Transcript Welcome to the November User Group

2009/ 2010 Monthly
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Risk Adjustment
User Group
March 2010
Welcome to the March
User Group
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2010
Introduction
Payment Process
Data Validation
Operations Update
Questions and Answers
Closing
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INTRODUCTION
2010
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
2010
• 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.
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INTRODUCTION
2010
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
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PAYMENT PROCESS
2010
• Post transition
• 100% resolved in December 2009
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81% resolved in January 2010
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73% resolved in February 2010
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PAYMENT PROCESS
2010
Question –
Will CMS be eliminating the use of
Evaluation and Management
Consultation CPT codes for
Medicare Providers?
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DATA VALIDATION
2010
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
distributed in January.
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DATA VALIDATION
2010
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
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* Submission Deadline is 11:59 p.m. Eastern
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DATA VALIDATION
2010
CY 2008
• National RADV
– 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.
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DATA VALIDATION
2010
CY 2007 Targeted & CY 2008 National
RADV
• Tips
– CMS-generated attestation
• Will only be accepted for physician/outpatient
medical records.
• Will be accepted if filled out completely as directed.
• Should accompany the related record.
• Do not alter or edit the CMS-generated attestation.
• May provide the treating physician with:
– A sample completed attestation; and
– A cover note identifying the date of service requiring
attestation.
– Plan-generated attestations will not be
accepted.
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DATA VALIDATION
2010
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
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DATA VALIDATION
2010
• 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.
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DATA VALIDATION
2010
• 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.
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OPERATIONS
2010
Frequently Asked Question
Q: Does the file size limitation of 1
million records per day also apply to
vendors?
A: The file size requirement applies to
all submitters, including vendors. CMS is
requesting files submitted for risk
adjustment are limited to 1 million CCC
(detail) records per day per submitter.
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RESOURCES
2010
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Sean Creighton (Director, Division of 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]
Mary Guy (RADV)
[email protected]
LTC - www.tarsc.info
CSSC - www.csscoperations.com
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