1. Risk Adjustment User Group
March 2010

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

3. Introduction
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 2010 monthly Risk Adjustment User Group dates are posted on 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
PAYMENT PROCESS

8. PAYMENT PROCESS Post transition 100% resolved in December 2009
81% resolved in January 2010
73% resolved in February 2010

9. PAYMENT PROCESS Question –
Will CMS be eliminating the use of Evaluation and Management Consultation CPT codes for Medicare Providers?

10. Data Validation
DATA VALIDATION

11. DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008)
Deadline for submission of corrective medical records and attestations was Sept. 16, 2009.
Medical Record Receipt Reports distributed in January.

12. DATA VALIDATION CY 2007 Targeted RADV - Important Dates
Plans Notified of Stage Assignment
MAOs Received Encrypted CD w/Contract-Specific Data
Deadline for Submission of Coversheets, Attestations, and Medical Records*
Stage I
Oct. 23, 2009
Nov. 10, 2009
Feb. 9, 2010
Stage II
Nov. 13, 2009
Nov. 19, 2009
Feb. 18, 2010
Stage III
Dec. 4, 2009
Dec. 10, 2009
March 11, 2010
* Submission Deadline is 11:59 p.m. Eastern

13. DATA VALIDATION CY 2008 National RADV
Deadline for submission of medical records (medical records, coversheets, and attestations) is March 12, 2010.
Plans may submit medical records via VPN, electronic media (e.g., USB, CD, DVD), fax, or hardcopy.

14. DATA VALIDATION CY 2007 Targeted & CY 2008 National RADV Tips
CMS-generated attestation
Will only be accepted for physician/outpatient medical records.
Will be accepted if filled out completely as directed.
Should accompany the related record.
Do not alter or edit the CMS-generated attestation.
May provide the treating physician with:
A sample completed attestation; and
A cover note identifying the date of service requiring attestation.
Plan-generated attestations will not be accepted.

15. DATA VALIDATION CY 2007 Targeted & CY 2008 National Tips
Requests for medical records—ensure that:
Providers receive all information needed to comply; and
Your complete request is received by the intended recipient—CMS contacted by multiple providers who receive incomplete medical record requests and are unable to determine—
MA organization
Patient information
Specific date(s) of service required

16. DATA VALIDATION
General Reminder--Observe CMS Requirements to Submit Documentation
MA organizations must ensure confidentiality of beneficiary information when sending protected health information (PHI) and/or personal identifiable information (PII) contained in medical records, attestations, and coversheets.

17. DATA VALIDATION General Reminder (cont’d)
Do not submit any medical records via . This may compromise PHI and/or PII and will be reported to the CMS Security Division as described in Security and Privacy Reminders and Clarification of Reporting Procedures (12/16/2008 CPC memorandum, available on the CMS Health Plan Management System website).
All submitted medical records must comply with the medical record requirements set forth in the Instructions Packet.

18. Operations Updates
OPERATIONS UPDATES

19. OPERATIONS Frequently Asked Question
Q:    Does the file size limitation of 1 million records per day also apply to vendors?
A: The file size requirement applies to all submitters, including vendors. CMS is requesting files submitted for risk adjustment are limited to 1 million CCC (detail) records per day per submitter.

20. Technical Assistance updates

21. Questions & Answers
QUESTIONS & ANSWERS

22. closing
CLOSING

23. RESOURCES
Sean Creighton (Director, Division of Risk Adjustment & Payment Policy)
Henry Thomas (Training, Project Officer)
Louis Johnson (FERAS,GTL)
Chanda.McNeal (RAS Payment)
Payment Research
Jennifer Harlow (RADV)
Lateefah Hughes (RADV)
Mary Guy (RADV)
LTC -
CSSC -