Transcript Welcome to the November User Group

2009/ 2010 Monthly
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Risk Adjustment
User Group
June 2010
Welcome to the June
User Group
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2010
Introduction
Payment Process
Data Validation
Operations Update
Questions and Answers
Closing
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Introduction
2010
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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
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PAYMENT PROCESS
2010
• Post transition
• 100% resolved in March 2010
• 100% resolved in April 2010
• 90% resolved in May 2010
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PAYMENT PROCESS
2010
Mid-Year Model Run for 2010
Payment in July 2010
Covers Dates of Service
1/1/09 – 12/31/09
Final Reconciliation for 2009
Payment in August 2010
Covers Dates of Service
1/1/08 – 12/31/08
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PAYMENT PROCESS
FAQ
2010
Question –
How often does CMS update
the beneficiary Risk Adjustment
Factor Type (RAFT) and during
what timeframes annually?
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Data Validation
2010
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DATA VALIDATION
2010
• CY 2007 Targeted Sample
– Technical Assistance Report: will soon be
released
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TA Report will identify inconsistencies in date of service
and/or provider type as well as other inconsistencies (e.g.,
obscured text).
• CMS will hold a teleconference to coincide with the
distribution of TA Reports
– CMS will discuss:
» Format of the report
» Time period and requirements for plan response
» Importance of reviewing and reporting any issues to the IMRRC
– Date, time, and dial-in information will be forthcoming.
• TA Reports and teleconference information will be sent by
the IMRRC (Healthcare Management Solutions) via email
to CY 2007 Targeted Sample plan-designated contacts.
• A Medical Record Receipt Report will also be distributed.
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DATA VALIDATION
2010
CY 2008 National Sample
MAOs were notified of selection on Dec. 14,
2009
Under the Improper Payments Information Act (IPIA),
CMS must annually measure and report the Part C
payment error rate to OMB
A key component of the Part C payment error rate is
payment error identified under RADV
Medical Record Receipt Report
Released on June 3, 2010 to CY 2008 National Sample
plan-designated contacts (MCO and primary/secondary
contacts)
Deadline for response was June 8, 2010.
Medical record review
Is nearing completion, and CMS will analyze data.
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DATA VALIDATION
2010
• CY 2008 Contract-Level Sample
– MA organizations (MAOs) selected
for this sample will be notified
– Notification will be sent to MAO
CEO and MCO
– Training will be provided—
• In-person at CMS, and
• Via Webinar
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DATA VALIDATION
2010
• RADV Mailbox – [email protected]
– Mailbox recently established
– MAOs may submit RADV questions to
this mailbox
– Questions will be reviewed by the RADV
team and answered via this mailbox
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Operations updates
2010
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Operations
2010
CSSC Can Help With…
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Verification of acceptance on file
submissions.
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Technical issues and problems encountered
with the submission of risk adjustment data.
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Restoring Risk Adjustment Reports
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Verification of data, addressing problems,
offering technical assistance, and developing
action plans through the monitoring and
review of the plans data..
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Operations
2010
FAQ
Q: Can the reconciliation payment date be
included on the Annual Risk Adjustment
Submission Timetable?
A: Future reconciliation payment dates have
not been determined; therefore, this
information is not included on the submission
timetable.
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Technical Assistance
Updates
2010
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TECHNICAL
ASSISTANCE UPDATES
2010
Next User Group Meeting
July 21, 2010
New participants can register
to attend the UG session
from the www.TARSC.info
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Questions & Answers
2010
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Closing
2010
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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]
Jennifer Harlow (RADV)
[email protected]
Lateefah Hughes (RADV)
[email protected]
Mary Guy (RADV)
[email protected]
Payment Research [email protected]
RADV Questions [email protected]
CSSC www.csscoperations.com
LTC www.tarsc.info
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