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

Welcome to the October 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 Medicaid Eligibility 2008 Initial Year Sweep Date September 21, 2007 2009 Payment Original Reason for Entitlement (OREC) Values 6

DATA VALIDATION 7

Data Validation Calendar Year 2006 August 17, 2007 was the Medical record submission deadline MA organizations must immediately submit any outstanding medical records Missing medical records Represent a violation of 42 CFR § 422.310 AND Will be considered for payment adjustments 8

Data Validation (cont’d) Calendar Year 2005 IVC and SVC medical record review results merged Data undergoing analysis and quality assurance CMS anticipates distributing results to selected organizations in late fall of 2007 9

Data Validation (cont’d) Calendar Year 2004 Mid to late October 2007 Anticipate mailing pre-reconciled findings to MA organizations with enrollees selected for the national sample 10

OPERATIONS UPDATE 11

Submission Deadline Next submission deadline for dates of service 01/01/2006 through 12/31/2006: January 31, 2008 Submit all outstanding claims Research and correct errors that can be corrected Resubmit 12

Error Codes For the last quarter (July – Aug – Sept), the highest percentage of error codes were: 408 = 5.66% 409 = 5.23% 410 = 8.67% 408 – Service From Date is not within MA organization enrollment period. 409 – Service Through Date is not within MA organization enrollment period. 410 – Beneficiary is not enrolled in plan on or after Service From Date. 13

TRAINING UPDATE 14

Training Update Enrollment and Payment Training October 2007 Training Now Registering Enrollment and Payment Training October 30 Risk Adjustment Training October 31 15

2007/2008 Monthly Training Schedule* *For detailed information Training Update 2007/2008 Monthly Training Schedule* *For detailed information and to register online log on to www.medicaretraining.net 16

QUESTIONS AND ANSWERS 17

CLOSING 18

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) raf_payment_questions@cms.hhs.gov LTC www.Medicaretraining.net CSSC www.csscoperations.com 19