Risk Adjustment User Group

1. Risk Adjustment User Group November 2007

2. Welcome to the November User Group 2007 / 2008 • Introduction • Payment Issues • Operations Update • Data Validation • Training Update • Questions and Answers • Closing

3. INTRODUCTION

4. INTRODUCTION User Group Process • All attendees must pre-register • Panel will answer questions during the Q&A portion of the session • Session will last for one hour • Q&A document and session notes will be available within 2 weeks after the session • Session slides will be available by the Tuesday before the session

5. PAYMENT PROCESS

6. PAYMENT PROCESS • 2007 Final Year Sweep Date • January 31, 2008 • New Risk Adjustment Scores • ICD-9 codes for 2009 Payment • Medicaid Eligibility Update • Frailty Scores for 2008 • Admission Diagnosis

7. DATA VALIDATION

8. DATA VALIDATION Calendar Year 2006 • Medical record reviews are in progress • Medical records will not be accepted after Friday November 16, 2007 • Missing medical records • Represent a violation of 42 CFR 422.310; and • Will be considered for payment adjustment.

9. DATA VALIDATION Calendar Year 2005 • IVC and SVC medical record review results are undergoing analysis and quality assurance • CMS anticipates distributing results to selected organizations in January 2008

10. DATA VALIDATION Calendar Year 2004 • October 24 • MA organizations with enrollees in the national sample received their pre-reconciliation medical record review findings • For questions, please contact Chanda McNeal at chanda.mcneal@cms.hhs.gov.

11. OPERATIONS UPDATE

12. Submission Deadline • The final submission deadline for claims with dates of service 01/01/2006 through 12/31/2006 is 01/31/2008. • Submit all outstanding claims • Research errors, make possible corrections and resubmit corrected data • CMS is currently reviewing monthly submission data for 2006 to identify organizations that appear to have low data submissions

13. CSSC OPERATIONS UPDATES 502 Edit • Overall average rate for all files submitted during the month of October was 3.06%. Reminder • The week of 11/11/2007, CMS will suspend processing of all RAPS and PDE files due to routine scheduled maintenance. Files will be held for processing at FERAS/PDFS until after 11/19/2007. Plans may also choose to hold their files until after 11/19/2007 for submission.

14. CSSC OPERATIONS UPDATES • Week of 11/19/07: • Non-Compliance letters will be issued for all RAPS files received during the following weeks • Week ending 10/19/07 • Week ending 10/26/07 • Week ending 11/02/07 • Week ending 11/09/07

15. TRAINING UPDATE

16. TRAINING UPDATE 2007 Monthly Training Now Registering • Enrollment and Payment Training • November 27 • Risk Adjustment Training • December 19

17. TRAINING UPDATE *For detailed information and to register online log on to www.medicaretraining.net

18. QUESTIONS & ANSWERS

19. CLOSING

20. RESOURCES • Sean Creighton (Director, Division Risk Adjustment Operations) sean.creighton@cms.hhs.gov • Henry Thomas (Training, Project Officer) henry.thomas@cms.hhs.gov • Lateefah Hughes (Data Validation, Team Lead) lateefah.hughes@cms.hhs.gov • Louis Johnson (FERAS, Risk Adjustment Coordination) louis.johnson@cms.hhs.gov • Chanda McNeal (Payment Issues) raf_payment_questions@cms.hhs.gov • LTC www.Medicaretraining.net • CSSC www.csscoperations.com