Transcript Welcome to the November User Group

2007 / 2008 Monthly
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Risk Adjustment
User Group
April 2008
Welcome to the April
User Group
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Introduction
Payment Process
Operations Update
Data Validation
Technical Assistance Update
Questions and Answers
Closing
2007 / 2008
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INTRODUCTION
2007 / 2008
User Group Process
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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
2007 / 2008
• The 2008 monthly Risk Adjustment
User Group Notes and Q & A
documents will be posted at:
www.csscoperations.com.
• Please continue to review the
CSSC website for updates to this
information.
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PAYMENT PROCESS
2007 / 2008
A. Announcement of Calendar Year (CY) 2009
Medicare Advantage Capitation Rates and
Medicare Advantage and Part D Payment
Policies
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• 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
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PAYMENT PROCESS
2007 / 2008
B. Notices:
• Final (April 7, 2007):
http://www.cms.hhs.gov/MedicareAd
vtgSpecRateStats/Downloads/Annou
ncement2009.pdf
• Advance (February 22, 2008):
http://www.cms.hhs.gov/MedicareAd
vtgSpecRateStats/Downloads/Advan
ce2009.pdf
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PAYMENT PROCESS
2007 / 2008
• 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
2009 Bids
– Part C Current Model Risk Scores
(FFS Normalized)
– Part D Risk Scores for Development of
2009 Bids
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DATA VALIDATION
2007 / 2008
• Calendar Year 2007
– Sampling expected to begin
April 2008
– MA notification of selection in
May/June 2008
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DATA VALIDATION
2007 / 2008
• Calendar Year 2006
– IVC and SVC medical record
reviews are complete
– Data analysis and quality
assurance of the results are in
progress
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DATA VALIDATION
2007 / 2008
• Calendar Year 2005
– March 6th: mailed risk adjustment
data validation (RADV) findings to
selected MA organizations
– March 12th: held RADV
teleconference
– April 1st: released postteleconference Q&A document
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DATA VALIDATION
2007 / 2008
• 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
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OPERATIONS
2007 / 2008
• 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.
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OPERATIONS
2007 / 2008
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.
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OPERATIONS
2007 / 2008
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.
1. HIC Number
2. Provider Type
3. From Date
4. Through Date
5. 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).
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TECHNICAL ASSISTANCE
UPDATES
2007 / 2008
2008 Monthly
Technical Assistance Sessions
• Risk Adjustment Session
– April 30th
• Enrollment & Payment Session
– May 28th
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Register today at
www.tarsc.info
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TECHNICAL ASSISTANCE
UPDATES
2007 / 2008
Next User Group Session
May 14, 2008
Sessions held on Wednesdays
at 1:30 pm Eastern Standard Time
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REGIONAL TECHNICAL
ASSISTANCE SESSIONS
2007 / 2008
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
2007 / 2008
• Sean Creighton (Director, Division Risk
Adjustment Operations)
[email protected]
• Henry Thomas (Training, Project Officer)
[email protected]
• Lateefah Hughes (Data Validation, Team
Lead) [email protected]
• Louis Johnson (FERAS, Risk Adjustment
Coordination) [email protected]
• Chanda McNeal (Payment Issues)
[email protected]
• LTC www.tarsc.info
• CSSC www.csscoperations.com
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