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2006/2007 Monthly

2006/2007 Monthly. Risk Adjustment User Group Session. A training initiative presented by. OCTOBER 2007. Welcome to the October 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 OCTOBER 2007

  2. Welcome to the October 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 • Medicaid Eligibility • 2008 Initial Year Sweep Date • September 21, 2007 • 2009 Payment • Original Reason for Entitlement (OREC) Values

  7. DATA VALIDATION

  8. Data Validation Calendar Year 2006 • August 17, 2007 was the Medical record submission deadline • MA organizations must immediately submit any outstanding medical records • Missing medical records • Represent a violation of 42 CFR § 422.310 AND • Will be considered for payment adjustments

  9. Data Validation(cont’d) Calendar Year 2005 • IVC and SVC medical record review results merged • Data undergoing analysis and quality assurance • CMS anticipates distributing results to selected organizations in late fall of 2007

  10. Data Validation(cont’d) Calendar Year 2004 • Mid to late October 2007 • Anticipate mailing pre-reconciled findings to MA organizations with enrollees selected for the national sample

  11. OPERATIONS UPDATE

  12. Submission Deadline • Next submission deadline for dates of service 01/01/2006 through 12/31/2006: • January 31, 2008 • Submit all outstanding claims • Research and correct errors that can be corrected • Resubmit

  13. Error Codes For the last quarter (July – Aug – Sept), the highest percentage of error codes were: 408 = 5.66% 409 = 5.23% 410 = 8.67% 408 – Service From Date is not within MA organization enrollment period. 409 – Service Through Date is not within MA organization enrollment period. 410 – Beneficiary is not enrolled in plan on or after Service From Date.

  14. TRAINING UPDATE

  15. Training Update October 2007 Training Now Registering • Enrollment and Payment Training • October 30 • Risk Adjustment Training • October 31

  16. Training Update 2007/2008 Monthly Training Schedule* *For detailed information and to register online log on to www.medicaretraining.net

  17. QUESTIONS AND ANSWERS

  18. CLOSING

  19. 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) raf_payment_questions@cms.hhs.gov • LTC www.Medicaretraining.net • CSSC www.csscoperations.com

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