Risk Adjustment User Group July 2009

Welcome to the July User Group Introduction Payment Process Data Validation Operations Update Questions and Answers Closing

INTRODUCTION

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

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

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

PAYMENT PROCESS

PAYMENT PROCESS Prior to transition 38% response rate Post transition 93% resolved in April 87% resolved in May 11% resolved in June

PAYMENT PROCESS FAQ The CMS press release state the 2010 MA rates reflect a provision requiring phase-out of the inclusion of costs of indirect medical education, with a maximum reduction of about 0.6% per year. Is this phase-out already incorporated into the county rate books for 2010, or is it an additional adjustment? If an additional adjustment is made, how can the plans estimate the impact of the inclusion costs?

DATA VALIDATION

DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008) Analyses in progress National Sample (notified Dec. 3, 2008)

DATA VALIDATION CY 2007 Targeted Sample (notified Nov. 10, 2008) Instructions Packet to be distributed Selected plans to be notified via email when packet is released Plans will have 12 weeks to submit medical records Random Sample To be implemented

OPERATIONS UPDATES

OPERATIONS Frequently Asked Questions Q: Can MA Organizations submit denied claims? A: Yes, information should be sent whether or not the claim is paid. But, if the MA Organization denies a claim due to inaccuracies in core data elements (i.e., from date, through date, diagnosis); the data should not be submitted until the correct information is verified.

OPERATIONS Frequently Asked Questions Q: When submitting data for a beneficiary who was previously enrolled with another MA Organization, will the resulting report be returned to the current MA Organization or the previous MA Organization? A: The reports will be returned to the current MA Organization or the new designated submitter who is submitting the data. However, the previous MA Organization/Submitter will continue to receive the reports on all data submitted prior to disenrollment.

TECHNICAL ASSISTANCE UPDATES

TECHNICAL ASSISTANCE UPDATES Next User Group Meeting August 19, 2009

QUESTIONS & ANSWERS

CLOSING

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