1. Risk Adjustment User Group
April 2008

2. Welcome to the April 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 Notes and Q & A documents will be posted at:
Please continue to review the CSSC website for updates to this information.

6. PAYMENT PROCESS

7. PAYMENT PROCESS
Announcement of Calendar Year (CY) 2009 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies
2009 Final Estimate of the Increase in the National Per Capita MA Growth Percentages
Recalibration of the CMS-HCC Model
Recalibrated Frailty Factors
Frailty Adjustment Transition for PACE
Normalization Factors
Budget Neutrality
ESRD Bidding and Payment
2007 CMS Audits
2009 Risk Adjustment Factors

8. PAYMENT PROCESS Notices:
Final (April 7, 2007):
Advance (February 22, 2008):

9. PAYMENT PROCESS
Risk scores and frailty posted to HPMS on Friday, April 11, 2008
Recalibrated Part C Risk Scores for Development of 2009 Bids
Frailty Factors for Development of Bids
Part C Current Model Risk Scores (FFS Normalized)
Part D Risk Scores for Development of 2009 Bids

10. DATA VALIDATION

11. DATA VALIDATION Calendar Year 2007
Sampling expected to begin April 2008
MA notification of selection in May/June 2008

12. DATA VALIDATION Calendar Year 2006
IVC and SVC medical record reviews are complete
Data analysis and quality assurance of the results are in progress

13. DATA VALIDATION Calendar Year 2005
March 6th: mailed risk adjustment data validation (RADV) findings to selected MA organizations
March 12th: held RADV teleconference
April 1st: released post-teleconference Q&A document

14. DATA VALIDATION Calendar Year 2005 (cont’d)
May 6th: Appeals submission deadline
May use sample appeals letter included in March 6th RADV Findings mailing
Submit questions as indicated in the RADV Findings mailing
Please “cc” CMS Project Officer when submitting appeals

15. OPERATIONS UPDATES

16. OPERATIONS
Should plans submit duplicate diagnosis clusters for the same date of service that overlap another submission?
There is no system limitation that would reject this type of scenario in the RAPS processing system.
However, please note that the diagnosis code will be counted only once towards your risk adjustment factor.

17. OPERATIONS To Illustrate:
1st diagnosis cluster submitted with DOS from 03/05/08 through 03/05/08.
2nd diagnosis cluster submitted with DOS from 03/05/08 through 03/15/08.
The RAPS system will accept both submissions.
Some plans ask why this scenario would not generate a 502 error.

18. OPERATIONS
CMS defines a duplicate diagnosis cluster as one that shares all of the following attributes and has been previously submitted and stored in the RAPS database.
HIC Number
Provider Type
From Date
Through Date
Diagnosis Code
The reason a 502 error would not be generated in the scenario presented is because the“through date” is different (assuming that all other attributes are the same).

19. TECHNICAL ASSISTANCE
UPDATES

20. TECHNICAL ASSISTANCE UPDATES
2008 Monthly
Technical Assistance Sessions
Risk Adjustment Session
April 30th
Enrollment & Payment Session
May 28th
Register today at

21. TECHNICAL ASSISTANCE UPDATES
Next User Group Session
May 14, 2008
Sessions held on Wednesdays
at 1:30 pm Eastern Standard Time

22. 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

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

24. QUESTIONS & ANSWERS

25. CLOSING

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