Risk Adjustment User Group March 2010

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

Introduction 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 2010 monthly Risk Adjustment User Group dates are posted on the CSSC Operations website. www.csscoperations.com/new/usergroup/usergroupinfo.html Please continue to review the website for updates to this information.

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

Payment Process PAYMENT PROCESS

PAYMENT PROCESS Post transition 100% resolved in December 2009 81% resolved in January 2010 73% resolved in February 2010

PAYMENT PROCESS Question – Will CMS be eliminating the use of Evaluation and Management Consultation CPT codes for Medicare Providers?

Data Validation DATA VALIDATION

DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008) Deadline for submission of corrective medical records and attestations was Sept. 16, 2009. Medical Record Receipt Reports distributed in January.

DATA VALIDATION CY 2007 Targeted RADV - Important Dates Plans Notified of Stage Assignment MAOs Received Encrypted CD w/Contract-Specific Data Deadline for Submission of Coversheets, Attestations, and Medical Records* Stage I Oct. 23, 2009 Nov. 10, 2009 Feb. 9, 2010 Stage II Nov. 13, 2009 Nov. 19, 2009 Feb. 18, 2010 Stage III Dec. 4, 2009 Dec. 10, 2009 March 11, 2010 * Submission Deadline is 11:59 p.m. Eastern

DATA VALIDATION CY 2008 National RADV Deadline for submission of medical records (medical records, coversheets, and attestations) is March 12, 2010. Plans may submit medical records via VPN, electronic media (e.g., USB, CD, DVD), fax, or hardcopy.

DATA VALIDATION CY 2007 Targeted & CY 2008 National RADV Tips CMS-generated attestation Will only be accepted for physician/outpatient medical records. Will be accepted if filled out completely as directed. Should accompany the related record. Do not alter or edit the CMS-generated attestation. May provide the treating physician with: A sample completed attestation; and A cover note identifying the date of service requiring attestation. Plan-generated attestations will not be accepted.

DATA VALIDATION CY 2007 Targeted & CY 2008 National Tips Requests for medical records—ensure that: Providers receive all information needed to comply; and Your complete request is received by the intended recipient—CMS contacted by multiple providers who receive incomplete medical record requests and are unable to determine— MA organization Patient information Specific date(s) of service required

DATA VALIDATION General Reminder--Observe CMS Requirements to Submit Documentation MA organizations must ensure confidentiality of beneficiary information when sending protected health information (PHI) and/or personal identifiable information (PII) contained in medical records, attestations, and coversheets.

DATA VALIDATION General Reminder (cont’d) Do not submit any medical records via email. This may compromise PHI and/or PII and will be reported to the CMS Security Division as described in Security and Privacy Reminders and Clarification of Reporting Procedures (12/16/2008 CPC memorandum, available on the CMS Health Plan Management System website). All submitted medical records must comply with the medical record requirements set forth in the Instructions Packet.

Operations Updates OPERATIONS UPDATES

OPERATIONS Frequently Asked Question Q:    Does the file size limitation of 1 million records per day also apply to vendors? A: The file size requirement applies to all submitters, including vendors. CMS is requesting files submitted for risk adjustment are limited to 1 million CCC (detail) records per day per submitter.

Technical Assistance updates

Questions & Answers QUESTIONS & ANSWERS

closing CLOSING

RESOURCES 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