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Risk Adjustment User Group

Risk Adjustment User Group. December 2008. Welcome to the November User Group. Introduction Payment Process Data Validation Operations Update Questions and Answers Closing. INTRODUCTION. INTRODUCTION. User Group Process. All attendees must pre-register

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Risk Adjustment User Group

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  1. Risk Adjustment User Group December 2008

  2. Welcome to the NovemberUser 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 Duplicate Diagnosis Cluster Submissions I.Definition: A duplicate diagnosis cluster is one with the same attributes: -HIC Number -Provider Type -From Date -Through Date -Diagnosis Code II. Cluster with the same attributes will receive 502 Error Message, which is: (“Diagnosis clusters was accepted but not stored. A diagnosis cluster with the same attributes is already stored in the RAPS database”)

  8. PAYMENT PROCESS Submission Requirements • Must report data at least once per enrollee in the data collection period; • Must submit data at least quarterly; • Submit quarterly submission that represent approximately one-fourth of the data that will be submitted during the data collection period. Note: In order to detect data collection and submissions problems early, CMS recommends that MA organizations submit more frequently than quarterly.

  9. PAYMENT PROCESS December, 2008 Payment Adjustments • SHMO • Other Adjustments

  10. DATA VALIDATION

  11. DATA VALIDATION • Calendar Year 2007 • January 2006 through December 2006 dates of service will be reviewed • Enrollee samples will include beneficiaries who were in the selected contract from January 2006 through January 2007 • RADV Samples • Contract-specific • Pilot • Targeted • Random • National

  12. DATA VALIDATION • Calendar Year 2007 (cont’d) • Pilot RADV (notified June 20, 2008) • IVC review completed • SVC review is in progress • Targeted RADV (notified Nov. 10, 2008) • CMS’ contractor, HMS, will distribute Instructions Packet shortly • Plans will have 12 weeks to submit medical records • Random RADV • To be implemented after release of the Instructions Packet

  13. DATA VALIDATION • Calendar Year 2007 (cont’d) • National RADV (notified on Dec. 3, 2008) • Under the Improper Payments and Information Act (IPIA), CMS must annually measure and report the Part C payment error rate • CMS recently completed its first analysis, reporting a 10.6 percent Part C national error rate for payment year 2006 • CMS will report a Part C payment error rate for 2007 at the end of fiscal year 2009 • Request plans’ best efforts to assist in correcting and improving payment error

  14. DATA VALIDATION • Calendar Year 2007 (cont’d) • National RADV (cont’d) • Contact Information Sheet was updated to include mailing address for Primary Contact • Instructions were distributed by traceable carrier to Primary Contact on Dec. 10, 2008 • Teleconference for plans in this sample is scheduled for Dec. 17, 2008 (2-4 p.m., Eastern) • Plans may submit medical records via VPN, electronic media (e.g., USB, CD), fax, or hardcopy • Deadline for medical record submission is Feb. 27, 2009

  15. OPERATIONS UPDATES

  16. OPERATIONS • CSSC Operations Holiday Closings: - Wednesday, December 24th - Thursday, December 25th - Thursday, January 1st • Please note: the Front-End Risk Adjustment System (FERAS) will be available during this time for RAPS submissions.

  17. CSSC Operations Reminder Submission Deadline • The final submission deadline for claims with dates of service 01/01/07 through 12/31/07 is 01/31/09. • Submit all outstanding claims. • Research errors, make possible corrections, and resubmit corrected data.

  18. TECHNICAL ASSISTANCE UPDATES

  19. TECHNICAL ASSISTANCE UPDATES Next User Group Meeting January 21, 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 • Lateefah Hughes (RADV) lateefah.hughes@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com

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