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Risk Adjustment User Group - March 2009

Welcome to the March User Group! This session will cover topics such as payment process, data validation, and operations updates. Register in advance and remember to keep your unique PIN for all sessions.

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Risk Adjustment User Group - March 2009

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  1. Risk Adjustment User Group March 2009

  2. Welcome to the MarchUser 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 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 • Payment Research Updates

  8. DATA VALIDATION

  9. DATA VALIDATION • CY 2007 • Pilot RADV (notified June 20, 2008) • Analyses in progress • Targeted RADV (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 RADV • To be implemented

  10. DATA VALIDATION • CY 2007 (cont’d) • National Sample (notified December 3, 2008) • Medical record submission deadline was Friday, February 27th • A plan-specific Tracking Report that confirms medical records and coversheets received will be released to plan-designated contacts • Please review the Tracking Report for inconsistencies and notify HMS as instructed

  11. DATA VALIDATION CY 2007 (cont’d) Lessons Learned Use CMS-Cover Provider Letters furnished for each sample Furnish medical record documentation that corresponds to the date(s) of service and provider type entered on the coversheet If submitting an inpatient medical record, submit the entire medical record Submit hard copy materials that contain protected health information (PHI) or personal identifiable information (PII) only via U.S. Postal Service Do not submit PHI and/or PII via e-mail unless encrypted Submission by virtual private network (VPN) was very successful and efficient 11

  12. DATA VALIDATION CY 2007 (cont’d) Submit your RADV-related questions to Ann Marshall on the RADV team at ann.marshall@cms.hhs.gov 12

  13. OPERATIONS UPDATES

  14. Operations: Submission Deadlines • Initial Submission Deadline • for data with through dates of service of 1/1/08 through 12/31/08 was 03/06/09 • Final Submission Deadline • for data with through dates of service of 1/1/08 through 12/31/08 is 01/31/10

  15. Operations: Submission Deadlines • The sweep of the RAPS data with dates of service 01/01/07 - 12/31/07 occurred on February 13, 2009. RAPS data accepted by 5:00 pm EST Friday, February 13th are included.

  16. OPERATIONS: Email Notification • Access the CSSC Registration Information Page, http://www.csscoperations.com/new/registration_home_raps.htm to register and to receive Email Notifications of informational updates

  17. TECHNICAL ASSISTANCE UPDATES

  18. TECHNICAL ASSISTANCE UPDATES Next User Group Meeting April 15, 2009

  19. QUESTIONS & ANSWERS

  20. CLOSING

  21. 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 • Lateefah Hughes (RADV) lateefah.hughes@cms.hhs.gov • Ann Marshall (RADV) ann.marshall@cms.hhs.gov • Risk adjustment payment questions analyst@askriskadjustment.com • LTC www.tarsc.info • CSSC www.csscoperations.com

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