Risk Adjustment User Group Session 2006/2007 Monthly Risk Adjustment User Group Session A training initiative presented by SEPTEMBER 2007 1

Welcome to the September User Group Introduction Payment Process Data Validation Operations Update Training Update Questions and Answers Closing 2

INTRODUCTION 3

Introduction User Group Process All attendees must pre-register Panel will answer questions during the Q&A portion of the session Session will last for one hour Q&A document and session notes will be available within 2 weeks after the session Session slides will be available by the Tuesday before the session 4

PAYMENT PROCESS 5

Payment Process September Submission Deadline Submission Deadline – September 7, 2007 DOS – July 1, 2006 thru June 30, 2007 Payment Date – January 1, 2008 6

DATA VALIDATION 7

Data Validation Calendar Year 2006 August 17, 2007 was the medical record submission deadline Ascellon will continue to accept medical records until medical record log-in process is completed CMS-HCCs and RxHCCs with missing medical records: Represent a violation of 42 CFR § 422.310; AND Will be considered for payment adjustments Organizations must immediately submit any outstanding medical records 8

Data Validation (cont’d) Calendar Year 2005 Second Validation Contractor (SVC) completed its review of medical records Responses were received from organizations contacted by CMS to confirm physician data sources IVC and SVC medical record review results merged, and currently undergoing analysis and quality assurance CMS anticipates releasing results to selected organizations in the fall of 2007 9

Data Validation (cont’d) Calendar Year 2004 July 12, 2007: Disseminated plan-specific findings to MA organizations in the targeted sample August 29, 2007: Conducted teleconference to communicate the CY 2004 pre-reconciled medical record review national results Mid-October 2007: Anticipate mailing pre-reconciled findings to MA organizations with enrollees selected for the national sample 10

OPERATIONS UPDATE 11

General Information Stand-alone PDP Stand-alone PDP plans are not required to submit Risk Adjustment data. They are, however, required to submit prescription drug data Duplicate 502 Status August 2007 The percentage rate for all files received = 7.72% 12

TRAINING UPDATE 13

2007 Monthly Training Schedule Training Update 2007 Monthly Training Schedule Now Registering Enrollment and Payment Training September 25 Risk Adjustment Training September 26 14

2007 Monthly Training Schedule* *For detailed information Training Update 2007 Monthly Training Schedule* *For detailed information and to register online log on to www.medicaretraining.net 15

QUESTIONS AND ANSWERS 16

CLOSING 17

Resources Sean Creighton (Director, Division Risk Adjustment Operations) sean.creighton@cms.hhs.gov Henry Thomas (Training, Project Officer) henry.thomas@cms.hhs.gov Lateefah Hughes (Data Validation, Team Lead) lateefah.hughes@cms.hhs.gov Louis Johnson (FERAS, Risk Adjustment Coordination) louis.johnson@cms.hhs.gov Chanda McNeal (Payment Issues) chanda.mcneal@cms.hhs.gov LTC www.Medicaretraining.net CSSC www.csscoperations.com 18