1. Risk Adjustment User Group
June 2008

2. Welcome to the June User Group
Introduction
Payment Process
Operations Update
Data Validation
Technical Assistance 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 and Notes documents are posted at the CSSC Operations website.
Please continue to review the website for updates to this information.

6. PAYMENT PROCESS

7. PAYMENT PROCESS Plan Payment Report (PPR)
Also known as the “Payment Letter”
The Automated Plan Payment System (APPS) produces the PPR
Itemizes final monthly payments to MCO, as part of the month-end process

8. PAYMENT PROCESS
Includes: Summarized Parts A/B and D payments, Adjustments, NMEC, COB, User Fees (Jan-Sep each year), Premium Settlement Information, monthly LIS Amounts, Identifies members with low-income cost sharing payment components, etc.
For further details review: Plan Communications User Guide, Ver 3.1 (April 18, 2008), Appendices, Section I, pages I-39 through I-43

9. PAYMENT PROCESS Budget Neutrality Factor YEAR Budget Neutrality % 2006
100
2007 55
2008 40
2009 25
2010 5
2011
Budget Neutrality Factor is calculated as the difference between payments under 100 % of the risk adjustment method (i.e., under the CMS-HCC Model) versus payment under 100 % of the demographic only method.
Phase Out of Budget Neutrality

10. DATA VALIDATION

11. DATA VALIDATION Calendar Year 2007 Calendar Year 2006

12. OPERATIONS UPDATES

13. OPERATIONS QUESTION: ANSWER:
The Medicare Advantage (MA) plan has a death certificate, but the provider continues to submit the encounter with the date of discharge after the date of death. How do we resolve this issue?
ANSWER:
If the date of discharge is after the date of death, then RAPS will reject the claim. Normally, MA plans may not change the date of discharge on an inpatient claim. However, in the circumstance that a hospital refuses to change the discharge date or through date to the date of death, then the MA may make this change.
Any other changes to the from and through dates must come from the hospital only (Reference: February, 2005 User Group Q&A, Data Submission, Question #4).

14. TECHNICAL ASSISTANCE
UPDATES

15. TECHNICAL ASSISTANCE UPDATES
2008 Monthly
Technical Assistance Sessions
Risk Adjustment Session
June 25th
Enrollment & Payment Session
July 30th
Register today at

16. TECHNICAL ASSISTANCE UPDATES
Next User Group Session
July 16, 2008
Sessions held on Wednesdays
at 1:30 pm Eastern Standard Time

17. 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

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

19. QUESTIONS & ANSWERS

20. CLOSING

21. RESOURCES
Sean Creighton (Director, Division Risk Adjustment Operations)
Henry Thomas (Training, Project Officer)
Lateefah Hughes (Data Validation, Team Lead)
Louis Johnson (FERAS,GTL)
Chanda McNeal (Payment Issues)
LTC
CSSC