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2006/2007 Monthly

2006/2007 Monthly. Risk Adjustment User Group Session. A training initiative presented by. MAY 2007. Welcome to the May User Group. Introduction Payment Process Data Validation Operations Update Training Update Questions and Answers Closing. INTRODUCTION. Introduction.

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2006/2007 Monthly

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  1. 2006/2007 Monthly Risk Adjustment User Group Session A training initiative presented by MAY 2007

  2. Welcome to the May User Group • Introduction • Payment Process • Data Validation • Operations Update • Training Update • Questions and Answers • Closing

  3. INTRODUCTION

  4. Introduction User Group Process • All attendees must pre-register. • Panel will answer questions during the Q&A portion of the session. • Session will last for one hour. • Q&A document and session notes will be available within 2 weeks after the session. • Session slides will be available by the Tuesday before the session.

  5. PAYMENT PROCESS

  6. Payment Process • 2007 Mid-Year Scheduled for July 2007 Payment • 2006 Final Scheduled for August Payment • 2004 and 2005 Reconciliation Model Output Reports (MOR) • 2005 and 2006 ESRD Reconciliation

  7. DATA VALIDATION

  8. Data Validation • Calendar Year 2006 • Sample selection in progress • Notification letter to selected MA organizations – no later than May 31, 2007 • Validation Selection Notification “test” email inadvertently sent to all MA organizations • The IVC, Ascellon Corporation, is currently testing its new form email system for this process • Email from tking@ascellon.com dated May 14, 2007 at 10:57 a.m. with subject line “THGFFF” was sent in error • Organizations are instructed to ignore the May 14th notification • Official notification will provide clarified subject line and definitive timeline

  9. Data Validation • Calendar Year 2005 • Medical record reviews are in progress • The second validation contractor (SVC) is in receipt of all discrepant medical records identified by the initial validation contractor (IVC) • CMS to contact certain MA organizations to request confirmation of provider credentials • Calendar Year 2004 • QA process completed • Plan-specific findings to be disseminated –June 2007 • Teleconference with MA organizations to communicate national results – July 2007

  10. OPERATIONS UPDATE

  11. Resolution to the Most Common Edits • 113 Duplicate File ID within last 12 months • Resolution: Check the AAA record field 2, position 4 through 9. Verify that the file ID being used has not been accepted in either 'TEST' or 'Production' within the last 12 months. • 311 At least one DX Cluster is required on transaction • Resolution: Check the CCC record, field 9 through 18, and ensure at least one diagnosis cluster is present. If error was received on the FERAS report, the error was performed on the first and last CCC record on each batch within the file. • 400 Missing/Invalid Provider-Type on CCC record • Resolution: Check the CCC record to ensure the correct provider type is present. If error was received on the FERAS report, the error was performed on the first and last CCC record on each batch within the file.

  12. Resolutions to RAPS Most Common Edits Eligibility Edits: 406 – Service From Date is not within Medicare Entitlement Period 407 – Service Through Date is not within Medicare Entitlement Period 408 – Service From Date is not within Plan’s enrollment period 409 – Service Through Date is not within Plan’s enrollment period 410 – Beneficiary is not enrolled in Plan on or after service from date Resolution: MA organizations can reduce the number of errors that are returned due to invalid eligibility by accessing MARx to determine eligibility and other demographic information. Implementing the following procedures can reduce time spent on resolving errors: Develop a monthly validation protocol verifying eligibility of plan’s enrollees. Program internal information systems that cross check MARx before submitting data to FERAS.

  13. TRAINING UPDATE

  14. Training Update MAKE YOUR HOTEL RESERVATIONS TODAY!!

  15. Training Update 2007 Regional Training Schedule* June 18 – 22, 2007 Chicago, IL June 25 – 27, 2007 Baltimore, MD August 7 – 9, 2007 Las Vegas, NV *Register online at www.medicaretraining.net

  16. QUESTIONS AND 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 • Lateefah Hughes (Data Validation, Team Lead) lateefah.hughes@cms.hhs.gov • Louis Johnson (FERAS, Risk Adjustment Coordination) louis.johnson@cms.hhs.gov • Chanda McNeal (Payment Issues) chanda.mcneal@cms.hhs.gov • LTC www.Medicaretraining.net • CSSC www.csscoperations.com

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