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Risk Adjustment User Group

Risk Adjustment User Group. April 2008. Welcome to the April User Group. Introduction Payment Process Operations Update Data Validation Technical Assistance Update Questions and Answers Closing. INTRODUCTION. INTRODUCTION. User Group Process. All attendees must pre-register

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Risk Adjustment User Group

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  1. Risk Adjustment User Group April 2008

  2. Welcome to the AprilUser Group • Introduction • Payment Process • Operations Update • Data Validation • Technical Assistance 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 Notes and Q & A documents will be posted at: www.csscoperations.com. • Please continue to review the CSSC website for updates to this information.

  6. PAYMENT PROCESS

  7. PAYMENT PROCESS • Announcement of Calendar Year (CY) 2009 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies • 2009 Final Estimate of the Increase in the National Per Capita MA Growth Percentages • Recalibration of the CMS-HCC Model • Recalibrated Frailty Factors • Frailty Adjustment Transition for PACE • Normalization Factors • Budget Neutrality • ESRD Bidding and Payment • 2007 CMS Audits • 2009 Risk Adjustment Factors

  8. PAYMENT PROCESS • Notices: • Final (April 7, 2007): http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/Downloads/Announcement2009.pdf • Advance (February 22, 2008):http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/Downloads/Advance2009.pdf

  9. PAYMENT PROCESS • Risk scores and frailty posted to HPMS on Friday, April 11, 2008 • Recalibrated Part C Risk Scores for Development of 2009 Bids • Frailty Factors for Development of 2009 Bids • Part C Current Model Risk Scores (FFS Normalized) • Part D Risk Scores for Development of 2009 Bids

  10. DATA VALIDATION

  11. DATA VALIDATION • Calendar Year 2007 • Sampling expected to begin April 2008 • MA notification of selection in May/June 2008

  12. DATA VALIDATION • Calendar Year 2006 • IVC and SVC medical record reviews are complete • Data analysis and quality assurance of the results are in progress

  13. DATA VALIDATION • Calendar Year 2005 • March 6th: mailed risk adjustment data validation (RADV) findings to selected MA organizations • March 12th: held RADV teleconference • April 1st: released post-teleconference Q&A document

  14. DATA VALIDATION • Calendar Year 2005 (cont’d) • May 6th: Appeals submission deadline • May use sample appeals letter included in March 6th RADV Findings mailing • Submit questions as indicated in the RADV Findings mailing • Please “cc” CMS Project Officer when submitting appeals

  15. OPERATIONS UPDATES

  16. OPERATIONS • Should plans submit duplicate diagnosis clusters for the same date of service that overlap another submission? • There is no system limitation that would reject this type of scenario in the RAPS processing system. • However, please note that the diagnosis code will be counted only once towards your risk adjustment factor.

  17. OPERATIONS To Illustrate: • 1st diagnosis cluster submitted with DOS from 03/05/08 through 03/05/08. • 2nd diagnosis cluster submitted with DOS from 03/05/08 through 03/15/08. • The RAPS system will accept both submissions. • Some plans ask why this scenario would not generate a 502 error.

  18. OPERATIONS CMS defines a duplicate diagnosis cluster as one that shares all of the following attributes and has been previously submitted and stored in the RAPS database. • HIC Number • Provider Type • From Date • Through Date • Diagnosis Code The reason a 502 error would not be generated in the scenario presented is because the“through date” is different (assuming that all other attributes are the same).

  19. TECHNICAL ASSISTANCE UPDATES

  20. TECHNICAL ASSISTANCE UPDATES 2008 Monthly Technical Assistance Sessions • Risk Adjustment Session • April 30th • Enrollment & Payment Session • May 28th Register today at www.tarsc.info

  21. TECHNICAL ASSISTANCE UPDATES Next User Group Session May 14, 2008 Sessions held on Wednesdays at 1:30 pm Eastern Standard Time

  22. REGIONAL TECHNICAL ASSISTANCE SESSIONS Registration Is Now Open! CHICAGO, IL August 11 – August 14 LAS VEGAS, NV August 26 – August 29 NEW ORLEANS, LA September 9 – September 10

  23. TECHNICAL ASSISTANCE UPDATES *For detailed information and to register online log on to www.tarsc.info Technical Assistance Registration Service Center

  24. QUESTIONS & ANSWERS

  25. CLOSING

  26. 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.tarsc.info • CSSC www.csscoperations.com

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