Risk Adjustment User Group May 2008

Welcome to the May User Group Introduction Payment Process Operations Update Data Validation Technical Assistance 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 Risk Adjustment Factor (Risk Score) HCC Models CMS-HCC RxHCC ICD-9/HCCs Demographic Factors New Enrollee Factors

PAYMENT PROCESS Encounter Data Collection Inpatient Prospective Payment System Proposed Rule

DATA VALIDATION

DATA VALIDATION Calendar Year 2007 Calendar Year 2006

OPERATIONS UPDATES

OPERATIONS CSSC continues to receive inquiries after non-compliance letters are distributed via HPMS. Plans receiving this notification generally exceed the 502-edit benchmark established by CMS. This benchmark is obtained by RAPS files that encountered a 502 edit.

Operations CSSC understands this schedule of notification may cause some confusion, however plans can monitor their 502 edit activity by reviewing the RAPS Duplicate Diagnosis Cluster Report generated after every file submission. This report is designed to only identify diagnosis clusters with 502 edit messages.   Inclusion of dates on the HPMS notification, which will identify the weeks the file exceeded the 502 benchmark, will be explored.

Operations Please Note: CSSC Operations will be closed on Monday, May 26, 2008 in observance of Memorial Day.

TECHNICAL ASSISTANCE UPDATES

TECHNICAL ASSISTANCE UPDATES 2008 Monthly Technical Assistance Sessions Enrollment & Payment Session May 28th Risk Adjustment Session June 25th Register today at www.tarsc.info

TECHNICAL ASSISTANCE UPDATES Next User Group Session June 11, 2008 Sessions held on Wednesdays at 1:30 pm Eastern Standard Time

REGIONAL TECHNICAL ASSISTANCE SESSIONS Registration Is Now Open! CHICAGO, IL August 11 – August 14 LAS VEGAS, NV August 26 – August 29 NEW ORLEANS, LA September 9 – September 10

TECHNICAL ASSISTANCE UPDATES *For detailed information and to register online log on to www.tarsc.info Technical Assistance Registration Service Center

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 Lateefah Hughes (Data Validation, Team Lead) lateefah.hughes@cms.hhs.gov Louis Johnson (FERAS,GTL) louis.johnson@cms.hhs.gov Chanda McNeal (Payment Issues) raf_payment_questions@cms.hhs.gov LTC www.tarsc.info CSSC www.csscoperations.com