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Risk Adjustment User Group
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  1. Risk Adjustment User Group May 2010

  2. Welcome to the MayUser 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 • Mary.guy@cms.hhs.gov for Data Validation

  7. PAYMENT PROCESS

  8. PAYMENT PROCESS • Post transition • 100% resolved in February 2010 • 96% resolved in March 2010 • 71% resolved in April 2010

  9. PAYMENT PROCESS • CMS-HCC Risk Adjustment Model for 2011 • Reference the factors in the CMS-HCC risk adjustment model from the 2009 Rate Announcement (published in April 2008). http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2009.pdf

  10. PAYMENT PROCESS • CMS-HCC ESRD Dialysis Risk Adjustment Model • Reference the factors in the CMS-HCC ESRD risk adjustment model from the 2008 Rate Announcement (published in April 2007). http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2008.pdf

  11. PAYMENT PROCESS • CMS-RxHCC Risk Adjustment Model for 2011 • CMS is implementing the new model in 2011. • Reference the factors in the CMS-RxHCC risk adjustment model from the 2011 Rate Announcement (published in April 2010).http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2011.pdf

  12. PAYMENT PROCESS • Updates to model coefficients versus Diagnosis Code File. • The risk adjustment models are not updated every year. • If there is an update to the diagnosis codes used in the Risk Adjustment models, CMS updates the Diagnosis Code File annually in October. http://www.cms.gov/MedicareAdvtgSpecRateStats/06_Risk_adjustment.asp#TopOfP

  13. PAYMENT PROCESSFAQ • When will an age coefficient for a beneficiary change in a given year?  • For example, a beneficiary enters a plan on January 1 at the age of 69 and on February 17 the beneficiary turns 70.

  14. DATA VALIDATION

  15. DATA VALIDATION • CY 2007 Targeted and CY 2008 National Sample - sample-specific reports • Two types (see April 2010 User Group slides for description of each) • Technical Assistance Report • Medical Record Receipt Report • CMS will release these reports to the plan-designated contacts (MCO and primary and secondary contacts) • It is very important that MA organizations review and report any issues to the Intake Medical Record Review Contractor (IMRRC) as directed

  16. DATA VALIDATION • CY 2008 Contract-Level Sample • MA organizations 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

  17. DATA VALIDATION • CY 2008 National Sample • MAOs 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

  18. 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 • Mary Guy and Carolyn Kapustij will be answering general RADV questions

  19. OPERATIONS UPDATES

  20. Operations 2011 Calendar Year RAPS Submission Timetable

  21. Operations CSSC Operations will be closed in observance of Memorial Day on Monday, May 31, 2010. FERAS will be available to accept files during this period.

  22. TECHNICAL ASSISTANCE UPDATES

  23. TECHNICAL ASSISTANCE UPDATES • Next User Group Meeting • June 16, 2010 • New participants can register to attend the UG session from the www.TARSC.info

  24. QUESTIONS & ANSWERS

  25. CLOSING

  26. 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 • Payment Research analyst@askriskadjustment.com • Jennifer Harlow (RADV) Jennifer.Harlow@cms.hhs.gov • Lateefah Hughes (RADV) Lateefah.Hughes@cms.hhs.gov • Mary Guy (RADV) mary.guy@cms.hhs.gov • LTC - www.tarsc.info • CSSC - www.csscoperations.com