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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