Transcript Welcome to the November User Group
A training initiative presented by
Risk Adjustment User Group
May 2008
Welcome to the May User Group
2 • Introduction • Payment Process • Operations Update • Data Validation • Technical Assistance Update • Questions and Answers • Closing
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INTRODUCTION User Group Process
4 • 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
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INTRODUCTION
• The 2008 monthly Risk Adjustment User Group Q & A and Notes documents are posted at the CSSC Operations website.
www.csscoperations.com/new/usergroup/usergroupinfo.html
5 • Please continue to review the website for updates to this information.
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PAYMENT PROCESS
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Risk Adjustment Factor (Risk Score)
• HCC Models – CMS-HCC – RxHCC • ICD-9/HCCs • Demographic Factors • New Enrollee Factors
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PAYMENT PROCESS
Encounter Data Collection
• Inpatient Prospective Payment System Proposed Rule
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DATA VALIDATION
• Calendar Year 2007 • Calendar Year 2006 • Calendar Year 2005
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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.
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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.
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Operations
• Please Note: CSSC Operations will be closed on Monday, May 26, 2008 in observance of Memorial Day.
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TECHNICAL ASSISTANCE UPDATES
2008 Monthly Technical Assistance Sessions
16 • Enrollment & Payment Session – May 28 th • Risk Adjustment Session – June 25 th
Register today at www.tarsc.info
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TECHNICAL ASSISTANCE UPDATES
Next User Group Session
June 11, 2008
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Sessions held on Wednesdays at 1:30 pm Eastern Standard Time A training initiative presented by
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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
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TECHNICAL ASSISTANCE UPDATES
2007 / 2008 *For detailed information
and to
register online
log on to
www.tarsc.info
Technical Assistance Registration Service Center
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RESOURCES
22 • Sean Creighton (Director, Division Risk Adjustment Operations) [email protected]
• Henry Thomas (Training, Project Officer) [email protected]
• Lateefah Hughes (Data Validation, Team Lead) • LTC • CSSC [email protected]
• Louis Johnson (FERAS,GTL) [email protected]
• Chanda McNeal (Payment Issues) [email protected]
www.tarsc.info
www.csscoperations.com
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