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Risk Adjustment User Group

Risk Adjustment User Group. December 2009. Welcome to the December User Group. Introduction Payment Process Data Validation Operations Update 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 December 2009

  2. Welcome to the DecemberUser 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 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

  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 • ann.marshall@cms.hhs.gov for Data Validation

  7. PAYMENT PROCESS

  8. PAYMENT PROCESS • Payment research response rate: • 95% resolved in September • 72% resolved in October • 79% resolved in November

  9. PAYMENT PROCESS • Addendum to November Software Release • Application of MA coding intensity • CMS-HCC community and institutional aged/disabled • CMS-HCC aged/disabled new enrollee • CMS-HCC community and institutional post graft • CMS-HCC post graft new enrollee

  10. PAYMENT PROCESS • Addendum to November Software Release cont. • CMS will not apply the MA coding adjustment to the following: • CMS-HCC ESRD risk scores (including community, institutional, and new enrollee) • Transplant Score • Part D risk scores

  11. PAYMENT PROCESS • Submission Deadline • For final 2009 dates of service 2008 is January 31, 2010. Payment will be reflected in the August 2010 MMR. • Rerun • December 15, 2009 was the final deadline to request to delete data for dates of service 2005, 2006 and 2007.

  12. DATA VALIDATION

  13. DATA VALIDATION CY 2007 • Pilot RADV (notified June 20, 2008) • Deadline for submission of corrective medical records and attestations was September 16, 2009. • CMS and its contractor, HMS, have completed technical assistance activities. • Increased use of virtual private network (VPN) submissions. • Medical Record Receipt Reports will be distributed in December.

  14. DATA VALIDATION CY 2007 • Targeted Sample (notified November 10, 2008) • Selected MAOs received instruction packets for audit on October 19, 2009. • All MAOs in sample have received medical record request sample data. • MAOs have 12 weeks to submit medical records and attestations. • Training provided to MAOs on October 23, 2009. • Medical Record Receipt Reports will inform MAOs about medical record submissions to date.

  15. DATA VALIDATION Targeted Sample Important Dates * Submission Deadline is 11:59 p.m. Eastern

  16. DATA VALIDATION CY 2007 • Targeted Sample: Tips • Attestations • Provide the treating physician with a sample completed attestation. • Provide a cover note identifying the date of service requiring attestation. • Faxing requests for medical records • Ensure that providers have all information needed to comply. • Ensure that your complete fax is received by the intended recipient.

  17. OPERATIONS UPDATES

  18. OPERATIONS Frequently Asked Question Q:    A beneficiary recently enrolled in a plan, what information must the plan provide to the CSSC to perform a lookup of the diagnosis submitted by another plan for the specific beneficiary? A: The plan must provide the beneficiary HICN to retrieve this information.

  19. OPERATIONS CSSC Operations will be closed for observance of • Christmas Eve -Thursday, November 24, 2009 • Christmas Day - Friday, December 25, 2009 • New Years Day - Friday, January 1, 2010 Please note: The Front-End Risk Adjustment System (FERAS) will be available during this time for RAPS submissions.

  20. TECHNICAL ASSISTANCE UPDATES

  21. TECHNICAL ASSISTANCE UPDATES Next User Group Meeting January 20, 2010

  22. QUESTIONS & ANSWERS

  23. CLOSING

  24. RESOURCES • Sean Creighton (Director, 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 • Ann Marshall (RADV) Ann.marshall@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com

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