Risk Adjustment User Group

transcript

A training initiative presented by

December 2009

A training initiative

presented by

Welcome to the DecemberUser Group

• Introduction

• Payment Process

• Data Validation

• Operations Update

• Questions and Answers

• Closing

presented by

INTRODUCTION

• 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

User Group Process

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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

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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

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PAYMENT PROCESS

• Payment research response rate:

• 95% resolved in September

• 72% resolved in October

• 79% resolved in November

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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

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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

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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.

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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.

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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.

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DATA VALIDATION

Plans Notified of Stage Assignment

MAOs Receive Encrypted CD w/Contract-Specific Data

Deadline for Submission of Coversheets, Attestations, and Medical Records*

Stage I Oct 23, 2009 Nov 10, 2009 Feb 9, 2010

Stage II Nov 13, 2009 Nov 19, 2009 Feb 18, 2010

Stage III Dec 4, 2009 Dec 10, 2009 Mar 11, 2010

* Submission Deadline is 11:59 p.m. Eastern

Targeted Sample Important Dates

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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.

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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.

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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.

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TECHNICAL ASSISTANCE UPDATES

Next User Group Meeting

January 20, 2010

presented by

• 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

RESOURCES

Risk Adjustment User Group

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