Risk Adjustment User Group April 2009

Welcome to the April 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 and Notes 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

PAYMENT PROCESS

PAYMENT PROCESS Prior to transition 38% response rate Post transition 73% resolved in March 67% resolved in February

PAYMENT PROCESS Question 1 Where can plans locate the coefficients for the CMS-HCC End-Stage Renal Disease Model, the CMS-HCC Community Model, and the CMS-HCC Institutional Model for payment years 2008 and 2009? 8

PAYMENT PROCESS Question 2 What does the risk score mean on the Part C Risk Adjustment Model Output Report (MOR) for a given month? 9

PAYMENT PROCESS 2010 Advanced Notice Frailty Adjustment Normalization Factors Budget Neutrality Adjustment for MA Coding Pattern Differences ESRD Payments IME Phase Out Network Areas for PFFS Plans in Plan Year 2011 Continuation of Clinical Trial Policy Adjustment to FFS Per Capita Costs for VA-DOD costs Calculation and Source of MSP Factors

PAYMENT PROCESS Notices: Final (April 7, 2008): http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2009.pdf Advance (February 20, 2009): http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/Downloads/Advance2010.pdf Expected release 2010 Final Notice April 2009

DATA VALIDATION

DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008) Analyses in progress Targeted RADV (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 RADV To be implemented

DATA VALIDATION CY 2007 (cont’d) National Sample (notified December 3, 2008) Medical record submission deadline was Friday, February 27th A plan-specific Tracking Report that confirms medical records and coversheets received has been released to plan-designated contacts Please review the Tracking Report for inconsistencies and notify HMS as instructed

DATA VALIDATION CY 2007 (cont’d) Submit your RADV-related questions to Ann Marshall on the RADV team at ann.marshall@cms.hhs.gov 15 15

OPERATIONS UPDATES

Operations: Reports Overview FERAS - Provides the status of accepted or rejected of submitted files, and identifies the rationale for the rejections. RAPS Return File - Contains the entire submitted transactions, and identifies the 300, 400, and 500 level errors. RAPS Transaction Error Report - Identifies errors found in CCC records during the RAPS processing cycle. Displays only 300, 400, and 500 level error codes RAPS Transaction Summary Report - Summarizes all transaction submitted.

Operations: Reports Overview Reports cont. RAPS Monthly Plan Activity Report – Provides the monthly summary of submitted transactions, which are stratified by Submitter ID and Plan Number. RAPS Cumulative Plan Activity Report - Contains monthly cumulative list of transactions, which are stratified by Submitter ID and Plan Number RAPS Monthly Error Frequency Report – Provides the monthly summary of all errors in the files that were submitted in test and/or production. RAPS Quarterly Error Frequency Report - Provides the quarterly summary of all errors on all files that were submitted within a 3-month period

TECHNICAL ASSISTANCE UPDATES

TECHNICAL ASSISTANCE UPDATES Next User Group Meeting May 20, 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 Payment Research analyst@askriskadjustment.com Lateefah Hughes (RADV) lateefah.hughes@cms.hhs.gov Ann Marshall (RADV) ann.marshall@cms.hhs.gov LTC www.tarsc.info CSSC www.csscoperations.com