Meeting May 20, 2009

  21. QUESTIONS & ANSWERS

  22. CLOSING

  23. RESOURCES • Sean Creighton (Director, Division Risk Adjustment Operations) sean.creighton@cms.hhs.gov • Henry Thomas (Training, Project Officer) henry.thomas@cms.hhs.gov • Louis Johnson (FERAS,GTL) louis.johnson@cms.hhs.gov • Payment Research analyst@askriskadjustment.com • Lateefah Hughes (RADV) lateefah.hughes@cms.hhs.gov • Ann Marshall (RADV) ann.marshall@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com

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