Risk Adjustment User Group August 2009

Welcome to the August 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 100% resolved in May 84% resolved in June 95% resolved in July Overall response rate since February 93%

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?

DATA VALIDATION

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

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)

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

OPERATIONS UPDATES

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.

OPERATIONS Upcoming Key Submission Date Initial Submission Deadline Sept.4, 2009 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.

TECHNICAL ASSISTANCE UPDATES

TECHNICAL ASSISTANCE UPDATES Next User Group Meeting September 16, 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