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

Welcome to the January 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 entertain questions during the Q&A portion of the session. Sessions will run for 60 minutes. Q&A document and session notes will be available within 2 weeks after the session. Session slides will be available by the Tuesday prior to the session. 4

PAYMENT PROCESS 5

Payment Process 2006 Reconciliation Payment Deadline Dates of Service January 31, 2007 Dates of Service January 2005 through December 2005 6

DATA VALIDATION 7

Data Validation Calendar Year 2005 December 2006 January 2007 Coders began medical record review Plans with <95% medical record response rate received a verification email from IPRO January 2007 Coders continue medical record review 8

Data Validation (cont’d) Calendar Year 2004 – Late January: Expect completion of QA to confirm medical record review results. – Late February: Anticipate communicating results to selected MA organizations. 9

OPERATIONS UPDATE 10

Who Should Submit RAPS Data? Risk Plans (Also known as Coordinate Care Plans (CCP) and Health Maintenance Organizations (HMO) COST HCPP PACE (Program for the All Inclusive Care of the Elderly) PFFS (Private Fee for Service Plans) PPO (Preferred Provider Organizations) RPPO (Regional Preferred Provider Organizations) PSO (Provider Sponsored Organizations) DEMO (Demonstration Projects) DEMP (PPO Demos, that is demonstration projects using the PPO model) DEMC (Cost Demos, that is demonstration projects using a cost payment scheme) 11

Who Should Submit RAPS Data? (cont’d) SNP (Special Needs Plans) RFB (Religious Fraternal Benefit) Plans MSA (Medical Savings Account) Plans Reference: Medicare Advantage Manual Publication 100-16; Chapter 1 (General Provisions) 12

Requesting Reports From CSSC The processing systems (FERAS and RAPS) send reports to the submitter’s mailbox where they remain for 14 days. The systems automatically delete reports from the mailbox after 14 days, but MA organizations can request restored reports through the Customer Service and Support Center (CSSC) at 1-877-534-2772. When requesting a restored report, the following information is required: Submitter Number File ID Date of Submission 13

502 Error Rates 14

TRAINING UPDATE 15

2007 Monthly Training Schedule Training Update 2007 Monthly Training Schedule Enrollment and Payment Training March 27, 2007 April 24, 2007 Risk Adjustment Training March 28, 2007 April 25, 2007 16

QUESTIONS AND ANSWERS 17

CLOSING 18

Resources Sean Creighton (Director) 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 Thomas Kornfield (Risk Adjustment Model) thomas.kornfield@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 19