Transcript Welcome to the November User Group

2009/ 2010 Monthly
A training initiative
presented by
Risk Adjustment
User Group
January 2010
Welcome to the January
User Group
•
•
•
•
•
•
2009
Introduction
Payment Process
Data Validation
Operations Update
Questions and Answers
Closing
A training initiative
presented by
2
2009
A training initiative
presented by
3
INTRODUCTION
2009
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
4
A training initiative
presented by
INTRODUCTION
2009
• The 2010 monthly Risk Adjustment
User Group dates are posted on the
CSSC Operations website.
www.csscoperations.com/new/usergroup/usergroupinfo.html
• Please continue to review the
website for updates to this
information.
A training initiative
presented by
5
INTRODUCTION
2009
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:
– [email protected] for Payment
Operations
– [email protected] for Data Validation
6
A training initiative
presented by
2009
A training initiative
presented by
7
PAYMENT PROCESS
2009
Payment Research Response
Rate
• 100% resolved in October
•
96% resolved in November
•
85% resolved in December
A training initiative
presented by
8
PAYMENT PROCESS
2009
Question –
Why doesn’t the MOR show all
HCCs accepted by RAPS for a
beneficiary?
A training initiative
presented by
9
2009
A training initiative
presented by
10
DATA VALIDATION
2009
CY 2007
• Pilot RADV (notified June 20, 2008)
– Deadline for submission of corrective
medical records and attestations was
Sept. 16, 2009.
– Medical Record Receipt Reports
• Distribution did not occur in December
• CMS will soon release these reports to
selected MA organizations.
A training initiative
presented by
11
DATA VALIDATION
2009
CY 2007
• Targeted RADV (notified Nov.10,
2008)
– Selected MAOs received—
• Instructions packet for audit on Oct. 19, 2009
• Training on Oct. 23, 2009
– CMS will soon distribute
• Technical Assistance Reports to help with
addressing potential issues with the medical
record documentation which may impact
medical record review findings for your plan
• Medical Record Receipt Reports to inform
MAOs about medical record submissions to
date.
12
A training initiative
presented by
DATA VALIDATION
2009
CY 2007
• Targeted RADV - Important Dates
Plans Notified
of Stage
Assignment
MAOs
Received
Encrypted CD
w/ContractSpecific Data
Deadline for
Submission of
Coversheets,
Attestations,
and Medical
Records*
Stage I
Oct. 23, 2009
Nov. 10, 2009
Feb. 9, 2010
Stage II
Nov. 13, 2009
Nov. 19, 2009
Feb. 18, 2010
Dec. 10, 2009
March 11, 2010
Stage III Dec. 4, 2009
A training initiative
* Submission Deadline is 11:59 p.m. Eastern
13
presented by
DATA VALIDATION
2009
CY 2008
• National RADV (notified Dec. 14,
2009)—under the Improper Payments and
Information Act (IPIA), CMS must annually
measure and report the Part C payment error
rate
– CMS recently completed its analysis, reporting a 15.4
percent Part C national error rate for payment year 2007
• CMS will report a Part C payment error rate for 2008
at the end of fiscal year 2010
• CMS requests plans’ best efforts to assist in
correcting and improving payment error.
A training initiative
presented by
14
DATA VALIDATION
2009
CY 2008
• National RADV (cont’d)
– Contact Information Sheets were completed by MA
organizations via electronic entry process.
– Instructions and enrollee data files were distributed by
traceable carrier to Primary Contacts on Dec. 17, 2009.
– Teleconference for selected MA organizations in this
sample was held on Dec. 18, 2009.
– Deadline for submission of medical records (medical
records, coversheets, and attestations) is March 12,
2010.
• Plans may submit medical records via VPN,
electronic media (e.g., USB, CD, DVD), fax, or
hardcopy.
A training initiative
presented by
15
DATA VALIDATION
2009
CY 2007 Targeted & CY 2008 National
RADV
• Tips
– Attestations—provide the treating
physician with:
• A sample completed attestation; and
• A cover note identifying the date of service
requiring attestation.
A training initiative
presented by
16
DATA VALIDATION
2009
CY 2007 Targeted & CY 2008 National
• Tips
– Requests for medical records—
ensure that:
• Providers receive all information needed to
comply; and
• Your complete request is received by the
intended recipient—CMS contacted by multiple
providers who receive incomplete medical
record requests and are unable to determine—
– MA organization
– Patient information
– Specific date(s) of service required.
A training initiative
presented by
17
DATA VALIDATION
2009
• General Reminder--Observe CMS
Requirements to Submit
Documentation
– MA organizations must ensure confidentiality of
beneficiary information when sending protected
health information (PHI) and/or personal
identifiable information (PII) contained in medical
records, attestations, and coversheets.
A training initiative
presented by
18
DATA VALIDATION
2009
• General Reminder (cont’d)
– Do not submit any medical records via email. This
may compromise PHI and/or PII and will be
reported to the CMS Security Division as
described in Security and Privacy Reminders and
Clarification of Reporting Procedures (12/16/2008
CPC memorandum, available on the CMS Health
Plan Management System website).
– All submitted medical records must comply with
the medical record requirements set forth in the
Instructions Packet.
A training initiative
presented by
19
2009
A training initiative
presented by
20
OPERATIONS
2009
Important Message Regarding Edit 501
Risk Adjustment plans will no longer receive
informational edit 501 (Valid diagnosis but not
relevant diagnosis for Risk Adjustment during this
service period).
CMS has determined that Error Code 501 is not valid
in the current Risk Adjustment environment and will
be retired January 1, 2010.
Please contact CSSC Operations for further
assistance at 1-877-534-2772.
A training initiative
presented by
21
OPERATIONS
2009
RAPS Deadline Reminder
• As a reminder, the deadline for
submission of Calendar Year 2008 data
(1/1/08 through 12/31/08) is January
31, 2010. This deadline date occurs on
a Sunday.
• To ensure sufficient time to edit
discrepancies in submitted 2008 data,
CMS is suggesting submitting your
2008 data by close of business Friday,
January 29, 2010.
22
A training initiative
presented by
OPERATIONS
2009
• Frequently Asked Question
• Q: How frequently are RAPS Return
file Reports delivered to the submitters
inbox?
•
A: RAPS Return Files are delivered
to the submitter the next business day
following submission.
A training initiative
presented by
23
2009
A training initiative
presented by
24
TECHNICAL ASSISTANCE
UPDATES
2009
Next User Group Meeting
February 17, 2010
New participants can register
to attend the UG session
from the www.TARSC.info
A training initiative
presented by
25
2009
A training initiative
presented by
26
2009
A training initiative
presented by
27
RESOURCES
2009
•
•
•
•
•
•
•
•
•
•
Sean Creighton (Director, Risk Adjustment Payment Policy)
[email protected]
Henry Thomas (Training, Project Officer)
[email protected]
Louis Johnson (FERAS,GTL)
[email protected]
Chanda.McNeal (RAS Payment)
[email protected]
Payment Research
[email protected]
Jennifer Harlow (RADV)
[email protected]
Lateefah Hughes (RADV)
[email protected]
Ann Marshall (RADV)
[email protected]
LTC
www.tarsc.info
CSSC
www.csscoperations.com
A training initiative
presented by