Risk Adjustment User Group

1. Risk Adjustment User Group July 2009

2. Welcome to the JulyUser Group • Introduction • Payment Process • Data Validation • 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, Notes, and Technical Assistance 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. INTRODUCTION 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: • Analyst@askriskadjustment.com for Payment Operations • ann.marshall@cms.hhs.gov for Data Validation

7. PAYMENT PROCESS

8. PAYMENT PROCESS • Prior to transition • 38% response rate • Post transition • 93% resolved in April • 87% resolved in May • 11% resolved in June

9. PAYMENT PROCESS • FAQ • The CMS press release state the 2010 MA rates reflect a provision requiring phase-out of the inclusion of costs of indirect medical education, with a maximum reduction of about 0.6% per year. Is this phase-out already incorporated into the county rate books for 2010, or is it an additional adjustment? If an additional adjustment is made, how can the plans estimate the impact of the inclusion costs?

10. DATA VALIDATION

11. DATA VALIDATION • CY 2007 • Pilot RADV (notified June 20, 2008) • Analyses in progress • National Sample (notified Dec. 3, 2008) • Analyses in progress

12. DATA VALIDATION • CY 2007 • Targeted Sample (notified Nov. 10, 2008) • Instructions Packet to be distributed • Selected plans to be notified via email when packet is released • Plans will have 12 weeks to submit medical records • Random Sample • To be implemented

13. OPERATIONS UPDATES

14. OPERATIONS Frequently Asked Questions Q: Can MA Organizations submit denied claims? A: Yes, information should be sent whether or not the claim is paid. But, if the MA Organization denies a claim due to inaccuracies in core data elements (i.e., from date, through date, diagnosis); the data should not be submitted until the correct information is verified.

15. OPERATIONS Frequently Asked Questions Q: When submitting data for a beneficiary who was previously enrolled with another MA Organization, will the resulting report be returned to the current MA Organization or the previous MA Organization? A: The reports will be returned to the current MA Organization or the new designated submitter who is submitting the data. However, the previous MA Organization/Submitter will continue to receive the reports on all data submitted prior to disenrollment.

16. TECHNICAL ASSISTANCE UPDATES

17. TECHNICAL ASSISTANCE UPDATES Next User Group Meeting August 19, 2009

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 • Louis Johnson – (FERAS,GTL) Louis.Johnson@cms.hhs.gov • Chanda.McNeal – (RAS Payment) Chanda.mcneal@cms.hhs.gov • Payment Research analyst@askriskadjustment.com • Jennifer Harlow Jennifer.Harlow@cms.hhs.gov • Lateefah Hughes Lateefah.Hughes@cms.hhs.gov • Ann Marshall (RADV) Ann.marshall@cms.hhs.gov • LTC www.tarsc.info • CSSC www.csscoperations.com