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Risk Adjustment User Group

Risk Adjustment User Group. November 2008. Welcome to the November User Group. Introduction Payment Process Operations Update Data Validation Questions and Answers Closing. 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 November 2008

  2. Welcome to the NovemberUser Group • Introduction • Payment Process • Operations Update • Data Validation • 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 Final Reconciliation • Due Date 1/31/2009 • Dates of Service (1/1/07 – 12/31/07)

  8. DATA VALIDATION

  9. DATA VALIDATION • Calendar Year 2007

  10. RADV Calendar Year 2007 • Pilot RADV • Currently working on IVC review • SVC review is underway

  11. RADV Calendar Year 2007 (cont’d) • Regular RADV • Sampling is underway • January 2006 through December 2006 dates of service will be reviewed • Enrollee sample will include beneficiaries who were in the selected contract from January 2006 through January 2007 • Targeted Plans • CMS’ contractor, HMS, distributed initial notification and request for medical record contact on Monday, November 10 • Reminder: Submit medical record contact information to HMS • Instructions Packet will be distributed shortly • Plans will be given 12 weeks to submit medical records

  12. OPERATIONS UPDATES

  13. OPERATIONS CSSC Operations Holiday Closings: • Thursday, November 27th • Friday, November 28th Please note: • The Front-End Risk Adjustment System (FERAS) will be available during this time for RAPS submissions.

  14. TECHNICAL ASSISTANCE UPDATES

  15. TECHNICAL ASSISTANCE UPDATES Next User Group Meeting December 17, 2008

  16. QUESTIONS & ANSWERS

  17. CLOSING

  18. 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 • Lateefah Hughes (RADV) lateefah.hughes@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com

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