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Risk Adjustment User Group

Risk Adjustment User Group. March 2010. Welcome to the March User Group. Introduction Payment Process Data Validation Operations Update Questions and Answers Closing. Introduction. 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 March 2010

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

  7. Payment Process PAYMENT PROCESS

  8. PAYMENT PROCESS • Post transition • 100% resolved in December 2009 • 81% resolved in January 2010 • 73% resolved in February 2010

  9. PAYMENT PROCESS Question – Will CMS be eliminating the use of Evaluation and Management Consultation CPT codes for Medicare Providers?

  10. Data Validation DATA VALIDATION

  11. 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.

  12. DATA VALIDATION • CY 2007 • Targeted RADV - Important Dates * Submission Deadline is 11:59 p.m. Eastern

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. Operations Updates OPERATIONS UPDATES

  19. 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.

  20. Technical Assistance updates TECHNICAL ASSISTANCE UPDATES

  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 • 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

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