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Risk Adjustment User Group

Risk Adjustment User Group

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Risk Adjustment User Group

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  1. Risk Adjustment User Group October 2008

  2. Welcome to the OctoberUser Group • Introduction • Payment Process • 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 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 Monthly Membership Report Changes Effective January, 2008 Payment Default Risk Factor Codes (Field #23) (Values): 1=Default Enrollee-Aged/Disabled 2=Default Enrollee-ESRD Dialysis 3=Default Enrollee-ESRD Transplant Kidney (Month 1) 4=Default Enrollee-ESRD Transplant Kidney (Months 2-3) 5=Default Enrollee-ESRD Post Graph (Months 4-9) 6=Default Enrollee-ESRD Post Graph (Months 10+) RA Factor Type Code (Field #43) Changed to be consistent with Field 23.

  8. PAYMENT PROCESS Required ICD-9 Codes • Plans may submit any valid ICD-9 code from allowable sources. • Required ICD-9 Codes: - Model Codes -Non-Model Codes • http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/06_Risk_adjustment.asp#TopOfPage

  9. PAYMENT PROCESS Budget Neutrality Factor • Budget Neutrality Factor is calculated as the difference between payments under 100 % of the risk adjustment method (i.e., under the CMS-HCC Model) versus payment under 100 % of the demographic only method. • Phase Out of Budget Neutrality

  10. OPERATIONS UPDATES

  11. CSSC OPERATIONS Frequent Questions Submission Deadline • The final submission deadline for claims with dates of service 01/01/07 through 12/31/07 is 01/31/09. • Submit all outstanding claims. • Research errors, make possible corrections, and resubmit corrected data.

  12. CSSC OPERATIONS Frequent Questions Con’t. TEST Files • Test files can be submitted to ensure that the plan’s duplicate logic is appropriate. CMS asked to limit the size to 3,000 or less CCC records per file. Report Restores • When requesting a restored report, the following information is required: • Submitter Number • File ID • Date of Submission

  13. TECHNICAL ASSISTANCE UPDATES Next User Group Session November 19, 2008 Sessions held on Wednesdays at 1:30 pm Eastern Standard Time

  14. QUESTIONS & ANSWERS

  15. CLOSING

  16. RESOURCES • Sean Creighton (Director, Division Risk Adjustment Operations) sean.creighton@cms.hhs.gov • Henry Thomas (Contract, Project Officer) henry.thomas@cms.hhs.gov • Louis Johnson (CSSC, GTL) louis.johnson@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com