1. Risk Adjustment User Group
August 2009

2. Welcome to the August 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
100% resolved in May
84% resolved in June
95% resolved in July
Overall response rate since February 93%

9. PAYMENT PROCESS
FAQ -1 If an MA enrollee goes from hospice to non-hospice in the middle of the month, will the MA plan receive its full payment retroactive to the first of that month?

10. DATA VALIDATION

11. DATA VALIDATION CY 2007 Pilot RADV (notified June 20, 2008)
Selected MA organizations notified of Corrective Medical Record and Attestation Submission Process on July 31, Mailing included:
Instructions
Preliminary discrepancy report (fictitious data – real to follow)
Attestations and revised coversheets

12. DATA VALIDATION CY 2007 Pilot RADV (cont’d)
Teleconference held on Aug. 10, 2009
Actual preliminary discrepant data was distributed on Aug. 17, 2009
Deadline for submission of corrective medical records and attestations is Sept. 16, 2009 (4 weeks)
Technical assistance
Healthcare Management Solutions (CMS contractor) and CMS
Individual MA organization teleconference(s)

13. DATA VALIDATION CY 2007 National Sample (notified Dec. 3, 2008)
Analyses in progress
Targeted Sample (notified Nov. 10, 2008)
Instructions Packet with dataset forthcoming
Will provide information on the attestation, documentation dispute and appeals processes
CMS will provide advance notice and training to sampled plans
Upon receipt of sample data, plans will have 12 weeks to submit medical records & attestations
Random Sample
To be implemented

14. OPERATIONS UPDATES

15. OPERATIONS Frequently Asked Questions
Q:    A plan is attempting to verify diagnosis codes that triggered HCCs for a recently enrolled beneficiary. The plan would like to verify the diagnosis codes submitted by the previous plan, what should the plan do to obtain this information?
A: The plan should contact the previous plan to obtain information as it pertains to the newly enrolled beneficiary.

16. OPERATIONS Upcoming Key Submission Date
Initial Submission Deadline Sept.4, 2009
Plans will receive payment on January 1, 2010, for data submitted for dates of service July 1, 2008 through June 30, 2009, if, data is submitted by the initial submission deadline of September 4, 2009.

17. TECHNICAL ASSISTANCE
UPDATES

18. TECHNICAL ASSISTANCE UPDATES
Next User Group Meeting
September 16, 2009

19. QUESTIONS & ANSWERS

20. CLOSING

21. 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