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Risk Adjustment User Group March 2010
Welcome to the MarchUser Group • Introduction • Payment Process • Data Validation • Operations Update • Questions and Answers • Closing
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
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
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.firstname.lastname@example.org for Data Validation
PAYMENT PROCESS • Post transition • 100% resolved in December 2009 • 81% resolved in January 2010 • 73% resolved in February 2010
PAYMENT PROCESS Question – Will CMS be eliminating the use of Evaluation and Management Consultation CPT codes for Medicare Providers?
DATA VALIDATION CY 2007 • Pilot RADV (notified June 20, 2008) • Deadline for submission of corrective medical records and attestations was Sept. 16, 2009. • Medical Record Receipt Reports distributed in January.
DATA VALIDATION • CY 2007 • Targeted RADV - Important Dates * Submission Deadline is 11:59 p.m. Eastern
DATA VALIDATION CY 2008 • National RADV • Deadline for submission of medical records (medical records, coversheets, and attestations) is March 12, 2010. • Plans may submit medical records via VPN, electronic media (e.g., USB, CD, DVD), fax, or hardcopy.
DATA VALIDATION CY 2007 Targeted & CY 2008 National RADV • Tips • CMS-generated attestation • Will only be accepted for physician/outpatient medical records. • Will be accepted if filled out completely as directed. • Should accompany the related record. • Do not alter or edit the CMS-generated attestation. • May provide the treating physician with: • A sample completed attestation; and • A cover note identifying the date of service requiring attestation. • Plan-generated attestations will not be accepted.
DATA VALIDATION CY 2007 Targeted & CY 2008 National • Tips • Requests for medical records—ensure that: • Providers receive all information needed to comply; and • Your complete request is received by the intended recipient—CMS contacted by multiple providers who receive incomplete medical record requests and are unable to determine— • MA organization • Patient information • Specific date(s) of service required
DATA VALIDATION • General Reminder--Observe CMS Requirements to Submit Documentation • MA organizations must ensure confidentiality of beneficiary information when sending protected health information (PHI) and/or personal identifiable information (PII) contained in medical records, attestations, and coversheets.
DATA VALIDATION • General Reminder (cont’d) • Do not submit any medical records via email. This may compromise PHI and/or PII and will be reported to the CMS Security Division as described in Security and Privacy Reminders and Clarification of Reporting Procedures (12/16/2008 CPC memorandum, available on the CMS Health Plan Management System website). • All submitted medical records must comply with the medical record requirements set forth in the Instructions Packet.
OPERATIONS Frequently Asked Question Q: Does the file size limitation of 1 million records per day also apply to vendors? A: The file size requirement applies to all submitters, including vendors. CMS is requesting files submitted for risk adjustment are limited to 1 million CCC (detail) records per day per submitter.
TECHNICAL ASSISTANCE UPDATES
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.email@example.com • Payment Research firstname.lastname@example.org • Jennifer Harlow (RADV) Jennifer.Harlow@cms.hhs.gov • Lateefah Hughes (RADV) Lateefah.Hughes@cms.hhs.gov • Mary Guy (RADV) email@example.com • LTC - www.tarsc.info • CSSC - www.csscoperations.com