Risk Adjustment User Group June 2010

Welcome to the June 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 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

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 RADV@cms.hhs.gov for Data Validation

PAYMENT PROCESS

PAYMENT PROCESS Post transition 100% resolved in March 2010 100% resolved in April 2010 90% resolved in May 2010

PAYMENT PROCESS Mid-Year Model Run for 2010 Payment in July 2010 Covers Dates of Service 1/1/09 – 12/31/09 Final Reconciliation for 2009 Payment in August 2010 1/1/08 – 12/31/08

PAYMENT PROCESS FAQ Question – How often does CMS update the beneficiary Risk Adjustment Factor Type (RAFT) and during what timeframes annually?

DATA VALIDATION

DATA VALIDATION CY 2007 Targeted Sample Technical Assistance Report: will soon be released TA Report will identify inconsistencies in date of service and/or provider type as well as other inconsistencies (e.g., obscured text). CMS will hold a teleconference to coincide with the distribution of TA Reports CMS will discuss: Format of the report Time period and requirements for plan response Importance of reviewing and reporting any issues to the IMRRC Date, time, and dial-in information will be forthcoming. TA Reports and teleconference information will be sent by the IMRRC (Healthcare Management Solutions) via email to CY 2007 Targeted Sample plan-designated contacts. A Medical Record Receipt Report will also be distributed.

DATA VALIDATION CY 2008 National Sample MAOs were 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 Medical Record Receipt Report Released on June 3, 2010 to CY 2008 National Sample plan-designated contacts (MCO and primary/secondary contacts) Deadline for response was June 8, 2010. Medical record review Is nearing completion, and CMS will analyze data.

DATA VALIDATION CY 2008 Contract-Level Sample MA organizations (MAOs) 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

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

OPERATIONS UPDATES

Operations CSSC Can Help With… Verification of acceptance on file submissions. Technical issues and problems encountered with the submission of risk adjustment data. Restoring Risk Adjustment Reports Verification of data, addressing problems, offering technical assistance, and developing action plans through the monitoring and review of the plans data..

Operations FAQ Q: Can the reconciliation payment date be included on the Annual Risk Adjustment Submission Timetable? A: Future reconciliation payment dates have not been determined; therefore, this information is not included on the submission timetable.

TECHNICAL ASSISTANCE UPDATES

TECHNICAL ASSISTANCE UPDATES Next User Group Meeting July 21, 2010 New participants can register to attend the UG session from the www.TARSC.info

QUESTIONS & ANSWERS

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 Jennifer Harlow (RADV) Jennifer.Harlow@cms.hhs.gov Lateefah Hughes (RADV) Lateefah.Hughes@cms.hhs.gov Mary Guy (RADV) mary.guy@cms.hhs.gov Payment Research analyst@askriskadjustment.com RADV Questions RADV@cms.hhs.gov CSSC www.csscoperations.com LTC www.tarsc.info