Risk Adjustment User Group June 2009

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 2008 monthly Risk Adjustment User Group Q & A and Notes 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

PAYMENT PROCESS

PAYMENT PROCESS Prior to transition 38% response rate Post transition 77% resolved in March 67% resolved in April 57% resolved in May

PAYMENT PROCESS CLARIFICATION Question: If a member transfers from another Medicare Advantage plan, can the current plan submit dates of service that pre-date the member’s eligibility in the new plan? Example: If a Member joins a MA Organization (Plan A) on August 1, 2007, can “Plan A” submit dates of service from January 2007 through July 2007, or only dates of service after August 1, 2007.

PAYMENT PROCESS Answer: Plans may only submit for beneficiaries who are enrolled in their plan on the DOS. If a beneficiary is not enrolled in the plan on the DOS included in the diagnosis cluster, the plan will receive a 408 and/or 409 error code on the RAPS reports. NOTE: Plan A can only submit a date with DOS after August 1, 2007

DATA VALIDATION

DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008) Analyses in progress National Sample (notified Dec. 3, 2008) Medical Record Review complete Targeted Sample (notified Nov. 10, 2008) Instructions Packet to be distributed Selected plans to be notified via email when packet is released Plans will have 12 weeks to submit medical records Random Sample To be implemented

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

OPERATIONS UPDATES

Operations Plans can now access the 2008 Risk Adjustment Participant Guide, Color Slides, Resource Guide, and the Job Aids on the CSSC Operations website at: http://www.csscoperations.com/new/usergroup/2008raps/participant-guide-publish_052909.pdf

OPERATIONS If experiencing technical problems submitting data, check the CSSC Operations website under the System Status page for messages and updates on the RAPS processing status: http://www.csscoperations.com/new/systemstatus/systemstatus.html

OPERATIONS Report Distribution Reports are sent to the mailbox as identified on the submitter application.

OPERATIONS Test Environment Submissions

TECHNICAL ASSISTANCE UPDATES

TECHNICAL ASSISTANCE UPDATES Next User Group Meeting July 15, 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 Lateefah Hughes (RADV) lateefah.hughes@cms.hhs.gov Ann Marshall (RADV) ann.marshall@cms.hhs.gov LTC www.tarsc.info CSSC www.csscoperation.com