1. Risk Adjustment User Group
July 2009

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

3. INTRODUCTION

4. 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

5. INTRODUCTION
The 2008 monthly Risk Adjustment User Group Q & A, Notes, and Technical Assistance documents are posted at the CSSC Operations website.
Please continue to review the website for updates to this information.

6. 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:
for Payment Operations
for Data Validation

7. PAYMENT PROCESS

8. PAYMENT PROCESS Prior to transition 38% response rate Post transition
93% resolved in April
87% resolved in May
11% resolved in June

9. PAYMENT PROCESS
FAQ
The CMS press release state the 2010 MA rates reflect a provision requiring phase-out of the inclusion of costs of indirect medical education, with a maximum reduction of about 0.6% per year. Is this phase-out already incorporated into the county rate books for 2010, or is it an additional adjustment? If an additional adjustment is made, how can the plans estimate the impact of the inclusion costs?

10. DATA VALIDATION

11. DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008)
Analyses in progress
National Sample (notified Dec. 3, 2008)

12. DATA VALIDATION CY 2007 Targeted Sample (notified Nov. 10, 2008)
Instructions Packet to be distributed
Selected plans to be notified via when packet is released
Plans will have 12 weeks to submit medical records
Random Sample
To be implemented

13. OPERATIONS UPDATES

14. OPERATIONS Frequently Asked Questions
Q: Can MA Organizations submit denied claims?
A: Yes, information should be sent whether or not the claim is paid. But, if the MA Organization denies a claim due to inaccuracies in core data elements (i.e., from date, through date, diagnosis); the data should not be submitted until the correct information is verified.

15. OPERATIONS Frequently Asked Questions
Q: When submitting data for a beneficiary who was previously enrolled with another MA Organization, will the resulting report be returned to the current MA Organization or the previous MA Organization?
A: The reports will be returned to the current MA Organization or the new designated submitter who is submitting the data. However, the previous MA Organization/Submitter will continue to receive the reports on all data submitted prior to disenrollment.

16. TECHNICAL ASSISTANCE
UPDATES

17. TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting
August 19, 2009

18. QUESTIONS & ANSWERS

19. CLOSING

20. RESOURCES
Sean Creighton - (Director, Division Risk Adjustment Operations)
Henry Thomas – (Training, Project Officer)
Louis Johnson – (FERAS,GTL)
Chanda.McNeal – (RAS Payment)
Payment Research
Jennifer Harlow
Lateefah Hughes
Ann Marshall (RADV)
LTC
CSSC