1. Risk Adjustment User Group Session
2006/2007 Monthly
Risk Adjustment User Group Session
A training initiative presented by
JANUARY 2007 1

2. Welcome to the January User Group
Introduction
Payment Process
Data Validation
Operations Update
Training Update
Questions and Answers
Closing 2

3. INTRODUCTION 3

4. Introduction User Group Process: All attendees must pre-register.
Panel will entertain questions during the Q&A portion of the session.
Sessions will run for 60 minutes.
Q&A document and session notes will be available within 2 weeks after the session.
Session slides will be available by the Tuesday prior to the session. 4

5. PAYMENT PROCESS 5

6. Payment Process 2006 Reconciliation Payment Deadline Dates of Service
January 31, 2007
Dates of Service
January 2005 through December 2005 6

7. DATA VALIDATION 7

8. Data Validation Calendar Year 2005 December 2006 January 2007
Coders began medical record review
Plans with <95% medical record response rate received a verification from IPRO
January 2007
Coders continue medical record review 8

9. Data Validation (cont’d)
Calendar Year 2004
– Late January: Expect completion of QA to confirm medical record review results.
– Late February: Anticipate communicating results to selected MA organizations. 9

10. OPERATIONS UPDATE 10

11. Who Should Submit RAPS Data?
Risk Plans (Also known as Coordinate Care Plans (CCP) and Health Maintenance Organizations (HMO)
COST
HCPP
PACE (Program for the All Inclusive Care of the Elderly)
PFFS (Private Fee for Service Plans)
PPO (Preferred Provider Organizations)
RPPO (Regional Preferred Provider Organizations)
PSO (Provider Sponsored Organizations)
DEMO (Demonstration Projects)
DEMP (PPO Demos, that is demonstration projects using the PPO model)
DEMC (Cost Demos, that is demonstration projects using a cost payment scheme) 11

12. Who Should Submit RAPS Data? (cont’d)
SNP (Special Needs Plans)
RFB (Religious Fraternal Benefit) Plans
MSA (Medical Savings Account) Plans
Reference: Medicare Advantage Manual Publication ; Chapter 1 (General Provisions) 12

13. Requesting Reports From CSSC
The processing systems (FERAS and RAPS) send reports to the submitter’s mailbox where they remain for 14 days. The systems automatically delete reports from the mailbox after 14 days, but MA organizations can request restored reports through the Customer Service and Support Center (CSSC) at
When requesting a restored report, the following information is required:
Submitter Number
File ID
Date of Submission 13

14. 502 Error Rates 14

15. TRAINING UPDATE 15

16. 2007 Monthly Training Schedule
Training Update
2007 Monthly Training Schedule
Enrollment and Payment Training
March 27, 2007
April 24, 2007
Risk Adjustment Training
March 28, 2007
April 25, 2007 16

17. QUESTIONS AND ANSWERS 17

18. CLOSING 18

19. Resources Sean Creighton (Director) sean.creighton@cms.hhs.gov
Henry Thomas (Training, Project Officer)
Lateefah Hughes (Data Validation, Team Lead)
Thomas Kornfield (Risk Adjustment Model)
Louis Johnson (FERAS, Risk Adjustment Coordination)
Chanda McNeal (Payment Issues)
LTC
CSSC 19