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Risk Adjustment User Group

Stay informed about the latest in risk adjustment with updates on payment processes, data validation, operations, and Q&A sessions. Join us for valuable insights and resources.

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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 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. www.csscoperations.com/new/usergroup/usergroupinfo.html • Please continue to review the website for updates to this information.

  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 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 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 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 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 QUESTIONS & ANSWERS

  22. Closing 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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