1. Risk Adjustment User Group
June 2010

2. Welcome to the June 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 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

8. PAYMENT PROCESS Post transition 100% resolved in March 2010
100% resolved in April 2010
90% resolved in May 2010

9. PAYMENT PROCESS Mid-Year Model Run for 2010 Payment in July 2010
Covers Dates of Service
1/1/09 – 12/31/09
Final Reconciliation for 2009
Payment in August 2010
1/1/08 – 12/31/08

10. PAYMENT PROCESS FAQ Question –
How often does CMS update the beneficiary Risk Adjustment Factor Type (RAFT) and during what timeframes annually?

11. DATA VALIDATION

12. DATA VALIDATION CY 2007 Targeted Sample
Technical Assistance Report: will soon be released
TA Report will identify inconsistencies in date of service and/or provider type as well as other inconsistencies (e.g., obscured text).
CMS will hold a teleconference to coincide with the distribution of TA Reports
CMS will discuss:
Format of the report
Time period and requirements for plan response
Importance of reviewing and reporting any issues to the IMRRC
Date, time, and dial-in information will be forthcoming.
TA Reports and teleconference information will be sent by the IMRRC (Healthcare Management Solutions) via to CY 2007 Targeted Sample plan-designated contacts.
A Medical Record Receipt Report will also be distributed.

13. DATA VALIDATION CY 2008 National Sample
MAOs were notified of selection on Dec. 14, 2009
Under the Improper Payments Information Act (IPIA), CMS must annually measure and report the Part C payment error rate to OMB
A key component of the Part C payment error rate is payment error identified under RADV
Medical Record Receipt Report
Released on June 3, 2010 to CY 2008 National Sample plan-designated contacts (MCO and primary/secondary contacts)
Deadline for response was June 8, 2010.
Medical record review
Is nearing completion, and CMS will analyze data.

14. DATA VALIDATION CY 2008 Contract-Level Sample
MA organizations (MAOs) selected for this sample will be notified
Notification will be sent to MAO CEO and MCO
Training will be provided—
In-person at CMS, and
Via Webinar

15. DATA VALIDATION RADV Mailbox – RADV@cms.hhs.gov
Mailbox recently established
MAOs may submit RADV questions to this mailbox
Questions will be reviewed by the RADV team and answered via this mailbox

16. OPERATIONS UPDATES

17. Operations CSSC Can Help With…
Verification of acceptance on file submissions.
Technical issues and problems encountered with the submission of risk adjustment data.
Restoring Risk Adjustment Reports
Verification of data, addressing problems, offering technical assistance, and developing action plans through the monitoring and review of the plans data..

18. Operations
FAQ
Q: Can the reconciliation payment date be included on the Annual Risk Adjustment Submission Timetable?
A: Future reconciliation payment dates have not been determined; therefore, this information is not included on the submission timetable.

19. TECHNICAL ASSISTANCE
UPDATES

20. TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting
July 21, 2010
New participants can register to attend the UG session from the

21. QUESTIONS & ANSWERS

22. 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)
Jennifer Harlow (RADV)
Lateefah Hughes (RADV)
Mary Guy (RADV)
Payment Research
RADV Questions
CSSC
LTC