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Risk Adjustment User Group

August 2009

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Welcome to the AugustUser Group

• Introduction

• Payment Process

• Data Validation

• Operations Update

• Questions and Answers

• Closing

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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 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

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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

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%

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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? 

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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

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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)

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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

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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.

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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.

Upcoming Key Submission Date Initial Submission Deadline Sept.4, 2009

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TECHNICAL ASSISTANCE UPDATES

Next User Group Meeting

September 16, 2009

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• 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

RESOURCES