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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 August 2009

  2. Welcome to the AugustUser 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 2008 monthly Risk Adjustment User Group Q & A, Notes, and Technical Assistance 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. 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 • Prior to transition • 38% response rate • Post transition • 100% resolved in May • 84% resolved in June • 95% resolved in July • Overall response rate since February 93%

  9. PAYMENT PROCESS FAQ -1 If an MA enrollee goes from hospice to non-hospice in the middle of the month, will the MA plan receive its full payment retroactive to the first of that month? 

  10. DATA VALIDATION

  11. DATA VALIDATION CY 2007 • Pilot RADV (notified June 20, 2008) • Selected MA organizations notified of Corrective Medical Record and Attestation Submission Process on July 31, 2009. Mailing included: • Instructions • Preliminary discrepancy report (fictitious data – real to follow) • Attestations and revised coversheets

  12. DATA VALIDATION CY 2007 • Pilot RADV (cont’d) • Teleconference held on Aug. 10, 2009 • Actual preliminary discrepant data was distributed on Aug. 17, 2009 • Deadline for submission of corrective medical records and attestations is Sept. 16, 2009 (4 weeks) • Technical assistance • Healthcare Management Solutions (CMS contractor) and CMS • Individual MA organization teleconference(s)

  13. DATA VALIDATION CY 2007 • National Sample (notified Dec. 3, 2008) • Analyses in progress • Targeted Sample (notified Nov. 10, 2008) • Instructions Packet with dataset forthcoming • Will provide information on the attestation, documentation dispute and appeals processes • CMS will provide advance notice and training to sampled plans • Upon receipt of sample data, plans will have 12 weeks to submit medical records & attestations • Random Sample • To be implemented

  14. OPERATIONS UPDATES

  15. OPERATIONS Frequently Asked Questions Q:    A plan is attempting to verify diagnosis codes that triggered HCCs for a recently enrolled beneficiary. The plan would like to verify the diagnosis codes submitted by the previous plan, what should the plan do to obtain this information? A: The plan should contact the previous plan to obtain information as it pertains to the newly enrolled beneficiary.

  16. OPERATIONS Upcoming Key Submission Date Initial Submission Deadline Sept.4, 2009 Plans will receive payment on January 1, 2010, for data submitted for dates of service July 1, 2008 through June 30, 2009, if, data is submitted by the initial submission deadline of September 4, 2009.

  17. TECHNICAL ASSISTANCE UPDATES

  18. TECHNICAL ASSISTANCE UPDATES Next User Group Meeting September 16, 2009

  19. QUESTIONS & ANSWERS

  20. CLOSING

  21. RESOURCES • Sean Creighton - (Director, Division Risk Adjustment Operations) 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 Jennifer.Harlow@cms.hhs.gov • Lateefah Hughes Lateefah.Hughes@cms.hhs.gov • Ann Marshall (RADV) Ann.marshall@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com