Risk Adjustment User Group

1. Risk Adjustment User Group June 2009

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 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 • 77% resolved in March • 67% resolved in April • 57% resolved in May

8. PAYMENT PROCESS • CLARIFICATION • Question: • If a member transfers from another Medicare Advantage plan, can the current plan submit dates of service that pre-date the member’s eligibility in the new plan? • Example: If a Member joins a MA Organization (Plan A) on August 1, 2007, can “Plan A” submit dates of service from January 2007 through July 2007, or only dates of service after August 1, 2007.

9. PAYMENT PROCESS Answer: Plans may only submit for beneficiaries who are enrolled in their plan on the DOS. If a beneficiary is not enrolled in the plan on the DOS included in the diagnosis cluster, the plan will receive a 408 and/or 409 error code on the RAPS reports. NOTE: Plan A can only submit a date with DOS after August 1, 2007

10. DATA VALIDATION

11. DATA VALIDATION • CY 2007 • Pilot RADV (notified June 20, 2008) • Analyses in progress • National Sample (notified Dec. 3, 2008) • Medical Record Review complete • Analyses in progress • Targeted Sample (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 Sample • To be implemented

12. 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 • ann.marshall@cms.hhs.gov for Data Validation

13. OPERATIONS UPDATES

14. Operations • Plans can now access the 2008 Risk Adjustment Participant Guide, Color Slides, Resource Guide, and the Job Aids on the CSSC Operations website at: http://www.csscoperations.com/new/usergroup/2008raps/participant-guide-publish_052909.pdf

15. OPERATIONS • If experiencing technical problems submitting data, check the CSSC Operations website under the System Status page for messages and updates on the RAPS processing status: http://www.csscoperations.com/new/systemstatus/systemstatus.html

16. OPERATIONS Report Distribution • Reports are sent to the mailbox as identified on the submitter application.

17. OPERATIONS • Test Environment • Submissions

18. TECHNICAL ASSISTANCE UPDATES

19. TECHNICAL ASSISTANCE UPDATES Next User Group Meeting July 15, 2009

20. QUESTIONS & ANSWERS

21. CLOSING

22. 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 • Chanda McNeal (RAS Payment) chanda.mcneal@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.csscoperation.com