1. Risk Adjustment User Group
May 2008

2. Welcome to the May 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 Risk Adjustment Factor (Risk Score) HCC Models
CMS-HCC
RxHCC
ICD-9/HCCs
Demographic Factors
New Enrollee Factors

8. PAYMENT PROCESS Encounter Data Collection
Inpatient Prospective Payment System Proposed Rule

9. DATA VALIDATION

10. DATA VALIDATION Calendar Year 2007 Calendar Year 2006

11. OPERATIONS UPDATES

12. OPERATIONS
CSSC continues to receive inquiries after non-compliance letters are distributed via HPMS.
Plans receiving this notification generally exceed the 502-edit benchmark established by CMS. This benchmark is obtained by RAPS files that encountered a 502 edit.

13. Operations
CSSC understands this schedule of notification may cause some confusion, however plans can monitor their 502 edit activity by reviewing the RAPS Duplicate Diagnosis Cluster Report generated after every file submission.
This report is designed to only identify diagnosis clusters with 502 edit messages.
Inclusion of dates on the HPMS notification, which will identify the weeks the file exceeded the 502 benchmark, will be explored.

14. Operations
Please Note: CSSC Operations will be closed on Monday, May 26, 2008 in observance of Memorial Day.

15. TECHNICAL ASSISTANCE
UPDATES

16. TECHNICAL ASSISTANCE UPDATES
2008 Monthly
Technical Assistance Sessions
Enrollment & Payment Session
May 28th
Risk Adjustment Session
June 25th
Register today at

17. TECHNICAL ASSISTANCE UPDATES
Next User Group Session
June 11, 2008
Sessions held on Wednesdays
at 1:30 pm Eastern Standard Time

18. 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

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

20. QUESTIONS & ANSWERS

21. CLOSING

22. 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