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Risk Adjustment User Group

Risk Adjustment User Group. October 2008. Welcome to the October User Group. Introduction Payment Process Operations Update Questions and Answers Closing. INTRODUCTION. INTRODUCTION. User Group Process. All attendees must pre-register It is only necessary to register once

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Risk Adjustment User Group

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  1. Risk Adjustment User Group October 2008

  2. Welcome to the OctoberUser Group • Introduction • Payment Process • Operations Update • Questions and Answers • Closing

  3. INTRODUCTION

  4. INTRODUCTION User Group Process • 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

  5. INTRODUCTION • The 2008 monthly Risk Adjustment User Group Q & A and Notes documents are posted at the CSSC Operations website. • Please continue to review the website for updates to this information. www.csscoperations.com/new/usergroup/usergroupinfo.html

  6. PAYMENT PROCESS

  7. PAYMENT PROCESS Monthly Membership Report Changes Effective January, 2008 Payment Default Risk Factor Codes (Field #23) (Values): 1=Default Enrollee-Aged/Disabled 2=Default Enrollee-ESRD Dialysis 3=Default Enrollee-ESRD Transplant Kidney (Month 1) 4=Default Enrollee-ESRD Transplant Kidney (Months 2-3) 5=Default Enrollee-ESRD Post Graph (Months 4-9) 6=Default Enrollee-ESRD Post Graph (Months 10+) RA Factor Type Code (Field #43) Changed to be consistent with Field 23.

  8. PAYMENT PROCESS Required ICD-9 Codes • Plans may submit any valid ICD-9 code from allowable sources. • Required ICD-9 Codes: - Model Codes -Non-Model Codes • http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/06_Risk_adjustment.asp#TopOfPage

  9. PAYMENT PROCESS Budget Neutrality Factor • Budget Neutrality Factor is calculated as the difference between payments under 100 % of the risk adjustment method (i.e., under the CMS-HCC Model) versus payment under 100 % of the demographic only method. • Phase Out of Budget Neutrality

  10. OPERATIONS UPDATES

  11. CSSC OPERATIONS Frequent Questions Submission Deadline • The final submission deadline for claims with dates of service 01/01/07 through 12/31/07 is 01/31/09. • Submit all outstanding claims. • Research errors, make possible corrections, and resubmit corrected data.

  12. CSSC OPERATIONS Frequent Questions Con’t. TEST Files • Test files can be submitted to ensure that the plan’s duplicate logic is appropriate. CMS asked to limit the size to 3,000 or less CCC records per file. Report Restores • When requesting a restored report, the following information is required: • Submitter Number • File ID • Date of Submission

  13. TECHNICAL ASSISTANCE UPDATES Next User Group Session November 19, 2008 Sessions held on Wednesdays at 1:30 pm Eastern Standard Time

  14. QUESTIONS & ANSWERS

  15. CLOSING

  16. RESOURCES • Sean Creighton (Director, Division Risk Adjustment Operations) sean.creighton@cms.hhs.gov • Henry Thomas (Contract, Project Officer) henry.thomas@cms.hhs.gov • Louis Johnson (CSSC, GTL) louis.johnson@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com

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