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Risk Adjustment User Group

Welcome to the May User Group meeting with updates on payment process, operations, data validation, technical assistance, and Q&A. Stay informed and interact with industry experts.

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Risk Adjustment User Group

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Presentation Transcript

  1. Risk Adjustment User Group May 2008

  2. Welcome to the MayUser Group • Introduction • Payment Process • Operations Update • Data Validation • Technical Assistance 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 Risk Adjustment Factor(Risk Score) • HCC Models • CMS-HCC • RxHCC • ICD-9/HCCs • Demographic Factors • New Enrollee Factors

  8. PAYMENT PROCESS Encounter Data Collection • Inpatient Prospective Payment System Proposed Rule

  9. DATA VALIDATION

  10. DATA VALIDATION • Calendar Year 2007 • Calendar Year 2006 • Calendar Year 2005

  11. OPERATIONS UPDATES

  12. OPERATIONS • CSSC continues to receive inquiries after non-compliance letters are distributed via HPMS. • Plans receiving this notification generally exceed the 502-edit benchmark established by CMS. This benchmark is obtained by RAPS files that encountered a 502 edit.

  13. Operations • CSSC understands this schedule of notification may cause some confusion, however plans can monitor their 502 edit activity by reviewing the RAPS Duplicate Diagnosis Cluster Report generated after every file submission. • This report is designed to only identify diagnosis clusters with 502 edit messages. • Inclusion of dates on the HPMS notification, which will identify the weeks the file exceeded the 502 benchmark, will be explored.

  14. Operations • Please Note: CSSC Operations will be closed on Monday, May 26, 2008 in observance of Memorial Day.

  15. TECHNICAL ASSISTANCE UPDATES

  16. TECHNICAL ASSISTANCE UPDATES 2008 Monthly Technical Assistance Sessions • Enrollment & Payment Session • May 28th • Risk Adjustment Session • June 25th Register today at www.tarsc.info

  17. TECHNICAL ASSISTANCE UPDATES Next User Group Session June 11, 2008 Sessions held on Wednesdays at 1:30 pm Eastern Standard Time

  18. REGIONAL TECHNICAL ASSISTANCE SESSIONS Registration Is Now Open! CHICAGO, IL August 11 – August 14 LAS VEGAS, NV August 26 – August 29 NEW ORLEANS, LA September 9 – September 10

  19. TECHNICAL ASSISTANCE UPDATES *For detailed information and to register online log on to www.tarsc.info Technical Assistance Registration Service Center

  20. QUESTIONS & ANSWERS

  21. CLOSING

  22. RESOURCES • Sean Creighton (Director, Division Risk Adjustment Operations) sean.creighton@cms.hhs.gov • Henry Thomas (Training, Project Officer) henry.thomas@cms.hhs.gov • Lateefah Hughes (Data Validation, Team Lead) lateefah.hughes@cms.hhs.gov • Louis Johnson (FERAS,GTL) louis.johnson@cms.hhs.gov • Chanda McNeal (Payment Issues) raf_payment_questions@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com

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