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Risk Adjustment User Group

May 2010

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Welcome to the MayUser 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 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– Mary.guy@cms.hhs.gov for Data Validation

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PAYMENT PROCESS

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• Post transition

• 100% resolved in February 2010

• 96% resolved in March 2010

• 71% resolved in April 2010

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PAYMENT PROCESS

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• CMS-HCC Risk Adjustment Model for 2011– Reference the factors in the CMS-

HCC risk adjustment model from the 2009 Rate Announcement (published in April 2008). http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2009.pdf

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PAYMENT PROCESS

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• CMS-HCC ESRD Dialysis Risk Adjustment Model– Reference the factors in the CMS-

HCC ESRD risk adjustment model from the 2008 Rate Announcement (published in April 2007). http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2008.pdf

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PAYMENT PROCESS

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• CMS-RxHCC Risk Adjustment Model for 2011– CMS is implementing the new model in

2011.– Reference the factors in the CMS-RxHCC

risk adjustment model from the 2011 Rate Announcement (published in April 2010). http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2011.pdf

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PAYMENT PROCESS

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• Updates to model coefficients versus Diagnosis Code File.– The risk adjustment models are not

updated every year.– If there is an update to the diagnosis codes

used in the Risk Adjustment models, CMS updates the Diagnosis Code File annually in October. http://www.cms.gov/MedicareAdvtgSpecRateStats/06_Risk_adjustment.asp#TopOfP

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PAYMENT PROCESSFAQ

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• When will an age coefficient for a beneficiary change in a given year?  For example, a beneficiary enters a plan on January 1 at the age of 69 and on February 17 the beneficiary turns 70.

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DATA VALIDATION

• CY 2007 Targeted and CY 2008 National Sample - sample-specific reports – Two types (see April 2010 User Group slides

for description of each)

• Technical Assistance Report

• Medical Record Receipt Report

– CMS will release these reports to the plan-designated contacts (MCO and primary and secondary contacts)

– It is very important that MA organizations review and report any issues to the Intake Medical Record Review Contractor (IMRRC) as directed

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DATA VALIDATION

• CY 2008 Contract-Level Sample– MA organizations selected for this

sample will be notified– Notification will be sent to MAO

CEO and MCO– Training will be provided—

• In-person at CMS, and• Via Webinar

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DATA VALIDATION

• CY 2008 National Sample– MAOs notified of selection on Dec. 14,

2009– Under the Improper Payments Information

Act (IPIA), CMS must annually measure and report the Part C payment error rate to OMB

– A key component of the Part C payment error rate is payment error identified under RADV

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DATA VALIDATION

• RADV Mailbox – RADV@cms.hhs.gov– Mailbox recently established – MAOs may submit RADV questions to

this mailbox– Questions will be reviewed by the RADV

team and answered via this mailbox– Mary Guy and Carolyn Kapustij will be

answering general RADV questions

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Operations

2011 Calendar Year RAPS Submission Timetable

Dates of Service

Initial Submission Deadline

First Payment Date

Final Submission Deadline

July 1, 2009 – June 30, 2010

September 3, 2010 January 1, 2011 N/A

January 1, 2010 – December 31, 2010

March 4, 2011 July 1, 2011 January 31, 2012

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Operations

CSSC Operations will be closed in observance of

Memorial Day on Monday, May 31, 2010.

FERAS will be available to accept files during this period.

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TECHNICAL ASSISTANCE UPDATES

Next User Group Meeting

June 16, 2010

New participants can register to attend the UG session from the www.TARSC.info

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• Sean Creighton (Director, Division of 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• Mary Guy (RADV) mary.guy@cms.hhs.gov• LTC - www.tarsc.info• CSSC - www.csscoperations.com

RESOURCES