Monthly Risk Adjustment User Group Session

1. 2006/2007 Monthly Risk Adjustment User Group Session A training initiative presented by JANUARY 2007

2. Welcome to the January User Group • Introduction • Payment Process • Data Validation • Operations Update • Training Update • Questions and Answers • Closing

3. INTRODUCTION

4. Introduction User Group Process: • All attendees must pre-register. • Panel will entertain questions during the Q&A portion of the session. • Sessions will run for 60 minutes. • Q&A document and session notes will be available within 2 weeks after the session. • Session slides will be available by the Tuesday prior to the session.

5. PAYMENT PROCESS

6. Payment Process • 2006 Reconciliation Payment • Deadline • January 31, 2007 • Dates of Service • January 2005 through December 2005

7. DATA VALIDATION

8. Data Validation • Calendar Year 2005 • December 2006 • Coders began medical record review • Plans with <95% medical record response rate received a verification email from IPRO • January 2007 • Coders continue medical record review

9. Data Validation (cont’d) • Calendar Year 2004 – Late January: Expect completion of QA to confirm medical record review results. – Late February: Anticipate communicating results to selected MA organizations.

10. OPERATIONS UPDATE

11. Who Should Submit RAPS Data? • Risk Plans (Also known as Coordinate Care Plans (CCP) and Health Maintenance Organizations (HMO) • COST • HCPP • PACE (Program for the All Inclusive Care of the Elderly) • PFFS (Private Fee for Service Plans) • PPO (Preferred Provider Organizations) • RPPO (Regional Preferred Provider Organizations) • PSO (Provider Sponsored Organizations) • DEMO (Demonstration Projects) • DEMP (PPO Demos, that is demonstration projects using the PPO model) • DEMC (Cost Demos, that is demonstration projects using a cost payment scheme)

12. Who Should Submit RAPS Data?(cont’d) • SNP (Special Needs Plans) • RFB (Religious Fraternal Benefit) Plans • MSA (Medical Savings Account) Plans Reference: Medicare Advantage Manual Publication 100-16; Chapter 1 (General Provisions)

13. Requesting Reports From CSSC • The processing systems (FERAS and RAPS) send reports to the submitter’s mailbox where they remain for 14 days. The systems automatically delete reports from the mailbox after 14 days, but MA organizations can request restored reports through the Customer Service and Support Center (CSSC) at 1-877-534-2772. • When requesting a restored report, the following information is required: Submitter Number File ID Date of Submission

14. 502 Error Rates

15. TRAINING UPDATE

16. Training Update 2007 Monthly Training Schedule • Enrollment and Payment Training • March 27, 2007 • April 24, 2007 • Risk Adjustment Training • March 28, 2007 • April 25, 2007

17. QUESTIONS AND ANSWERS

18. CLOSING

19. Resources • Sean Creighton (Director) 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 • Thomas Kornfield (Risk Adjustment Model) thomas.kornfield@cms.hhs.gov • Louis Johnson (FERAS, Risk Adjustment Coordination) louis.johnson@cms.hhs.gov • Chanda McNeal (Payment Issues) chanda.mcneal@cms.hhs.gov • LTC www.Medicaretraining.net • CSSC www.csscoperations.com