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A training initiative presented by 2008 / 2009 Monthly Risk Adjustment User Group August 2009
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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:– [email protected] for Payment
Operations– [email protected] 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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OPERATIONS
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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) [email protected]• Henry Thomas – (Training, Project Officer) [email protected]• Louis Johnson – (FERAS,GTL) [email protected]• Chanda.McNeal – (RAS Payment) [email protected]• Payment Research [email protected]• Jennifer Harlow [email protected]• Lateefah Hughes [email protected]• Ann Marshall (RADV) [email protected]• LTC www.tarsc.info• CSSC www.csscoperations.com
RESOURCES
