Transcript Welcome to the November User Group

2008 / 2009 Monthly
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Risk Adjustment
User Group
February 2009
Welcome to the February
User Group
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2009
Introduction
Payment Process
Data Validation
Operations Update
Questions and Answers
Closing
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INTRODUCTION
2009
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
2009
• 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
• Please continue to review the
website for updates to this
information.
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PAYMENT PROCESS
2009
• Updates, February 2009 Payment
Issues
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DATA VALIDATION
2009
• CY 2007
– Pilot RADV (notified June 20, 2008)
• Analyses in progress
– Targeted RADV (notified Nov. 10, 2008)
• Instructions Packet to be distributed shortly
• Selected plans to be notified via email when
packet is released
• Plans will have 12 weeks to submit medical
records
– Random RADV
• To be implemented
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DATA VALIDATION
2009
• CY 2007 (cont’d)
• National Sample (notified December 3,
2008)
– Medical record submission deadline is
Friday, February 27th.
– CMS does not expect to extend the deadline.
– As indicated on the December 17th
teleconference, it is important that you submit
all requested records because:
• The data will be used to estimate a Risk Adjustment
Part C error rate for the Medicare Advantage
program that must be publicly reported; and
• Failure to respond may be taken into consideration
by CMS when selecting plans for the next cycle of
contract-level Risk Adjustment Data Validation.
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DATA VALIDATION
2009
• CY 2007 (cont’d)
– Submit your RADV-related questions:
• To Ann Marshall on the RADV team at
[email protected]
• By close of business the Friday before the
User Group call
– Contact Health Management Solutions (HMS)
for technical assistance and questions that
require an immediate response relating to
medical record submission.
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DATA VALIDATION
2009
• Signature Stamp Policy
– Stamped signatures are no longer acceptable
for provider documentation (Medicare
Program Integrity Manual, Transmittal 248,
Change Request 5971, 5550). CMS
implemented this policy retroactively.
– For purposes of Part C Risk Adjustment Data
Validation, we are applying an alternative
implementation date. Stamped signatures will
no longer be acceptable on medical records
with dates of service on or after January 1,
2009. Medical records with dates of service
in CY 2009 will impact CY 2010 payments.
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DATA VALIDATION
2009
• Medical Record Submission
– CMS’ contractor received several
packages that did not meet our criteria.
– Reminders:
» Complete only one coversheet for
each enrollee CMS-HCC.
» Do not submit multiple copies of the
same medical record.
» Do not intersperse coversheets with
unrelated medical record dates of
service.
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DATA VALIDATION
2009
• Medical Record Submission
– Do not highlight material in the
medical record to draw attention to it;
upon contractor scanning, it becomes
illegible text.
– Submit coversheets and medical
records to Melissa Sayre as directed
in your RADV Instructions. (Note fax
number is 1-866-779-8488).
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DATA VALIDATION
2009
• Submission Security Requirements
• If submitting medical records via:
– Virtual Private Network (VPN), contact
HMS as soon as possible to
» Obtain VPN User ID and password
» Conduct an IT-to-IT teleconference to
address system-to-system differences
(e.g., firewalls)
– Electronic media (USB, CD, DVD)
» Encrypt files
» If sending accompanying hardcopy PII
and/or PHI, send via USPS certified mail
with return receipt
» If sending only electronic media (i.e., no
hardcopy PII and/or PHI), may send via
commercial traceable carrier
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DATA VALIDATION
2009
• Submission Security Requirements
(cont’d)
• If submitting medical records via:
– Hardcopy
» Use tamper-proof packaging
» Mail via USPS certified mail with return
receipt
– Fax
» Coordinate a “test” with HMS in
advance of submitting PII and/or PHI
• Never submit PII and/or PHI by e-mail
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OPERATIONS: General Information
2009
• There are 57 new plans for 2009.
CSSC encourages new plans to
send in the necessary EDI
Agreement package if they have
not done so thus far. CMS expects
new plans to begin submitting
data by the end of March.
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Operations: Top most Front-End
Errors
2009
AAA Record:
• 113 – File name duplicates another File accepted within last 12
months.
BBB Record:
• 202 – Missing or invalid sequence number on BBB Record.
CCC Record:
• 311 - At least one diagnosis cluster required on transaction.
YYY Record:
• 263 – Plan Number does not match Plan Number in BBB Record.
ZZZ Record:
• 163 – The File ID does not match File ID on AAA Record.
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Operations: Top most RAPS Errors
Month of January 2009
2009
CCC Record:
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501 – (Informational Edit) Valid diagnosis but not a relevant
diagnosis for risk adjustment during this service period. (This
represents 62.04% of the total errors.)
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410 – Beneficiary is not enrolled in Plan on or after Service From
Date. (This represents 10.47% of the total errors.)
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408 – Service From date is not within MA enrollment period. (This
represents 9.37% of the total errors.)
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409 – Service Through date is not within MA enrollment period.
(This represents 8.65% of the total errors.)
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502 – Diagnosis cluster was accepted but not stored. A diagnosis
cluster with the same attributes is already stored in the RAPS
database. (This represents 2.94% of the total errors/)
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Operations: Most Common Question
2009
• When will the Sweep Occur?
– CMS does not release the sweep
date, until the sweep is completed.
However, CMS informs plans of the
final submission date and for 2007
data the final submission is January
31, 2009 for guaranteed inclusion in
the risk adjustment run.
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TECHNICAL ASSISTANCE
UPDATES
2009
Next User Group Meeting
March 18, 2009
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RESOURCES
2009
• Sean Creighton (Director, Division Risk
Adjustment Operations)
[email protected]
• Henry Thomas (Training, Project Officer)
[email protected]
• Louis Johnson (FERAS,GTL)
[email protected]
• Chanda McNeal (RAS Payment)
[email protected]
• Lateefah Hughes (RADV)
[email protected]
• LTC www.tarsc.info
• CSSC www.csscoperations.com
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